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PubMed2006

How we do it: tympanoplasty: are different three- and four-frequency averages comparable?

The results of tympanoplasty may be reported in a variety of ways. Pure-tone audiometry underpins reporting, yet there is no constancy in the pure-tone threshold average used. We examine the relationship between the 0.5, 1, 2 kHz, 0.5, 1, 2, 3 kHz and 0.5, 1, 2, 4 kHz pure-tone audiometry averages. Using audiometric data collected for 77 patients, we have compared hearing threshold using three different frequency averages derived from pure-tone audiometry. The 0.5, 1, 2 kHz, 0.5, 1, 2, 3 kHz and 0.5, 1, 2, 4 kHz three- and four-frequency averages are significantly different, this difference being primarily determined by the changes in the 4-kHz threshold. Using an average including 4 kHz results in 8% few patients achieving an ABG closure to within either 10 dB or 20 dB. When comparing surgical results with others, surgeons should use reports employing comparable audiometric measures of analysis.

Adolescent↗
PubMed1991

Restoration of hearing with type V tympanoplasty.

Type V tympanoplasty with fenestration of the oval window and protection of the round window in a residual hypotympanic cavity can be considered as the last-chance procedure for rehabilitation of hearing in ears with 'canal wall down' or other conditions. The review of 64 cases suggests that restoration of hearing can be adequate in the majority of cases.

Adipose Tissue↗
PubMedDate not supplied

Revision tympanoplasty: surgical findings and results in Riyadh.

A report on the surgical findings and long-term results of 68 revision tympanoplasties performed at King Abdul Aziz University Hospital over a period of 7 years is presented. Temporalis fascia was used in all operations, with an overall success rate of 85% of graft take up, with significant improvement of hearing in the majority of cases. The causes of immediate failure were found to be due to faulty surgical techniques, however most of the late reperforations were due to infections and in some to atrophy of the graft. It is concluded that better surgical technique and improvement of medical facilities in most rural areas are of utmost importance in Saudi Arabia.

Adolescent↗
PubMed2006

Evaluation of recovery from transient facial palsy following canalplasty and tympanoplasty for the treatment of congenital aural atresia.

OBJECTIVES: Canalplasty is a surgical procedure of the external auditory canal. In this study we examined anatomic risk factors for facial nerve injury in aural atresia surgery, in addition to facial nerve outcomes and the time course of recovery in patients with facial nerve palsy following atresia surgery. METHODS: Transient facial palsy was observed immediately after surgery in 6 of 99 ears (6 of 87 patients) after canalplasty and tympanoplasty for the treatment of congenital aural atresia. We assessed the course of recovery and mean scores using Jahrsdoerfer's grading system. RESULTS: The rate of absence of the stapes and the rate of presence of positional anomalies of the facial nerve were significantly higher among cases with facial palsy, and Jahrsdoerfer total scores were significantly lower among cases with facial palsy. The mean recovery time in 5 cases with a minimum electroneurography value of 0% was 16.2 weeks (range, 14 to 18 weeks). No trends during recovery were detected for the nerve excitability test and R1 components of the blink reflex. CONCLUSIONS: The anatomic conditions that cause a predisposition to transient facial palsy include absence of the stapes and the presence of positional anomalies of the facial nerve. Although some patients displayed transient facial palsy after surgery, all patients fully recovered. Mechanisms of facial nerve injury are proposed.

Adolescent↗
PubMedDate not supplied

Silastic and gelatin film sheeting in tympanoplasty.

In 78 patients, representing 10% of the most severe case of chronic otitis media and in whom the mucosa from the promontory had been removed or severely damaged, the promontory was covered in one-stage mastoidectomy-tympanoplasty with a large piece of thin silastic or of Gelfilm. The results in the silastic group, comprising 50 patients, and in the Gelfilm group, comprising 28 patients, were compared on the basis of various criteria. The results proved better in the Gelfilm group. In particular, the percentage of recurrent perforations was considerably lower than in the silastic group. In one-stage operations, which we prefer, it is therefore recommended to use Gelfilm rather that silastic.

Chronic Disease↗
PubMed1996

Residue of middle ear cholesteatoma after intact canal wall tympanoplasty: surgical findings at one year.

The rate of residual disease after surgery for acquired middle ear cholesteatoma was investigated in 167 ears of 164 patients who had undergone planned second-look tympanoplasty by the intact canal wall technique. Overall, operative findings at the second stage revealed 65 cases of residual disease in 48 ears (29%). These consisted of 50 squamous pearls, 11 cases of the flat, open type, and 4 cases of the extensive type. The configuration of residual disease is closely related to the technical difficulty of eradication, since en bloc removal is much easier in the squamous pearl than in the open or extensive type, mainly because of the unclear margin with the surrounding tissues. The proportion of cases of the open type was greater in children than in adults, in pars tensa cholesteatoma than in pars flaccida cholesteatoma, and in severe primary middle ear disease than in moderate or mild disease, although these differences were not statistically significant. The extensive type occurred in 4 ears with severe primary disease, 3 of which were in children. These results support the value and importance of the staged procedure for middle ear cholesteatoma, particularly when operated on by the intact canal wall technique.

Adolescent↗
PubMed1984

TORPs and PORPs in tympanoplasty: a review of 1042 operations.

We reviewed 1042 operations in which a Plasti-Pore prosthesis was used for reconstruction of the sound pressure transfer mechanism. In all cases cartilage was interposed between the prosthesis and the tympanic membrane or graft. The short-term hearing results for these cases are the same as for other techniques but the hearing is more stable in the long run. Other advantages of this technique are a reduced incidence of recurrent and residual cholesteatoma. Extrusion occurred in 7% of the cases but has become less frequent with recent refinements in technique. We intend to continue using Plasti-Pore prostheses in tympanoplasty.

Cartilage↗
PubMed1986

Regenerated middle ear mucosa after tympanoplasty. Part I. Transmission electron microscopy.

The ultrastructural appearance of the regenerated middle ear mucosa--found at the second operation of staged intact canal wall tympanoplasty (ICWT) with mastoidectomy--has been evaluated with the transmission electron microscope. The regenerated epithelium showed all the morphologic characteristics of the normal middle ear mucosa: ciliated cells, nonciliated cells, and secretory cells. All of these (including goblet cells) have been found in the specimens. It is concluded that a normal middle ear mucosa regenerates to cover all denuded bone surfaces after the first operation of staged ICWT with mastoidectomy, when silicone rubber sheeting has been used to prevent adhesions and maintain an air-containing middle ear space.

Biopsy↗
PubMed1976

Intact canal wall tympanoplasty in the management of cholesteatoma.

There are presently two schools of thought on the proper surgical management of cholesteatoma associated with chronic ear disease: one feels that the ear should be exteriorized and left "open"; the other takes the position that the disease can be removed, and the ear left in its normal anatomical and functional state. The latter group are known to favor a "closed" or more conservative procedure. The purpose of this paper is to review a series of patients who have had cholesteatoma managed by an intact canal wall procedure that prevents a postoperative cavity. Out of a series of 590 chronic ear surgeries performed between January 1, 1970, and December 31, 1974, there were 179 done for cholesteatoma (30 percent). There were 153 patients, 26 of whom had bilateral disease. Twenty-three patients were lost to follow-up, giving an overall total of 154 surgeries with from one to five-year information. The overall follow-up rate was 85 percent. Recurrent cholesteatoma was the most bothersome complication and occurred in 14 percent of the series. Residual cholesteatoma was managed by doing all procedures in two stages. The authors feel that the intact canal wall tympanoplasty is a procedure that will gain acceptance and will be more widely used in the future.

Adolescent↗
PubMed1978

Tympanoplasty: cartilage prostheses--a report of 564 cases.

We reviewed 564 tympanoplasties operated upon over an eight year period at the Otologic Medical Group in which tragal cartilage was used to re-establish the sound pressure transfer mechanism. Eighty-six percent of the cases were revisions, and half of these were planned second stage procedures. In the majority of cases the stapes crural arch was missing. The conductive deficit in these cases was reduced to 20 db or less in 67% and 10 db or less in 40%. The commonest single cause of failure was a short prosthesis. There were no instances of cartilage resorption. Extrusion occurred in one case. Tragal cartilage has been more satisfactory than ossicular tissue in many situations. Recently we have been using plastic prosthesis (TORP and PORP) in combination with tragal cartilage and believe that the results will be even better.

Cartilage↗
PubMed1979

Bone conduction changes following successful tympanoplasty type I.

Pre and one year postoperative bone conduction (b.c.) thresholds were compared for 50 ears of 48 patients, ranging in age from 14 to 42 years, in whom successful tympanic grafts resulted in at least an average improvement of 10 db for 500 to 4000 Hz. While pre and postoperative data are included for all ears and test frequencies, significant BC improvement is seen only at those frequencies, in each case, where the pre-op BC thresholds were worse than 10 db. Normal pre-op BC thresholds cannot show substantial improvement because of audiometric limitations. The amount of BC shift at each frequency for those with pre-op BC thresholds that were subnormal averaged 6 db at 500 Hz, 13.3 db at 1000 Hz, 13.8 db at 2000 Hz and 9 db at 4000 Hz, all highly significant statistically. There were no significant postoperative BC shifts related either to duration of the disease process, length of postoperative period before final test (all were more than one year) or whether the surgical procedure was tympanoplasty type I or myringoplasty.

Adolescent↗
PubMed1983

Bioactive glass ceramic: a new material in tympanoplasty.

The practicability of the bioactive glass ceramic Ceravital in ear surgery was tested in animals. The histological findings are presented. Over the last 3 years implants of bioactive glass ceramic were used in humans. Prostheses for the total or partial reconstruction of the ossicular chain and the reconstruction of the bony wall of the outer ear canal were fashioned. We have conducted about 300 tympanoplasties and 60 total or partial reconstructions of the bony wall of the outer ear canal. The otoscopic and functional results were satisfactory.

Animals↗
PubMed1987

Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets.

The atelectatic retraction pocket (ARP) has been implicated in the development of chronic otitis media and cholesteatoma. The ARP's tendency for persistence or recurrence despite treatment is a significant otologic problem. The purpose of this study is to define and discuss this clinical entity and the use of cartilage-perichondrium tympanoplasty as a safe and predictable method of treatment, reducing destructive complications while maintaining ear function. A retrospective analysis of 85 operated ears is presented.

Ear Cartilage↗
PubMed1990

Composite autograft for tympanoplasty and tympanomastoid surgery.

In 1982, 40 composite cartilage perichondrial autografts performed to prevent recurrent cholesteatoma secondary to canal wall defects were reviewed. A follow-up of those cases, plus 62 new cases, as well as the composite autografts for severe tympanic membrane retractions (55 cases) and selected tympanoplasties (22 cases) is presented. No recurrent cholesteatomas or retraction pockets developed at the graft sites, with one graft failure in the latter group.

Adolescent↗
PubMed1990

Allograft tympanoplasty: predictive value of preoperative status.

The functional and anatomical results of a series of 181 consecutive allograft tympanoplasties for ears with drum perforation and an intact ossicular chain were retrospectively reviewed and related to preoperative factors. Drum closure was realized in 92% (166 of 181 cases evaluated 1 year after surgery), and 96.6% of the reconstructed drums were still intact 3 years after surgery (118 cases evaluated). An air-bone gap of less than 21 dB was reached in 79.6% (of a total of 162 cases) 1 year after surgery, and in 78% (of a total of 118 cases) 3 years after surgery. Age, contralateral pathology, the wet or dry status of the ear preoperatively, and the preoperative air-bone gap had no influence on anatomical results. The preoperative air-bone gap did not predict the postoperative air-bone gap. The influence of age and existence of contralateral pathology on hearing gain was only visible in some of the strictly defined patient groups. The wet preoperative status of the ear generally predicted lower functional gain.

Adolescent↗
PubMed1993

Manipulating the mobile stapes during tympanoplasty: the risk of stapedial luxation.

Manipulating the mobile stapes is a central procedure during tympanoplasty, i.e., mounting a prosthesis onto the stapedial head or dissecting cholesteatoma matrix off the oval window niche. An excessive displacement of the stapedial suprastructure as caused by these manipulations with hand-held instruments might result in a rupture of the annular ligament. Bacteria invading through this perilymphatic fistula threaten the inner ear. In experiments with temporal bones, the author investigated the rupture mechanisms of the annular ligament with definite stapedial manipulations. Leaks, which became detectable by exerting pressure on the inner ear fluid, occur only when all suspension fibers are completely ruptured. Further clinical aspects with different directions of stapedial manipulations are demonstrated.

Cochlear Diseases↗
PubMedDate not supplied

Uptake and release of alcohol by homograft tissues in tympanoplasty.

Alcohol is known to produce severe cochlear damage and it is possible that deafness as a complication of tympanoplasty can be caused by alcohol which remains in homograft materials after inadequate washing. An investigation was made in which the quantity of alcohol taken up by ossicles, cartilage, temporalis fascia, dura and ear-drum was estimated. The rate of release of alcohol from such materials into saline during washing was also measured. The amount absorbed was found to depend upon the nature of the material, its weight and its surface area. The rate of release of alcohol from these materials differed significantly for each material.

Cartilage↗
PubMed1979

Middle ear pressure following tympanoplasty for various middle ear diseases. Pressure related to follow-up period and retractions.

In 512 ears with various middle ear diseases, the middle ear pressure was measured a minimum of 2 years and a maximum of 10 years after tympanoplasty. The findings were related to the length of the follow-up period and to retractions of the drum and/or in the epitympanum. The tympanometric findings were best in sequelae to otitis with dry perforations, poorest in cholesteatomas and adhesive otitis. Tubal function had not further deteriorated 4 years after the operation. There was a highly significant correlation between the middle ear pressure and the frequency of retractions, which also does not essentially increase--except in the cholesteatoma cases.

Acoustic Impedance Tests↗