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PubMed1977

[How to avoid strictures of the external auditory meatus after tympanoplasty with the modified enaural incision by Heermann (author's transl)].

Report on a surgical technique to avoid strictures of the external auditory meatus with the enaural method on tympanoplasty. A pedicle flap is formed by a modified short Heermann's incision on the beginning of the bony and cartilagenous external auditory meatus. During the operation it is fixed by a retractor and it is readapted at the end of the operation. The skin of the external auditory meatus which is situated medial of this pedicle flap can be used for transplantation to replace the tympanic membrane without danger of stenosis. The authors has had 15 years of positive experience with this method.

Auditory Pathways↗
PubMed1992

[Tympanoplasty].

The first goal of tympanoplasty as treatment for chronic otitis media is to obtain a clean, disease-free ear, the second one hearing improvement. Prerequisite for success is the sufficient functioning of the inner ear as well as of the Eustachian tube. Therefore, patients very often have to undergo adjuvant treatment such as adenotomy, rhino-surgery and surgery of the paranasal sinuses. Microsurgery of the ear has become very refined. Thus even after removal of extensive inflammation it is now possible to rebuild the middle ear using various proved as well as newly developed biomaterials. Often a two-stage procedure is advisable for cholesteatoma surgery. In this disease meticulous postoperative care and longterm follow-ups are very important.

Cholesteatoma↗
PubMed1992

[An analgesic strategy for tympanoplasties].

UNLABELLED: After induction with vecuronium, etomidate and then isoflurane or enflurane, nitrous oxide, useful at the beginning of tympanoplasty is washed out before the end of operation. So barotrauma on the graft is avoided. In the expectation of analgesia insufficiency, alfentanil is infused intravenously all over the operation period following two modes: constant flow mode (1.25 micrograms.kg-1.min-1) after a bolus (25 micrograms.kg-1): 33 patients; decreasing hyperbolic flow mode (H): cumulative dose = 10.8 x t0.5 (where t = minutes of infusion) = 47 patients. In this mode, plasma concentration is measured by 12 patients. RESULTS: the mean plasmatic level of alfentanil is steady during the 120 minutes duration of anaesthesia: standard deviation is higher than 30%. After high quality anaesthesia in both technics, recovery time was shorter with H mode than with constant flow one (extubation time = 46 +/- 31 min. versus 92 +/- 54 min). H. mode seems to be safer. Though, individual reactivity, drug interaction and genetic polymorphism must make us cautious! Two patients presented apnea 20 and 60 minutes after an efficient awakening.

Adult↗
PubMed1991

Radical mastoido-epitympanectomy with tympanoplasty and partial obliteration: a new surgical procedure?

The modern concept of an open cavity is to combine a safe with a dry, self cleansing ear. The prerequisites to achieve this goal are: the radical exenteration of the mastoid, antrum and epitympanum, the maximal reduction of the volume of the cavity by extensive lateral removal of bone and the adequate shaping of the cavity walls by obliteration of the bone pockets. To perform correctly a radical mastoido-epitympanectomy with tympanoplasty and partial obliteration is difficult and requires a perfect anatomical knowledge of the deepest regions of the temporal bone, particularly of the supralabyrinthine space. Using the technique exposed in this article, 75 out of 79 ears (95% of our revision cases) achieved a dry and self cleansing cavity at three years follow-up.

Cholesteatoma↗
PubMed1991

Defects in the bony wall of the mastoid bowl: a study based on staged intact canal-wall tympanoplasty.

The incidence and outcome of bony wall defects in the mastoid bowl were studied in 175 ears of 167 patients who underwent staged tympanoplasty by the intact canal-wall technique. In the first stage, the middle fossa dura was exposed iatrogenically in 38 ears and pathologically in eight ears through a defect at the tegmen. In the second stage, the bone defect was cured in 27 ears of the former group and in 3 ears of the latter group. The overall cure rate of the defect in the tegmen during these stages was 65.2 percent (30/46). Exposure of the sigmoid sinus or posterior fossa dura, which had occurred iatrogenically in 12 ears in the first stage, was cured in 11 ears (91.7%) in the second stage. Defects of the anterior wall of the mastoid bowl, i.e., the posterior wall of the external auditory canal, were recognized in 105 ears in the first stage, 91 of which involved pathologic defects of the tympanic scutum caused by cholesteatoma. In the second stage, these defects remained unhealed with cures occurring in only two ears (1.9%), in which a small hole had been created iatrogenically in the middle of the canal wall. Defects in the canal wall due to bone resorption following the first stage operation were noted in the second stage in 26 of 175 ears (14.9%).

Adolescent↗
PubMed1991

[Stapes dislocation and opening in the inner ear due to tympanoplasty].

During tympanoplasty, the stapes is often exposed to considerable manipulations, i.e. the dissection of cholesteatoma matrix from the oval window niche or the insertion of a prosthesis for ossicular chain reconstruction. Too much strain may rupture the annular ligament resulting in an opening of the inner ear. Furthermore it is conceivable that microperilymphatic fistulas, which remain undetected, may develop prior to a visible luxation of the stapes. Therefore, temporal bone experiments with definite manipulations on the stapes were performed to study the rupturing strength of the annular ligament. Increasing the pressure of the methylene blue dyed perilymphatic fluid facilitated the detection of even smallest ruptures. A leakage occurs only in case of a complete rupture of all fibres. Further findings of clinical interest, gained from these experiments with different directions of stapedial manipulation, are discussed.

Ear, Inner↗
PubMed1990

[Tympanoplasty in the treatment of sequelae of blast injuries of the ear].

This study deals with 40 clinical files relating to auricular blast injury patients with ensuing eardrum perforation, managed either by tympanoplasty or by placement of a healing support. An analysis of the functional symptoms, the size and localization of the perforation; determination of the presence or lack of immediate post-injury infection, and of the degree and type of hearing loss suffered, permits to define the characteristics of postoperative ear status. A comparison of the study results with published data provides for specifying surgical indications and sheds light on the long-term evolution pattern in such patients.

Adolescent↗
PubMed1990

Homograft tympanoplasty: a long-term review of 477 ears.

Homograft materials have been employed to reconstruct the tympanic membrane and ossicular chain since the mid-1960s. Although the use of homograft materials remains somewhat controversial, this technique has been shown to provide excellent long-term results, both anatomically and functionally. This study reports on the long-term results of 477 ears undergoing homograft tympanoplasty and the modification of previously reported surgical techniques.

Audiometry↗
PubMedDate not supplied

[Tympanoplasty. Apropos of various clinical cases].

Taking some complex cases of otitis media operated in their hospital, the authors report some considerations about tympanoplasty peculiar technical details, following the order established by F. Olaizola in the official work in 1985. They think that the above mentioned order can be good to show their opinion and how to perform it, and useful for those who are beginning the theme.

Adult↗
PubMedDate not supplied

[Functional results of tympanoplasty using autologous cartilage].

During 6 years we performed 352 tympanoplasty surgeries and used cartilage plates in 175 cases (49.7%). Total or subtotal defects of the tympanum were found in 83 patients. The tragus or floor of the auricle cartilage was used for surgery. Good morphological results were seen in 93.1% cases by the end of the 1st month and in 92% cases by the end of the 2nd month of observation; good functional results were recorded in 75.4% and 69.1% cases, respectively. Socially adequate hearing improvement was observed in 63.4% patients. In summary, the de novo built system of air conduction becomes functionally operational 9 to 12 months after surgery and remains stable thereafter.

Adult↗
PubMed1989

Stability of tympanoplasty in children.

The results of tympanoplasty performed for noncholesteatomatous chronic otitis in children aged 2 to 14 years are described. The authors report that the stability of hearing was excellent; they found hearing to be equally good in young children and in older children. Tympanic membrane perforation can be closed at any age. There is no age limit below which perforation should not be closed.

Adolescent↗
PubMed1979

[Hearing results following tympanoplasty (author's transl)].

Tympanoplasty can produce a stable hearing improvement in many patients with chronically inflamed ears. In our series of patients, severe damage to the inner ear following surgery occurred in 3% patients and was associated with a hearing loss of greater than 15 dB. Complete hearing loss occurred in 0.2% of the patients reviewed. In patients with an intact ossicular chain, simple myringoplasty is associated with the best results. Loss of the stapedial arches affects the postoperative air-bone gap most significantly, while loss of the manubrium mallei or the creation of a radical mastoid cavity are additional negative factors. Extent or localization of ossicular fixation has no direct influence on hearing results when appropriate ossicular reconstruction is performed.

Cochlear Implants↗
PubMed1985

Columellar tympanoplasty.

This article discusses the problem that ossicular reconstruction presents when the malleus handle has been destroyed and a columella must be used. The technical problems and failures of the past twenty-five years are exposed in an effort to glean the lessons of this experience. A comparison of three types of columella currently used--bone, ceramic, and polyethylene--is presented. Since there have been disadvantages and excessive failure rates with each type of columella, other techniques have been attempted and are described. Many of the questions posed by the efforts to develop adequate solutions to the problems of columellar tympanoplasty are restated here in the hope that cooperative research and development between surgeon and manufacturer will continue and prosper.

Bone Transplantation↗
PubMed1986

Posterior canal wall atrophy after intact canal wall tympanoplasty.

The present study investigates the occurrence of asymptomatic posterior canal wall breakdowns following intact canal wall tympanoplasty (ICWT) with mastoidectomy. Twenty-four ears out of 501 (4.8%) presented with a posterior canal wall atrophy. A partial defect was found in 15 ears (62.5%), while a subtotal or total atrophy occurred in the remaining nine ears (37.5%). Posterior wall atrophy could be considered among ICWT complications during follow-up visits, but, according to our investigation, its incidence remains low.

Atrophy↗
PubMed1986

Anatomic findings one year after combined approach tympanoplasty.

Fifty-six patients were treated surgically for middle ear cholesteatoma using the combined approach tympanoplasty technique. One year later a second-look procedure was performed in all the patients, which permitted the anatomic effects of the combined technique to be mapped out before ossicular reconstruction was performed. At three, six, and twelve months after the first operation the development of retraction pockets was also studied. Recurrent cholesteatoma was found in twelve cases (21.4%), and residual cholesteatoma in fourteen (25%). The posterior tympanotomy was closed in 31 cases (55.4%), whereas the mastoidectomy cavity was overgrown and closed in 22 (39.4%). Twelve months after the first operation (just before the second look), a retraction pocket was found in twenty-one cases (37.5%), and at the second-look operation twelve of these were proven to be a manifest recurrent cholesteatoma. The formation of new retraction pockets was found to be time-dependent, that is, to increase almost linearly during the control interval between the operations. The investigation shows the necessity for standardizing the presentation of results after cholesteatoma operations and the importance of determining a convenient postoperative time for reporting the incidence of cholesteatoma recurrences.

Cholesteatoma↗
PubMed1985

Tympanoplasty in children and anatomical variations of the epipharynx.

Short-term results or post-operative check-ups after tympanoplasties in children and adults are compared. There is no higher incidence of recurrent perforations in children. The distribution of air cells in adults and children does not vary, indicating that anatomic variations, rather than disease, are responsible for the sclerosis in the mastoid. Anatomic variations of the epipharynx might influence ventilation. Correlations between the width of the epipharynx and the distance between molars and premolars are shown, as is an inverse relation between the height of the palate and the height of the septum. These observations might be important for a prognosis in patients with ear disease.

Adolescent↗
PubMed1979

[Some reasons for failure in tympanoplasty (author's transl)].

The reasons for failures in tympanoplasty are classified and discussed as anatomical or pathological ones and those, that rise from method and technique. A main cause insists in the pathopolymorphism of the chronic purulent otitis media and the discrepancy of clinical impression and pathological reality. The author wishes to encourage the surgeons to a more radical technique by these examples and to the use of new methods in the field of reconstructive surgery of the middle ear.

Humans↗
PubMed1978

[Tympanoplasty with human dura mater preserved in cialit (author's transl)].

In 26 cases allogenetic human dura mater, conserved in CialitTM 1:5000, was used to close perforations of the eardrum instead of commonly used autogenetic fascia of the temporal muscle. In preceding animal studies, it had been found that "Cialit dura" acts as guideline and stimulates the development of new host connective tissue. In 25 human ear drums the perforations healed up without any problems. The healing process took times of up to 8 weeks. Only in one case a new perforation was found. The moderate flexibility of "Cialit dura" proved as a special advantage during the surgery procedure. Human dura is easily to acquire and its conservation is simple and cheep. Therefore it can serve as a grafting material for tympanoplasty available at any time and in any size. For very large transplants and a lack of postoperative treatment the prolonged healing period could be of some disadvantage. For normal sized transplants, however, there seems not to be a difference in healing time between the commonly used fascia and the "Cialit dura".

Animals↗