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The analysis of follow-ups shows, that the lack of success in tympanoplasty is often due to errors in operative technique and insufficient postoperative analysis of our failures. The failures has to be analysed in any case, always with exactly operative report comprises the dynamics factors of the operation and written immediately after surgery.
In order to improve the hearing results of tympanoplasty, we performed the operation on 113 cases (124 ears) by using ossicular replacement prostheses made of Titanium. The results demonstrated that among all the operated ears, 73/124 (58.9%) had obtained a narrow gap (< 20 dB HL) between BC and AC, 89/124 (71.8%) had regained socially acceptable hearing ability. The total effective rate of hearing gain (> 10 dB HL) was 115/124 (92.7%). No reject reaction and recurrent cholesteatoma were found. This operation method, based on animal experiments and applied anatomic study of human suprastapedial structure, resulted in a high effective rate and maked hearing improvement with a relatively large magnitude. It was because of the application of a new material-Titanium, which has high biocompatibility with human body tissues. The ossicular replacement prosthesis was appropriately designed and delicately manufactured. It fitted well and could be tightly joined to the suprastapedial structure, and uneasy to be displaced. In addition, we adopted the method of enlarging tympanic isthmus, that lead to well aeration in mastoid and attic, thus set the tympanic membrane to the best state of mobility. All these contributed to the effective hearing gain.
BACKGROUND: The formation of a retraction pocket of the pars flaccida remains a difficult problem for otologists to treat. It may lead to ossicular erosion and the development of a cholesteatoma, especially when the pocket is adherent to the malleus neck. We designed a new method of surgery for the treatment of small attic cholesteatomas. METHODS: From 1986 to 1996, 20 patients with a retraction pocket of the pars flaccida or a small attic cholesteatoma underwent surgery as described below. The complete lesion was removed after widening the posterior-superior bony external ear canal wall and placing pieces of conchal cartilage (usually less than 10 pieces, according to their scutum defect) lateral to the malleus neck or incus. The temporalis fascia was then laid. RESULTS: The average follow-up period was 32 months. The paired t-test was used to compare the results of preoperative and postoperative air conduction and air-bone gap. The preoperative average air conduction was 31.17 dB and the air-bone gap was 15.09 dB. The postoperative average air conduction was 20.66 dB and the air-bone gap was 3.09 dB. The difference between preoperative and postoperative measurements was considered significant (p < 0.05). No recurrent retraction pockets or cholesteatomas were noted during follow-up. CONCLUSIONS: Tympanoplasty for correction of a retraction pocket of the pars flaccida can prevent further attic retraction and the development of cholesteatomas. Postoperative hearing results were also encouraging.
The efficacy of hyaluronic acid (HA) foam in the prevention of middle ear adhesions and other structural abnormalities in guinea pigs undergoing experimental tympanoplasty was investigated. Postoperative changes in the middle ear were evaluated by light microscopy after 6 weeks. The presence of adhesions, diminution of airspace, new bone formation, tympanic membrane (TM) formation, and mucosal inflammation was characterized by an objective grading system. Results were compared to absorbable gelatin sponge (AGS) and a control group (no middle ear packing). The control group showed the best average scores for all parameters tested except for adhesion formation. However, these results were statistically significant only when compared with those of the AGS group for airspace preservation, new bone formation, and TM formation. Although the HA foam group showed better average results than did the AGS group for all parameters tested, none were statistically significant. Although HA foam appears to be a promising middle ear packing agent, further experimental trials are warranted before any firm conclusions may be made.
OBJECTIVE: This study evaluates the effectiveness and safety of fiberoptic carbon dioxide (CO2) laser welding for graft closure of tympanic membrane perforations in an animal model. STUDY DESIGN AND SETTING: Tympanic membrane perforation was surgically induced in 11 eardrums of 7 given pigs. A lumbar facial graft was placed over the wound, and albumin drops served as a biologic solder. CO2 laser energy, transmitted through silver halide infrared transmitting fibers, was used for "spot-welding" along the circumference of the graft. The welded sites were evaluated by using a surgical microscope as well as by evaluating the sites histologically. RESULTS: Healing started 3 to 4 days after surgery and was completed within 3 weeks with the formation of a neotympanum. Some inflammation with granulation tissue was noted in 5 eardrums. CONCLUSIONS AND SIGNIFICANCE: These preliminary results indicate that CO2 laser tympanoplasty with a fiberoptic delivery system may be a promising new technique for the clinical setting.
Tympanoplasty reconstruction of the eardrum approached normal anatomy and function with the use of connective tissue to replace the substantia media. Perichondrium taken from the concha is preferred because it lies flat and is easy to manipulate. Grafts placed on the outer surface of the remnant tend to lateralize with loss of drum conization. Grafts placed on the undersurface of the remnant do not have this disadvantage.
Temporal fascia placed medially to the tympanic remnants with the malleus handle exteriorized has been used successfully in over 1,200 tympanoplasties with adequate conization of the drumhead produced in most cases.
The use of homograft materials in reconstructive, mastoid, and middle ear surgery is increasing. Not only are they useful and practical, but they also do the job well in both anatomical and functional restoration. Many encouraging reports have been written to support their use. Their advantages, in the opinion of the author, outweigh their cost since they can offer a more efficient, versatile, and better method of restoration of hearing in tympanoplasty surgery.
The authors described 8 patients with almost total defects of tympanic membrane. The patients were operated on with palisade tympanoplasty technique (m. Heermann) with the use of conchal autografts for reconstruction of the tympanic membrane. The technique is very useful and gives good results.
A review of type 1 Tympanoplasty operations (myringoplasty) done on thirty (30) ears in the University of Benin Teachinhg Hospital, Benin City, (UBTH) during a ten - year period was carried out. The patients were aged 21 to 69 years, and consisted of 21 males and 9 females. 15 (50% ) of the ears had medium to large sized central perforations whilst 13 (43.3 % ) were subtotal perforations. Two cases (6.6% ) had marginal perforations. The overall success rate in terms of full graft take was 66.6%, whilst 32.3 % had partial take of the graft. Post operative audiograms showed improvement in hearing in 77% of those cases for which records were available. However long term outcome both for graft take and hearing improvement was impossible to establish due to poor follow-up compliance in the majority of patients. Although there are many cases of chronic suppurative otitis media (CSOM) with resultant persistent tympanic (TM) perforation and concomitant hearing defect in the community, the relutance or inability of patients to have reconstructive ear surgery, relative lack of the facilities for the operation in our hospitals and poor follow-up compliance amongst our patients are some of the identificable problems related to this otherwise worthwhile procedure.
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