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PubMed1983

Revision of previous stapedectomy, tympanoplasty, mastoidectomy, or endolymphatic shunt.

I have reviewed a group of otologic patients who represent controversial problems in management. Decisions for revisional otologic surgery must be based on each patient's individual findings. Statistical reviews are of little help in deciding which patient will benefit. Physicians managing patients with poor results after surgery for hearing, infection, or vertigo must obtain accurate audiologic, electronystagmographic, and laboratory data before deciding on revisional surgery. The overall interests of the patient are sometimes best served by avoiding further surgical insults to the ear.

Adolescent↗
PubMed2002

Efficacy of mastoid cortex plasty for middle ear aeration in intact canal wall tympanoplasty for cholesteatoma.

OBJECTIVE: To determine the effect of closing the bone defect of the mastoid cortex using bone pate after mastoidectomy (mastoid cortex plasty) during the first-stage operation for the restoration of the mastoid cavity aeration. STUDY DESIGN: This was a prospective study. SETTING: Tertiary medical center. PATIENTS: Thirty-five patients with cholesteatoma invading the mastoid cavity. INTERVENTION: Seventeen patients received mastoid cortex plasty with scutum plasty and insertion of a Silastic sheet after removal of the cholesteatoma using a combined approach during the first-stage operation. The 18 control patients received only scutum plasty with the insertion of a Silastic sheet without mastoid cortex plasty during the first-stage operation. MAIN OUTCOME MEASURES: The restoration of the middle ear aeration was assessed with high-resolution computed tomography before both the first-stage operation and the second-stage operation. RESULTS: The range of middle ear aeration ameliorated significantly whether or not mastoid cortex plasty was performed. Scutum plasty with the insertion of a Silastic sheet without mastoid cortex plasty was significantly effective only for the amelioration of the epitympanum aeration. Mastoid cortex plasty with scutum plasty with the insertion of a Silastic sheet was significantly effective for the amelioration of the epitympanum and also the mastoid cavity aeration. In both groups, before the first-stage operation, approximately 70% of the patients had good mesotympanum aeration, and the mesotympanum aeration ameliorated further after the first-stage operation, although this amelioration was not significant. CONCLUSIONS: Mastoid cortex plasty is statistically effective for the amelioration of mastoid cavity aeration after the first-stage operation.

Adolescent↗
PubMed2002

Cartilage palisade tympanoplasty in sinus and tensa retraction cholesteatoma.

OBJECTIVE: The aim of this study was to investigate whether reconstruction of the eardrum with palisade cartilage technique could prevent retraction of the new eardrum after surgery for sinus and tensa retraction cholesteatoma in children and to investigate the postoperative hearing. STUDY DESIGN: In 32 children aged 5 to 15 years, operated on from June 1995 to October 2000 for cholesteatoma (21 with sinus cholesteatoma and 11 with tensa retraction cholesteatoma) the eardrum was reconstructed with the palisade cartilage technique. Postoperatively, the children were seen as outpatients and were recently reevaluated with otomicroscopy, tympanometry, and audiometry. All patients (100%) were reevaluated on an average of 37 months (range 3-63 months). MAIN OUTCOME MEASURES: Postoperative retractions, perforations, cholesteatoma recurrence, and hearing. RESULTS: At the final examination, posterosuperior retraction was observed in two patients, both operated on for sinus cholesteatoma with reconstruction of the ossicular chain. In those cases, the palisades were not placed in the posterosuperior drilling defect behind the interpositioned incus. All the patients had an intact tympanic membrane at the final follow-up visit. One small perforation was surgically closed during the observation period. No patients developed cholesteatoma during the follow-up period. The postoperative hearing was good, and the hearing did not deteriorate with increasing observation time. CONCLUSIONS: The palisade technique effectively prevented postoperative retraction of the eardrum. The postoperative hearing was good.

Acoustic Impedance Tests↗
PubMed2003

Cartilage tympanoplasty for posterosuperior retraction pockets of the pars tensa in children.

OBJECTIVE: To assess the functional and anatomic results of cartilage grafting in children with a severe retraction pocket of the posterosuperior part of the pars tensa and operated on by pocket excision and cartilage grafting. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fifty six children (60 ears) with severe posterosuperior retraction pockets. INTERVENTION: Excision of the pocket and tympanic reinforcement with a tragal or conchal cartilaginous graft. MAIN OUTCOME MEASURES: Postoperative anatomic (otoscopy, computed tomography) and functional (pure tone audiometry thresholds) outcome. The follow-up time was 27 +/- 18 months (mean +/- SD). RESULTS: Retraction recurrences requiring additional surgery occurred in 5 cases (8%). The risk of recurrence was lower in children older than 10 years and when the whole surface of the pars tensa was reinforced (chi(2) test, p< 0.05 for both factors). Functionally, hearing was improved even when the ossicular chain was intact. In case of disrupted ossicular chain, direct contact between the graft and eroded incudostapedial joint gave good hearing results. CONCLUSIONS: Cartilage reinforcement of the whole surface of the pars tensa is probably the best treatment of a severe posterosuperior retraction pocket. The flexibility and thinness of cartilage from the cymba conchae makes it particularly suitable in this indication.

Cartilage↗
PubMed2004

A comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction cholesteatoma in children.

OBJECTIVE: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction cholesteatoma in children, with respect to postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing. MATERIAL: From March 1995 to October 2000, a total of 64 children, aged 5 to 15 years, underwent surgery for either sinus or tensa retraction cholesteatoma. The eardrum was reconstructed using cartilage palisades in 32 children and fascia or perichondrium in 32 children. Postoperatively, the patients were seen as out-patients and were recently reevaluated by otomicroscopy and audiometry. MAIN OUTCOME MEASURES: Postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing (pure tone average, speech reception threshold, and air-bone gap). RESULTS: All patients in the palisade group and all but one patient in the fascia group attended the follow-up examination. In the palisade group, the mean follow-up period was 37 months (range, 3-65 mo) and in the fascia group 52 months (range, 17-75 mo). Two (6%) retractions and no perforations were found in the palisade group, versus 12 (36%) retractions and 4 perforations (12%) in the fascia group at follow-up (both significant differences). No cholesteatoma recurrence occurred. Late hearing results in sinus cholesteatomas were significantly better in the palisade group. CONCLUSIONS: The comparison of fascia and cartilage palisade grafting for drum reconstruction after tensa cholesteatoma surgery in children indicates that the palisade technique may be superior in respect to prevention of drum retraction and perforation. Further, in sinus cholesteatoma surgery, the long-term hearing results are better when grafting cartilage palisades.

Adolescent↗
PubMed2006

Cartilage tympanoplasty for management of tympanic membrane atelectasis: is ventilatory tube necessary?

OBJECTIVES: Cartilage/perichondrium composite graft with concomitant placement of a ventilation tube is a common practice among otologists to reverse atelectasis and to repneumatize the middle ear. We conducted this study to investigate the necessity of a ventilation tube primarily incorporated into the perichondrium/cartilage graft for reconstruction of the atelectatic tympanic membrane (TM). STUDY DESIGN: Prospective clinical trial. METHODS: Forty-six patients with TM atelectasis and intact ossicular chain were randomized to 2 groups. In Group I, 23 patients underwent reconstruction of the TM with perichondrium/cartilage graft and intraoperative T-tube insertion and in Group II, 23 patients underwent reconstruction of the TM with perichondrium/cartilage graft without ventilation tube insertion. Outcome measures were as follows: graft success, improvement of hearing, and postoperative complications. Analysis of the results was performed by Student's paired t test. The level of significance was set at 5%. RESULTS: Significant postoperative improvement of pure-tone air-conduction threshold averages and air-bone gap averages were reported in the 2 studied groups (p < 0.001). The postoperative air-bone gap averages showed no statistically significant difference between Groups I and II (p > 0.05). Conductive hearing loss requiring revision developed in 2 patients (8.69%) in Group I and in 3 patients (13%) in Group II. CONCLUSION: In the atelectatic ear, cartilage allowed reconstruction of the TM with good anatomical and functional results. Primary insertion of a ventilation tube into the graft is not necessary.

Adult↗
PubMed1976

Growth rate and recurrence of residual epidermoid cholesteatoma after tympanoplasty.

One hundred and forty-one consecutive patients with chronic otitis media and cholesteatoma treated mainly by open surgical techniques between 1965 and 1972 were studied to investigate the phenomenon of residual cholesteatoma. The average rate of emergence of residual cholesteatoma was 0.25% of the cases per month during the first 5 years, after which the rate of discovery almost ceased. Observed cumulative frequencies of recurrence were 1.4% at 10 months, 14.9% at 5 years and 17.0% at 8.3 years postoperatively. The null hypothesis of no apparent predilection of cholesteatoma for recurrence at any one site was retained. Parameters of growth rates of epidermoid cysts arising from residual cholesteatoma were estimated. Epitympanic cysts grew fairly rapidly, doubling in diameter every 10 months. Mastoid cysts were slower, doubling in diameter every 25 months. Results for the mesotympanum were inconclusive. The practical implications of this information for the management of future cases is discussed.

Cholesteatoma↗
PubMed1978

Tympanoplasty with preformed autologous ossicles.

A method of creating a preformed new bone graft from the patient's temporal region using a titanium mould is described. The preliminary work which was performed on animals demonstrated the ability to generate healthy bone in this way. Subsequent application of this technique to the problems of ossicular reconstruction in human ears has proved encouraging in selected cases.

Animals↗
PubMed1978

Tympanoplasty and eustachian tube function.

In an attempt to assess the value of preoperative tubal testing in the selection of cases most likely to respond favourably to surgery, 100 ears with a central perforation following chronic otitis media were investigated. Tubal function was tested manometrically with different known tests. Postoperatively the healing and hearing results were correlated with the preoperative test results. No positive correlation was found between healing or hearing and tubal function. Postoperatively 50 ears were re-tested in a pressure chamber with a flow volume technique. It was found that the tubal function improves postoperatively in spite of no visible pathological changes in the aural end of the tube. Possible explanations are offered.

Adolescent↗
PubMed1978

TORPs and PORPs in tympanoplasty.

In an attempt to improve results in ossicular reconstruction, a newly introduced material, PlastiPore, has been evaluated over a short term. The techniques employed are described in detail and the use of a lateral covering material such as tragal cartilage is advocated as a means of preventing extension of this foreign material. The results in over 100 ears are better than those obtained with previous methods.

Ear Cartilage↗
PubMed1980

Homografts in tympanoplasty: will they be a disaster? an experimental study.

Experimentally transposed homograft ossicles in rats showed behaviour less stables than autografts, all being resorbed within 48 weeks. Using information derived from this and other experimental work in both animals and humans it is predicted that homografts will be unstable in humans in the long term.

Animals↗
PubMed1989

Anatomical and functional reconstruction of old radical mastoidectomy cavities by obliteration tympanoplasty.

One hundred and seventeen patients who had previous radical mastoidectomies, atticotomies or Bondy operations were operated on between 1973 and 1984. An open technique with obliteration and traction meatoplasty was used in one stage in 19 ears (normal mucosa in mesotympanum) and in 2 stages in 98 ears (poor mesotympanum which needed to be dissected and covered with silastic sheeting). The second stage was performed 12 to 18 months later. Closure of the tympanic membrane was achieved in 93% of ears at the first stage. In 6 ears out of 81 second stages, residual cholesteatoma was found in the mesotympanum. No residual cholesteatoma was subsequently observed behind the flap but only 4 ears were checked behind the flap at the second stage. An air-bone gap within 20 dB was achieved in 85% of ears if the stapes was intact and surgery was performed in one stage, and in 55% of ears of the stapes was intact and surgery performed in 2 stages. If the crura were missing, an air-bone gap within 20 dB was achieved in 57% of ears in 2 stages.

Adolescent↗
PubMed1991

Composite tragal perichondrial/cartilage autografts vs cartilage or bone paste grafts in tympanoplasty.

Extrusion of plastic or ceramic implants is a significant cause of failure in ossiculoplasty for chronic ear disease. This paper reports the use of a composite tragal cartilage and perichondrial autograft compared to cartilage or bone paste between the graft and tympanic membrane. At 2 years, there were no extrusions in the group with the composite graft (n = 18) and 5 extrusions in the cartilage/bone paste group (n = 18) (P = 0.02). The mean average air-bone gap was significantly better for the composite grafts at 2 years (15 dB vs 24 dB) (P less than 0.05). Extrusions were eliminated and hearing results better at 2 years using the composite graft.

Biocompatible Materials↗