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PubMed1982

A decade of tympanoplasty: progress or regress?

The surgery of chronic ear disease has continued to be a popular topic during the seventies. The literature for this period has been collected and organized by both surgical topics and disease topics. The changes in technique, particularly for ossiculoplasty, are discussed in the light of the author's experiences. The surgical approaches to a particular disease process are likewise reviewed. Changes in surgical philosophy are discussed both for particular authors as well as for the overall trends.

Cholesteatoma↗
PubMed1982

Postauricular undersurface tympanic membrane grafting: a follow-up report.

The authors review 1,939 chronic ear surgeries in which 1,556 underwent some form of tympanic membrane grafting. The overall take rate was 93%. There was no selection of cases with regard to presence of infection, cholesteatoma, polyps, or granulation tissue at the time of surgery. There appeared to be no difference in the take rate based upon age of the patient, presence of infection, or cholesteatoma. Autogenous and homograft fascia performed well and there was no significant difference in take rate. Complications were minimal and were related more to the disease process than the grafting technique per se. In addition to reviewing the long-term follow-up of the original technique the authors present a method of dealing with tympanic membrane retraction pockets. Called a cartilage tympanoplasty this procedure incorporates a large piece of full thickness tragal cartilage with attached perichondrium into the substance of the tympanic membrane. With 2 years follow-up at this writing, this procedure has markedly reduced postoperative retraction pockets and recurrent cholesteatoma.

Follow-Up Studies↗
PubMed1982

Myringotomy and ventilation tubes: a report of 1,568 ears.

We reviewed the records of all patients who had a myringotomy and insertion of a ventilation tube at Otologic Medical Group during a 6-year period; there were 2,266 intubations on 1,568 ears. Uncomplicated serous otitis media was the indication in 1.055 ears; 19% developed brief episodes of otorrhea. Persistent otorrhea necessitated tube removal in 9 ears, all but 2 of which became dry. These 2 patients required mastoid surgery. We conclude that myringotomy and insertion of a ventilation tube in serous otitis media is associated with infrequent complications, and these complications are probably related more to the underlying disease process than to the ventilation tube.

Adolescent↗
PubMed1984

Comparative study in tympanoplasties with nitrous oxide anesthesia.

A number of intra and postoperative accidents in close cavity surgery when using nitrous oxide have been reported. In order to check the influence of nitrous oxide anesthesia in tympanic surgery, 38 patients were operated on by the usual techniques in middle ear surgery. Half the patients received continuous nitrous oxide inhalation throughout the procedure while, in the remaining cases, the anesthetic gas was suspended 30 minutes before applying the tympanic graft. Audiological differences in both groups, as controlled at 6 and 12 months, were negligible.

Anesthesia, Inhalation↗
PubMed1984

Type I tympanoplasty: influencing factors.

Type I tympanoplasties utilizing an underlay technique with temporalis fascia performed at the Medical University associated hospitals over a 5-year period were reviewed. Cases were excluded if follow-up was less than 18 months or if a previous tympanoplasty had been performed. The remaining 71 cases, 40 adults and 25 children, were analyzed for influencing factors. The overall success rate was 89%. The age of the patient, the length of time the ear had been dry, and the presence of infection at the time of surgery had no influence on the success rate. The two factors which adversely influenced the success rate were the presence of a near total or total perforation and the presence of bilateral perforations.

Adolescent↗
PubMed1986

Perichondrial-cartilage island graft in one stage tympano-ossiculoplasty.

A one stage reconstruction of the tympanic membrane and the ossicular chain using a composite graft of tragal perichondrium with cartilage is described (Type III tympanoplasty). The long-term results in 18 operated cases reveals closure of the air-bone gap to within 0 to 10 dB in 72% of the cases. The above procedure used autologous graft material, does not disturb the remaining middle ear structures, can be performed under local anesthesia, and in most cases is done on an outpatient basis.

Adolescent↗
PubMed1986

Post-tympanostomy otorrhea.

Otorrhea is the most common complication of surgical drainage of the tympanum for the treatment of chronic secretory otitis media. Otorrhea present at the first postoperative visit may be due to the operative procedure, the underlying disease process, or both. After analyzing data from 525 operations on 1045 ears of 396 children with chronic secretory otitis media, and finding an over-all incidence of immediate postoperative otorrhea of 3.4%, we conclude that preparations of the ear canal with povidone iodine and the postoperative prophylactic use of an antimicrobial-corticosteroid topical preparation provides optimal control of postoperative wound infection. Sporadic increases in the incidence of postoperative otorrhea may be due to extrinsic factors such as outbreaks of upper respiratory infection.

Adenoidectomy↗
PubMed1986

Effects of tympanic membrane scars on tympanometry: a study in cats.

The efficacy of tympanometry in the diagnosis of ossicular abnormalities and the differentiation of such from eardrum scarring is controversial. This paper presents a study of the tympanometric effects of specific eardrum scars and ossicular abnormalities in cats. For both normal eardrums and healed myringotomies, a normal middle ear could be differentiated from stapes fixation or incudostapedial discontinuity using static immittance parameters and tympanogram morphology. Twenty percent myringectomy scars caused abnormal 660 Hz tympanograms but this effect could be distinguished from changes caused by a concomitant ossicular abnormality. The very low impedance of a 50% myringectomy scar resulted in tympanograms which could not be differentiated from an ossicular discontinuity alone. With this neomembrane, stapes fixation could not even be differentiated from an ossicular discontinuity. This study supports the view that tympanometry should be interpreted as part of a battery of tests which includes otoscopy, audiometry, and acoustic reflex measurements.

Acoustic Impedance Tests↗
PubMed2006

Recent developments in the treatment of otitis media with effusion.

The management of otitis media with effusion (OME) has received much attention recently as a result of, among other factors, the development of resistant bacteria and the finding of less long-term impact of middle-ear effusion (MEE) on development than previously believed. Guidelines have recently been published for the management of OME promoting more accurate diagnosis, particularly distinguishing acute otitis media from OME, and recommending the 'judicious' use of antibacterials. Today, more emphasis is being placed on prevention of disease by reducing risk factors and the development of vaccines. The identification of susceptibility genes may lead to better understanding of the pathogenesis of otitis media, which in turn may lead to the development of more innovative and satisfactory methods for prevention and treatment.

Anti-Bacterial Agents↗
PubMed2001

Formaldehyde fasciaform tympanoplasty: a reliable technique for closing large tympanic membrane perforations.

Formaldehyde fasciaform grafting tympanoplasty is a reliable method, in experienced hands, to close large tympanic membrane perforations. The technique involves using autogenous temporalis fascia shaped by formaldehyde cross-linking on a special fasciaform mold (Hear America, Palo Alto, CA). This study was undertaken with the objective of assessing if an otologist with less experience in using this technique could obtain comparable results. The results of the initial 23 patients treated in this manner by one surgeon between August 1996 and January 1998 are reviewed. Success was measured by the rate of closure of the tympanic membrane perforation and by functional closure of the air-bone gap. Favourable results were obtained, with complete closure of 86% of the perforations and closure of the air-bone gap to 20 dB or less in 90% of subjects when the ossicular chain was intact. The formaldehyde fasciaform tympanoplasty technique produces consistent, reliable, and reproducible results for large tympanic membrane perforations.

Fascia↗