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PubMed2003

[The evaluation of cartilage and perichondrium grafts for the reconstruction of the tympanic membrane].

Since the publication of Miodoński, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplastic surgery. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplastic surgery with the use of cartilage and perichondrium grafts. The studies included a selected group of 112 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery.

Adolescent↗
PubMed2004

[Operative therapy of the adhesive otitis media].

OBJECTIVE: To study the operative indications and treatment for adhesive otitis media (AOM). METHODS: Sixty-nine cases of AOM were undergone tympanoplasty between 1995 to 2000. Preoperative average air-bone gap(A-B gap) were (43.7 +/- 3.9) dB. Forty-one cases could be postoperative followed up for more than one year. Preoperative average A-B gap of this group were (43.8 +/- 4.2) dB. The adhesive ear drum and the other processes in middle ear were inserted and reconstructed with cartilage. RESULTS: The postoperative average A-B gap after one month(69 cases) and one year(41 cases) were (23.7 +/- 8.6) dB and (27.9 +/- 10.7) dB. In the long-time follow-up group, the A-B gap of 18 cases (43.9%) were less than 20 dB. Twenty-four cases (58.5%) become a nearly normal tympanum. CONCLUSION: The AOM can treatment with tympanoplasty. But the indication must be carefully selected. The cartilage was a good material for reconstruction of the ear drum to treatment the AOM. The influence factor were analyzed.

Adult↗
PubMed1992

Real ear unaided responses in ears with tympanic membrane perforations.

This study evaluated 13 adult patients with tympanic membrane (TM) perforations in one or both ears. Probe microphone real ear unaided responses (REURs) for mean peak frequency and peak dB gain showed no substantial differences among patients, across ears with intact TMs, ears with TM perforations (regardless of size), or between measures taken before and after closure of the perforations. Inspection of individual differences in the patients' REURs, however, produced an interesting finding. The REURs of ears having small TM perforations did not differ from those with intact TMs, but the REURs for ears having larger perforations consistently revealed bimodal responses (two prominent peaks separated by a valley of at least 10 dB lower gain). Thus, size of the perforation affected the REURs.

Acoustics↗
PubMed2005

[Long-term results of functional surgery for attic cholesteatoma].

OBJECTIVES: We evaluated the long-term results of functional surgery for attic cholesteatoma. PATIENTS AND METHODS: In this study, we presented the results of 81 patients (42 males 39 females; mean age 34 years; range 8 to 59 years) who underwent functional surgical techniques for attic cholesteatomas between January 1992 and January 1998. All the patients were followed-up for at least five years. RESULTS: For eradication of attic cholesteatoma, canal wall-down technique tympanoplasty was required in the majority of the patients. After surgery there was a statistically significant hearing improvement in all but four cases. In the postoperative period, residual cholesteatoma and graft perforation were found in five and six patients, respectively. Two patients required revision meatoplasty for problems related with cavity clearance. CONCLUSION: Apart from satisfactory hearing improvement with functional surgery, a successful self-clearance was obtained in mastoid cavities with saucerization and meatoplasty. Canal wall-down tympanoplasty is associated with very low incidences of residual or recurrent cholesteatoma in the majority of patients.

Adolescent↗
PubMed2005

[Reinforcing tympanoplasty with cartilage mosaic (differences from the palisade technique)].

OBJECTIVES: To demonstrate the interest of cartilage mosaic tympanoplasty in the reconstruction of the tympanic membrane. MATERIALS AND METHODS: Retrospective series of 103 patients; the authors analyzed their results after cartilage mosaic tympanoplasty, with a mean follow up of 3.5 years (3 to 7 years). They explain the surgical technique in detail. The average gain was calculated on the difference of the pre-and post-operative thresholds in air conduction on the four frequencies 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz. RESULTS: The authors detail and analyze their anatomical and audiologic results. The total rate of closing of the tympanic membrane is 93.2%, accounting for 96 perforations closed among 103. A tympanic retraction sitting apart from the reinforced zone was noted in 0.97%, representative only one case of 103. Then the total rate of success is 92.23%, representing 8 failures of 103. The average pre- and post-operative air bone gap were 26.5 dB and 14.6 dB. The average gain was 12.5 dB (extremes of 0 dB to 40 dB). CONCLUSION: The authors show the great reliability of cartilage mosaic tympanoplasty to reconstruct the tympanic membrane. They widen the indications with all types of tympanoplasties. Especially with the recurrent perforations, and the perforations evolving in an inflammatory context and/or dysfunction of the Eustation tube. Their results show a major interest to use this technique in the anterior and inferior perforations, and whatever the ossicular chain status.

Adolescent↗
PubMed2006

Underlay tympanoplasty with laser tissue welding.

We investigated the feasibility of using laser tissue welding techniques to perform transcanal underlay tympanoplasty. We used 10 temporal bones obtained from human cadavers. After creating a subtotal tympanic membrane perforation, we introduced harvested periosteum through the perforation and used laser tissue welding to secure the periosteum graft in place in an underlay fashion. The procedure was performed via a transcanal approach and did not require middle ear packing. Immediately after the graft had been placed, we qualitatively tested its integrity with a blunt probe. The graft was as strong as the native cadaver tympanic membrane in all 10 cases. We conclude that laser transcanal underlay tympanoplasty is a feasible and effective method of repairing a tympanic membrane. The ultimate goal is to develop a technique that will allow physicians to routinely perform underlay tympanoplasty on moderately sized perforations in an office setting.

Cadaver↗
PubMedDate not supplied

Management outcome of secretory otitis media.

BACKGROUND: Secretory otitis media is a common otological manifestation, that most of the time is left undiagnosed on account of unawarenes s and negligence in seeking early medical attention for trivial ailments. Untreated, it might end up in serious consequences in the form of poor speech and intellectual development and permanent anatomical disabilities within middle ear cleft. The objectives of the study were to determine most affected age group, the common etiological factors. to access the efficacy of medical and surgical treatment and finally to find out the coumplication associated with the surgical procedures. METHODS: This study was conducted in the ENT, Head and Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 to December 2003. Only the diagnosed cases of SOM were included in the study. After detailed history, clinical examination, routine investigations and special investigations such as pure tone audiogram and tympanometry were carried out to confirm the diagnosis of SOM . All patients were initially treated by medical therapy. In cases of failure, underwent myringotomy with or without ventilation tube insertion and where indication present adenotonsillectomy and antial lavage was done. Follow up of cases was carried out from 18-24 months. RESULTS: It included 87 patients, 58 were males (66.6%) and 29 females (33.3%). Majority of the patients were between 5-8 years (62%). The most common aetiological factor was rhinosinusitis (36.7%) followed by hypertrophic adenoids (34.5%). All patients were initially given medical treatment. Out of 87 patients,30 patients (34.4%) improved and 57 patients (65.5%) had no response and underwent surgery. Surgical procedures included myringotomy with and without ventilation tube insertion., adenotonsillectomy and antral lavage. CONCLUSION: lt is concluded from this study that conservative treatment has a definite role and should be tried before any surgical step is taken however surgery is the treatment of choice in more resistant cases.

Adolescent↗
PubMed2006

[The use of palisade technique in tympanoplasties after Heermann].

INTRODUCTION: The palisade tympanoplasties-technique with using of tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall was described. MATERIAL AND METHODS: The operation started with the endaural incision. Tragal and conchal autograft palisade fragments with perichondrium for reconstruction of the tympanic membrane and the auditory canal wall have been used up to 1996 in 15,300 cases. We placed palisaded cartilage fragments parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "tunnel plasty" in the eustachian tubal entrance is performed with "simmering", "architrave" and "anti-architrave" to keep the tubal entrance open. This "tunnel plasty" results in a nice reconstruction of the tympano-meatal niche. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus, crossing the promontory and reducing adhesions. This annulus-stapes bridge is fixed with a further palisade cartilage, "step plasty", which connects the "tunnel-plasty" with "annulus-stapes plate". The palisade-epitympanum-antrum plasty allows ventilation of the antrum via a tunnel constructed of well-fitting parallel pieces of cartilage fixed by self-tension (no glue) and replacing the bony canal wall. The "columella-tunnel plasty" has an L-shaped notch in the "annulus-stapes plate" fixing a columella of cartilage, placed in the oval window. Only in a case with a narrow oval window niche, a type IV palisade plasty can be performed or a prosthesis placed. RESULTS: The "annulus-stapes cartilage plate" is more stable reconstruction in type III tympanoplasties than are incus of foreign body interpositions. Adhesions on the promontory are found more often with fascia than with cartilage fragments. Histologic study of autograft cartilage showed good preservation of cartilage cells even 26 years after transplantation. CONCLUSIONS: The use of palisade cartilage technique brings very good functional and better long-term results.

Audiometry↗