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PubMed2001

[Surgical results of canal wall reconstruction tympanoplasty in middle ear cholesteatoma].

Materials were 236 ears of 213 patients with middle ear cholesteatoma undergoing canal wall reconstruction during 1993-1998. Subjects were followed up for at least 1 year after final operation. Of 236 ears, 147 (62%) underwent 1-stage operation and 89 ears (38%) required 2-stage operation. Hearing results were successful in 157 ears (67%) based on criteria proposed by the Otological Society of Japan. The success in ears undergoing 1-stage operation was 74% and 54% in ears undergoing 2-stage operation. Postoperative hearing and air-bone gap in the 1-stage group were significantly better than in the 2-stage group. For tympanoplasty, success was 97% in type I, 64% in type III, and 53% in type IV. The likelihood of undergoing 2-stage operation increased with the type of tympanoplasty, from type I to IV. Postoperative hearing was significantly worse in older age groups. Of the 89 ears, 13 (15%) had recurrent cholesteatoma and 29 (33%) had residual cholesteatoma at 2-stage operation. In the 135 in the 1-stage group, recurrent cholesteatoma was observed at follow-up in 13 ears (9.6%). When we analyzed clinical risk factors for both recurrent and residual cholesteatoma in age, gender, otorrhea, types of cholesteatoma, and types of tympanoplasty, no significant factors were seen for recurrent or residual cholesteatoma. These results indicate that canal wall reconstruction tympanoplasty for middle ear cholesteatoma yields relatively good hearing results. However, more effort is needed to reduce the incidence of recurrent and residual cholesteatoma.

Adult↗
PubMed1999

Age as a factor in the success of tympanoplasty: a comparison of outcomes in the young and old.

In order to determine if age is a factor in healing after tympanic membrane grafting, the author compared the results of 163 consecutive type I tympanoplasties performed on patients aged 20 to 40 with those of 97 consecutive type I tympanoplasties performed on patients aged 65 and older. The tympanoplasties were performed over a 5-year period. The postoperative followup period ranged from 6 to 10 years. The author found no difference in the success or failure of the graft-take rates between the two groups. Therefore, it would appear that in general, age is not a factor in the success or failure of healing following tympanoplasty surgery.

Adult↗
PubMed1999

Areolar temporalis fascia: a reliable graft for tympanoplasty.

OBJECTIVE: This study examines the success rate of areolar temporalis fascia (fool's fascia) as a graft material for tympanoplasty. DESIGN: This study is a retrospective review of surgical cases. SETTING: This study was conducted at Kaiser Permanente Medical Center, San Diego, a tertiary referral center for otologic surgery within Southern California Permanente Medical Group. PATIENTS: Four hundred six patients having undergone tympanoplasty (with and without mastoidectomy) from September 1992 to December 1997 were observed. Medial graft (underlay) techniques were used in all cases, including total drum replacement procedures. Sixty-three percent (256/406) of the cases were revision surgeries. Seventy-three percent (296/406) of the cases were for total drum replacement. In 342 (84%) cases, areolar temporalis fascia was used as the graft material. OUTCOME MEASURE: Successful tympanic membrane healing. Failure of a graft was considered to be reperforation during the entire period of follow-up (range 6 months-5 years). RESULTS: Tympanic membrane healing was successful in 98.54% (337/342) of the cases in which areolar temporalis fascia was used as the graft material. Graft failure for other graft materials was slightly higher. Overall success rate for all 406 cases was 97.5%. CONCLUSIONS: Areolar temporalis fascia is an effective and reliable graft material for primary and revision tympanoplasty. Areolar fascia is readily found in most revision surgeries. Revision tympanoplasty achieved a success rate better than 95%.

Adolescent↗
PubMed2001

Hearing results after tympanoplasty in elderly patients with middle ear cholesteatoma.

Many reports about the effect of aging on hearing results after tympanoplasty have been published. However, they have not been evaluated comprehensively, i.e. by taking into consideration other aspects which also affect the outcome. In this study, the effect of aging on hearing results after canal wall reconstruction tympanoplasty was assessed in 236 consecutive ears of 213 patients > 20 years old with middle ear cholesteatoma. The elderly group (n = 34), defined as patients > or = 60 years old, was compared to the younger groups in terms of hearing results of postoperative hearing level, hearing gain, A-B gap and change in bone conduction hearing level at 4000 Hz after adjustment for age, gender, staged operation, preoperative hearing level and type of tympanoplasty, all of which affect hearing results, using the generalized linear regression method. Postoperative hearing level and hearing gain were found to be better amongst patients aged 20-29 and 30-39 years than in the elderly group, whilst A-B gap did not differ between all age categories. Within the elderly group, air conduction hearing level was shown to have improved after surgery. Changes in bone conduction hearing level at 4000 Hz were not significantly different between the age groups, suggesting that operative stress, i.e. mechanical stress or ossicular manipulation stress, does not aggravate sensorineural hearing loss in the elderly. We conclude that surgeons should be encouraged to perform tympanoplasty aimed not only at eradicating the lesion itself but also at improving hearing acuity in the elderly.

Adult↗
PubMedDate not supplied

[Comparison of hearing levels and tympanic membrane healing obtained by cartilage palisade and temporal fascia tympanoplasty techniques: preliminary results].

OBJECTIVES: We compared the levels of hearing and tympanic membrane healing obtained by cartilage palisade and temporal fascia tympanoplasty techniques. PATIENTS AND METHODS: Tympanoplasty procedures with the use of cartilage palisade (30 patients; 14 males, 16 females; mean age 28 years; range 10-62 years) and temporal fascia (30 patients; 17 males, 13 females; mean age 30 years; range 12-58 years) were compared with respect to tympanic membrane healing and hearing levels. The size of perforations in the cartilage tympanoplasty group was greater than that of the temporal fascia group. Audiological assessments were performed in the postoperative third and sixth months. The follow-up period was at least six months. Tympanic membrane healing and hearing levels were statistically analyzed using the chi-square and Mann-Whitney U-tests. RESULTS: Tympanic membrane healing rates were 80% (24 patients) and 86% (26 patients) in the temporal fascia and cartilage tympanoplasties, respectively. Postoperatively, hearing levels improved in both groups. However, no significant differences were found between the two treatment groups with respect to tympanic membrane healing and hearing levels. CONCLUSION: Our findings suggest that cartilage palisade graft can be safely used in the treatment of tympanic membrane perforations, with no adverse effects on the hearing levels in the postoperative six months.

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↗
PubMed1991

[Tympanoplasty on only-hearing ears].

It presents a dilemma whether an only-hearing ear with chronic otitis media should be managed surgically. From August 1981 to December 1988, 26 only-hearing ears were operated on by the authors. All of them had chronic otitis media and, furthermore, 7 ears had cholesteatomas. Prior to the operation, the patients must be informed in detail and really understand the risk of the operation. Tympanoplasty type I (16 ears), tympanoplasty type III (4 ears), classic modified radical mastoidectomy (1 ear), tympanoplasty type III with cartilage obliteration (3 ears), and tympanoplasty for pars flaccida (2 ears) were performed. After an average of 4 years and 2 months of follow-up, 16 ears showed hearing improvement but 10 ears remained the same. The average hearing gain was 12.7 dB. The operation on only-hearing ears should be performed by the most experienced otosurgeon. In these cases, special precautions were taken during surgery to minimize the potential for intraoperative or postoperative hearing loss.

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↗
PubMed1990

One-stage total reconstruction of the ear with simultaneous tympanoplasty.

The one-stage total ear reconstruction (auricular reconstruction and tympanoplasty) has a number of merits. 1. Satisfactory esthetic results obtained in one operation. 2. The "super thin" skin flap is elevated on a plane that excludes hair follicles from the flap, so the hair-bearing areas of the scalp can be readily incorporated as part of the ear reconstruction. 3. The reconstructed ear has adequate blood supply and protective sensation. 4. The surgeon may choose to carry out a tympanoplasty and obtain restoration of auditory function or may choose to carry out a pseudomeatus procedure and reduce the operating time. We feel that the "super thin" skin flap and the simultaneous tympanoplasty are valuable supplements to ear reconstruction. The functional results of the tympanoplasty must be considered only a partial success at this time; long-term evaluation as well as technologic improvements are needed.

Adolescent↗
PubMed1986

[Long-term results following tympanoplasty in complete atelectasis of the tympanum].

24 patients with complete tympanal atelectasis were followed up for at least 7 years after tympanoplasty. The operation was done by the intact canal technique, the eardrum and ossicles were reconstructed. In 10 of the 24 patients the tympanic membrane remained intact and the tympanUM was aerated for over 7 years; in 8 patients postoperative retraction of the tympanic membrane was prevented by grommets. Atelectasis recurred in the remaining 6 patients. Even in normal tube function and normal middle ear pressure these recurrences may develop. In these cases histological studies have shown a change in eardrum elasticity. In most of the cases followed up, social hearing was sufficient for more than 7 years. Even though the long-term results of the operation are satisfactory, when tympanoplasty is indicated it must be kept in mind that there is a high percentage of recurrence in all patients, even in those with normal tube function. A prerequisite for long-term success is that the patient accepts follow-up observation for a matter of years. Otherwise therapeutic alternatives to tympanoplasty (e.g. tympanoplasty of Type IV) must be considered.

Audiometry, Pure-Tone↗
PubMed1984

Residual and recurrent cholesteatoma in closed tympanoplasty.

There are actually two principal approaches to the surgical treatment of middle ear cholesteatoma, a subject very much debated. First, the cholesteatoma can be exteriorized and treated with an open technique (classic or modified radical mastoidectomy, open tympanoplasty); and second, the radical removal of the cholesteatoma is also possible in the majority of cases by closed tympanoplasty. In this article we examine 283 patients (forty-four children and 239 adults) operated on by the closed technique to review and discuss the postsurgical cholesteatoma problem (residual and recurrent). Total incidence of residual cholesteatoma is 13.43 percent. It is higher in children (25 percent) than in adults (11.72 percent) and is more frequently localized in the mesotympanum (47.54 percent) than in the epitympanum (40.98 percent) or in the mastoid (6.56 percent). Recurrent cholesteatoma, with a total incidence of 7.77 percent, is much less frequent when staged tympanoplasty has been performed than when a one-stage operation has been done. No endotemporal or endocranial complications (labyrinthine fistula, facial nerve paralysis) have been noticed in cases of postsurgical cholesteatoma. These data confirm the opinion that staged tympanoplasty with Silastic sheeting and reconstruction of the erosions of the posterior wall is the technique of choice for surgical therapy of middle ear cholesteatoma.

Adult↗
PubMed1996

Tympanoplasty in adults: a five-year survey.

In order to identify factors that could influence the success of tympanoplasties in adults, a retrospective study of 291 tympanoplasties performed on patients aged 15 years and older during the years 1984-1989 was carried out. Surgical success was defined as an intact membrane after two years follow-up and hearing improvement of at least 15 decibels. The success rate of the tympanoplasties was 90%. A functioning eustachian tube was found to be important for graft take. No difference was found in the rate of graft take regardless of whether fascia of the temporal muscle or tragal perichondrium was used or if fibrin glue was used. An audiological improvement was seen in 77% of the patients, and no significant difference regarding hearing gain was found between the different prostheses. It is concluded that tympanoplasty in adults is a simple operation with a high probability of success which can improve the quality of life of those operated upon.

Adolescent↗
PubMed1996

Type I tympanoplasty in children.

To identify factors that could influence the success of tympanoplasties in children, a retrospective study was done of 51 tympanoplasties performed on children aged 9-14 years during the years 1984-1989. Surgical success was defined as an intact membrane found after 3 years' follow-up. The success rate of tympanoplasties was 92%. A functioning eustachian tube was found to be important for graft take. No difference was found in the rate of graft take whether fascia of the temporal muscle or tragal perichondrium was used. An audiologic improvement was seen in 70.6% of the patients. We conclude that tympanoplasty in children has a high probability of success and will enable most children operated on to resume a normal lifestyle.

Adolescent↗
PubMed1998

Pediatric tympanoplasty of iatrogenic perforations from ventilation tube therapy.

OBJECTIVES: This study aimed to determine surgical outcome of tympanoplasty in children with iatrogenic perforations, to determine whether age is a factor in successful tympanoplasty, and to determine whether surgical outcome is affected by preoperative factors (e.g., perforation size and location, otorrhea, cholesteatoma, and tympanosclerosis) or surgical technique (e.g., underlay or overlay). STUDY DESIGN: The study design was a retrospective series review. SETTING: The study was conducted at a multiphysician private otologic practice. PATIENTS: Ninety-three pediatric patients with iatrogenic perforations caused by the insertion of ventilation tubes for otitis media with effusion (OME) participated. Surgical selection criteria included a year's observation of the perforation with a 6-month OME-free interval in the involved and contralateral ear. The 46 males and 47 females had a mean age at surgery of 10.8 years (standard deviation = 2.9) ranging from 3-16 years. INTERVENTIONS: All patients underwent underlay or overlay tympanoplasty using temporalis fascia grafts. MAIN OUTCOME MEASURES: Outcome was evaluated in terms of drum healing (healed or perforated), hearing (air-bone gap), and complications. RESULTS: There was a graft take-rate of 94.6% with reperforations occurring in 5.4% with an average follow-up of 16.8 months. Duration of follow-up ranged from 10.8-77.5 months. The air-bone gap was completely closed in 53.8% and was closed to within 10 dB in 80.7% and 20 dB in 94.7%. The incidence of major and minor complications was 16.1%. Surgical outcome was not influenced by age, technique, or any of the preoperative factors. CONCLUSIONS: Tympanoplasty of persistent perforations after ventilation tube therapy for recurrent OME can be performed successfully regardless of age, surgical technique, or other preoperative factors.

Adolescent↗
PubMed2001

Tympanoplasty with and without mastoidectomy for non-cholesteatomatous chronic otitis media.

OBJECTIVES: Cases of non-cholesteatomatous chronic otits media (COM) were reviewed to determine whether mastoidectomy is helpful when combined with tympanoplasty for these conditions. STUDY DESIGN: A retrospective analysis of 251 ears with non-cholesteatomatous COM operated on by one surgeon (Y.M.) in an 11-year period was conducted. METHODS: Patients in group A (n = 147) were treated by tympanoplasty with mastoidectomy. Patients in group B (n = 104) were operated on without mastoidectomy. RESULTS: Graft success rates were 90.5% in group A and 93.3% in group B. There was no statistically significant difference. Graft success rates of discharging ears were 90.0% in group A and 85.7% in group B. Graft success rates of dry ears were 90.7% in group A and 94.4% in group B. There was no statistically significant difference between discharging ears and dry ears. The rates of the postoperative air-bone gap within 20dB were 81.6% in group A and 90.4% in group B, without a statistically significant difference. CONCLUSIONS: Mastoidectomy is not helpful in tympanoplasty for non-cholesteatomatous COM, even if the ear is discharging.

Bone Conduction↗
PubMed2002

[Morphological and functional results of Palisade Cartilage Tympanoplasty].

BACKGROUND AND OBJECTIVE: The application of cartilage in tympanoplasty has been generally accepted, because cartilage as a bradytrophic tissue allows stable and functionally reliable reconstruction of the eardrum even in difficult pathological conditions (such as subtotal defects, tympanosclerosis etc.). A special surgical technique using small cartilaginous chips for the reconstruction of the eardrum has been developed by J. Heermann, who introduced it as Palisade Cartilage Tympanoplasty (PCT). Although being increasingly applied in otosurgery, this technique has to date neither been evaluated regarding morphological and hearing results nor regarding its combination with titanium ossicular reconstruction prostheses. PATIENTS AND METHODS: Therefore we reviewed 84 of 94 ears (92 patients, 58 female, 34 male) 12 to 36 months after PCT. RESULTS: A recurrent defect was seen in 2 ears (1 adhesive otitis, 1 subtotal defect). There were no extrusions of prostheses. Preoperatively an ear-bone-gap of 0-10 dB was seen in 2 ears, 11-30 dB in 48 and 31-59 dB in 34 ears. Postoperatively the corresponding numbers were 25, 50 and 9 ears. CONCLUSIONS: The low rate of recurrent tympanic membrane defects (2.4%) shows that palisade cartilage tympanoplasty is particularly appropriate for the management of difficult indications in middle ear surgery. Further, it could be demonstrated that the PCT can be combined safely with titanium ossicular reconstruction prostheses. Regarding postoperative hearing results the negative preselection of pathological conditions has to be considered.

Adolescent↗
PubMed1998

Current status and future challenges of tympanoplasty.

Four decades after the introduction of tympanoplasty, the goal of achieving stable and long-term hearing improvement after tympanoplasty surgery for chronic otitis media continues to be elusive. In this review, we focus on the current status of our understanding of the mechanics and pathology of the middle ear after tympanoplasty surgery. We also analyze some problems and challenges faced by clinicians and basic scientists in the quest for improved postoperative hearing results.

Chronic Disease↗
PubMedDate not supplied

Areolar connective tissue grafts in pediatric tympanoplasty: a pilot study.

PURPOSE: To compare the surgical and audiologic success rates of areolar connective tissue with temporalis fascia in pediatric tympanoplasty. METHODS: Retrospective case series review of 10 patients younger than 18 years who underwent primary tympanoplasty between December 1997 and December 2000 using areolar connective tissue grafts. Tympanoplasty patients receiving temporalis fascia grafts during this period were used as a control group. Surgical and audiometric results were gathered after a minimum follow-up of 1 year. RESULTS: Both groups were similar in their clinical characteristics (P <.05). The surgical success rates for areolar and temporalis fascial groups were 90% and 91%, respectively. Closure of the air bone gap to within 25 dB was achieved in 90% and 91% of the areolar and temporalis fascial groups, respectively. CONCLUSIONS: This study showed equivalent surgical and audiometric success rates between areolar connective tissue and temporalis fascia. Both are excellent sources of graft material in pediatric patients.

Case-Control Studies↗