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At least 127 records · Page 7Linked to original sources
PubMed2006

Storage of the incus in the mastoid bowl for use as a columella in staged tympanoplasty.

OBJECTIVE: To evaluate whether the incus of the cholesteatomatous ear preserved in the mastoid bowl during the first stage of planned two-stage tympanoplasty can tolerate long-term implantation and be used in ossicular reconstruction during the second stage. METHODS: The study group included 24 ears of 23 patients who underwent staged tympanoplasty for the treatment of middle ear cholesteatoma. At the first stage, after removing the incus to eradicate the middle ear disease, it was returned to the mastoid bowl and stored there until use at the second stage. The average interval between the two stages was 8.3 months (range 6-12 months). RESULTS: The incus was identified in all cases at the second stage: 10 incudes were found to be covered with a thin mucosa layer, 12 were buried in fibrous or granulation tissue, and 2 were joined to the surrounding bone. Residual cholesteatoma was found in six ears, either in the attic (three ears) or tympanic sinus (three ears). It never occurred in the mastoid bowl where the incus had been preserved. In 19 cases, the incus was available as a short columella for ossicular reconstruction. The remaining five cases were reconstructed using a hydroxyapatite ossicle as a long columella, since the stapes superstructure was missing at the second stage. In one case, the stored incus underwent remarkable absorption between stages. CONCLUSION: Preservation of the incus in the mastoid bowl is an effective option in planned two-stage tympanoplasty, when the incus is considered useful for ossicular reconstruction at the second stage.

Cholesteatoma, Middle Ear↗
PubMed2004

Preliminary functional results of tympanoplasty with titanium prostheses.

OBJECTIVE: To assess the use of titanium prostheses in tympanoplasty for reconstruction of the sound pressure and to evaluate the audiometric results obtained. STUDY DESIGN AND SETTING: and patients Retrospective chart review in a tertiary referral center. Between September 1998 and October 2000, 23 titanium middle ear implants (23 TORP) were used for reconstruction of the ossicular chain after tympanomastoidectomy. Preliminary functional results were obtained in 23 cases. RESULTS: Average follow-up time was 18 months (range, 12-40) and no adverse reactions or extrusions occurred. Seven of 16 canal wall down tympanoplasties (43.7%), and 3 of 7 canal wall up tympanoplasties performed (42.9%) had a postoperative air-bone gap of between 0 and 10 dB. CONCLUSIONS: Preliminary results show that titanium prosthesis provide a promising hearing result after total ossicular reconstruction, although long-term results are not yet available. The low weight of these prostheses may be the reason for the decrease in the air-bone gap.

Adolescent↗
PubMed2006

Postoperative auricular perichondritis after an endaural approach tympanoplasty.

BACKGROUND: Postoperative auricular perichondritis is a problematic and embarrassing surgical complication after an endaural approach tympanoplasty. However, a search through the literature showed only a few papers regarding postoperative auricular perichondritis, and the reported treatment experience is scarce. This study reviews the clinical aspects of postoperative auricular perichondritis and the different treatment methods. METHODS: The medical records of 8 patients with postoperative auricular perichondritis over a 5-year period were reviewed. Five patients were treated using the wide excision method, 2 underwent tubal drainage, and 1 was placed on antibiotics alone. RESULTS: In 8 patients with postoperative auricular perichondritis after an endaural approach tympanoplasty, the time between the previous ear operation and the symptoms of infection ranged from 2 to 37 days, with a mean of 17.3 days. The wide excision method was performed after the abscess localized, an average of 8.4 days after initial antibiotic treatment. The culture results found fungus in 4 patients. Multiple excision procedures were required in 4 patients, and the mean number of surgical procedures was 2.6. The mean hospital stay of patients having wide excision was 15.2 days. Two patients had stenosis of the external auditory canal resulting from repeated excision procedures. Two patients underwent tubal drainage, and their mean hospital stay was 51 days. CONCLUSION: In postoperative auricular perichondritis after an endaural approach tympanoplasty, wide excision seems to be a better choice to treat this problem. Repeated limited excisions could result in ear deformity. Cartilage exposure during chronic ear surgery should be avoided, and early precautions after operation should be taken in order to prevent complications.

Adult↗
PubMed1987

Pathology as it relates to ear surgery. VII. Tympanoplasty.

The surgical anatomy and pathology of the middle ear have been reviewed in relation to tympanoplasty. The results of tympanoplasty in providing a disease-free and functional middle ear varies widely with the pathology involving the eardrum, ossicles, mucoperiosteum, mastoid air cells and eustachian tube. Post-tympanoplasty changes in the eardrum graft, ossicular grafts, and middle ear have been described in six cases which underwent surgery one to eleven years before death. Proper understanding of the pathophysiology of the different diseases of the middle ear is mandatory in planning tympanoplastic procedures. The causes of graft failure and of post-operative conductive hearing loss are discussed and the ways to avoid technical complications are emphasized.

Aged↗
PubMed2006

Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear cholesteatoma: hearing results.

The aim of this study was to evaluate the hearing results of ossiculoplasty in canal wall down tympanoplasty in one stage middle-ear cholesteatoma surgery. We carried out a retrospective review of a consecutive series of 142 cases which had undergone type two or three canal wall down tympanoplasty with ossicular reconstruction, between January 1995 and December 2002, due to chronic otitis media with cholesteatoma.Pre-operative audiometric testing revealed a mean air conduction pure tone average (PTA) of 50.97 dB and a mean bone conduction PTA of 22.14 dB. The mean post-operative result for air conduction PTA was 37.62 and for bone conduction PTA was 23.37 dB. The mean pre- and post-operative air-bone gaps (ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost 62.67 per cent of patients closed their ABGs to within 20 dB. Our functional results are comparable with those of other authors. In the present study, we show that hearing improvement is possible following cholesteatoma surgery with canal wall down tympanoplasty and ossicular chain reconstruction.

Adult↗
PubMed2004

Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane.

BACKGROUND AND OBJECTIVES: This prospective, randomized, double-blinded study was designed to compare the effects of desflurane, isoflurane and sevoflurane when combined with remifentanil for induced hypotension on surgical conditions and operative field during tympanoplasty. METHODS: Sixty patients undergoing tympanoplasty were enrolled in the study. The patients were randomized into three groups of 20 each to receive the inhalation anaesthetics desflurane, isoflurane or sevoflurane. Propofol 2 mg kg(-1) was administered for induction of anaesthesia in all groups. All patients received a continuous infusion of remifentanil which was titrated between 0.2 and 0.5 microg kg(-1) min(-1) to achieve a mean blood pressure (BP) of 60-70 mmHg. Nitroglycerine was infused if this BP could not be achieved. Arterial pressures were recorded continuously throughout the operation. Surgical conditions were assessed every 20 min by the blinded surgeon using a six-point category scale (0-5). RESULTS: One patient in the desflurane group and two patients in isoflurane group required nitroglycerine to maintain desired mean BP. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Category scale scores were < or =3 throughout the study, except one patient in the sevoflurane group who had a score of 4 at the 60th minute of the operation. No difference was found among groups when haemodynamic parameters and surgical category scale scores were compared. There were no postoperative respiratory and circulatory complications. CONCLUSION: Desflurane, sevoflurane or isoflurane combined with remifentanil provided adequate induced hypotension and similar operating conditions and any of them could be safely and equally used in anaesthesia for tympanoplasty.

Adolescent↗
PubMed2000

Inlay butterfly cartilage tympanoplasty (Eavey technique) modified for adults.

INTRODUCTION: Popular myringoplasty techniques include either an underlay or an onlay approach using tissues such as temporalis fascia or perichondrium as grafts. In 1998, Eavey described an inlay tympanoplasty technique in children using a cartilage graft which resembled butterfly wings. This technique was effective for closure of tympanic membrane perforations, while being more rapid for the surgeon and more comfortable for the patient. The aim of this study was to describe our results with modification of this technique in adults under local anesthesia. METHODS AND MATERIAL: Cartilage butterfly inlay tympanoplasty was carried out in 20 adult patients to close small-to-medium tympanic membrane perforations over a period of 11 months. Compared with the original description, 3 modifications are noted: (1) adult patients, (2) local anesthesia, and (3) no skin graft over the cartilage. We evaluated the success rate and postoperative hearing results. RESULTS: Two patients were not evaluated in terms of hearing gain because they had profound preoperative hearing loss. Fourteen patients had a postoperative 4 pure-tone average between 0 and 9 dB, 3 patients between 10 and 20 dB, and 1 patient greater than 20 dB. The graft "take rate" was 90% (18/20) at the end of the follow-up period (mean follow-up 7.25 months). Seventeen of 18 successful cases had cartilage grafts that were intact and dry at the last visit. CONCLUSIONS: The tympanoplasty technique described by Eavey is effective to close tympanic membrane perforation in adults as well as children. The technique modifications introduced here (abandonment of the skin graft and local anesthesia) reduced surgery time and postoperative morbidity. Postoperative results compared with those of the original technique were good.

Adolescent↗
PubMed2002

Posterior canal wall reconstruction tympanoplasty for operated ears with open mastoid.

We investigated the postoperative conditions of ears and the hearing acuity of patients who underwent posterior canal wall reconstruction tympanoplasty for operated ears with open mastoid. The study included 118 ears of 105 patients (57 males, 48 females; age range 5-75 years) and the patients were followed for > 1 year after the final operation. Although 114 ears (97%) were dry after the final operation, retraction pockets and eardrums in a lateral position were observed in 5 ears and in 1 ear, respectively. Ossicular reconstruction was performed in 83 ears and in these the mean air conduction hearing levels were significantly improved after the final operation in those that were subjected to type III and IV tympanoplasty. These results indicate that posterior canal wall reconstruction tympanoplasty can be considered to be an effective procedure.

Adult↗
PubMed2006

Butterfly cartilage graft inlay tympanoplasty for large perforations.

OBJECTIVE: Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small perforations. However, the efficacy of the technique for medium and large tympanic membrane perforations remains unknown. STUDY DESIGN: Retrospective case series. METHODS: Postauricular tympanoplasty and tympanomastoidectomy using a large butterfly cartilage inlay graft (>4 mm diameter to total drum replacement) were analyzed in 90 pediatric patients (99 ears). RESULTS: Patient ages ranged from 2 to 20 years; mean follow-up duration was 27.6 months. Successful closure occurred in 92% of the ears. No graft lateralized nor displaced into the middle ear. No retraction pocket occurred during the follow-up period. In 62 cases, intact canal wall or canal wall window tympanomastoidectomy was performed; Fifty-one (82.2%) of the patients having mastoidectomy procedures had chronic otitis media with cholesteatoma. The mean preoperative to postoperative four-tone air-bone gap improved from 23 to 21 dB; the number of patients with 0 to 10 dB hearing results increased from 16 ears preoperatively to 32 ears postoperatively. Postoperative suboptimal results included eight patients with postoperative perforations in the residual tympanic membrane adjacent to an intact cartilage graft; two of these patients were the only individuals who exhibited otorrhea. CONCLUSIONS: Cartilage butterfly graft inlay tympanoplasty is effective in the vast majority of patients with moderate to large perforations. The closure rate exceeded 90% with no graft displacement, postoperative adverse events were respectably low, and hearing results improved or remained stable despite the need for concurrent mastoidectomy in the majority of patients.

Adolescent↗
PubMed2006

Lateral tympanoplasty for total or near-total perforation: prognostic factors.

OBJECTIVE: To identify prognostic factors affecting outcome in lateral tympanoplasty for total or near-total tympanic membrane perforation. STUDY DESIGN: Retrospective case series. METHODS: Patients were those presenting with total or near-total tympanic membrane perforation undergoing lateral tympanoplasty from 1999 to 2004. We systematically collected demographic, clinical, audiologic, and outcome information. Student t test was used to determine group differences. Logistic regression analysis was used to examine the relationship between success of grafting (dependent variable) and the independent variables. Multiple regression analysis was used to examine the relationship between postoperative air-bone gap (ABG) and independent variables. RESULTS: There were seventy-seven cases (58 primary and 19 revision cases) with average follow-up of 17 months. Successful tympanic membrane grafting occurred in 91% of cases. None of the independent variables studied was predictive of the success of graft incorporation (P > .05). The mean preoperative ABG was 29.8 +/- 10 dB and improved to a postoperative ABG of 16.5 +/- 11 dB (P < .001). Smaller preoperative ABG and normal malleus handle were associated with smaller postoperative ABG. In revision cases, mastoidectomy was associated with better functional results. CONCLUSIONS: Successful grafting of near-total and total tympanic membrane perforations occurred in 91% of the cases and was independent of demographic, disease, and technical variables. Disease variables (preoperative ABG and status of malleus handle) had a greater prognostic value on postoperative ABG than other variables. In revision tympanoplasty, mastoidectomy is associated with a better functional outcome.

Adolescent↗
PubMed1976

[Tympanoplasty and congenital cardiopathies].

During the course of 1974, 16 tympanoplasties were performed on patients who suffered from serious congenital heart defects. 50% of the cases had recurrence of the perforation. It was not possible to deny the evidence of other failing factors such as the poor hemodynamic condition. Indications for performing a tympanoplasty were motivated by the necessity to eliminate a focus of dangerous infection to the patient before under-going a major cardiac intervention. These indications have been modified to the following: (a) chronic cholesteatomatous otitis remains a valid surgical indication and (b) simple chronic otitis could be controlled by local medical treatment. The tympanoplasty could be postponed after the cardiac intervention when the hemodynamic condition had been corrected.

Cholesteatoma↗
PubMed1982

Regenerated middle ear mucosa after tympanoplasty.

The surgeon's attitude towards the diseased middle ear mucosa during intact canal wall tympanoplasty has remained a controversial problem. Our approach consists of the complete removal of the irreversibly diseased mucosal lining. A planned staged operation has been carried out in most cases of tympanoplasty with the use of Silastic sheeting. At the time of the second operation, the middle ear and mastoid process appear to be lined by the regenerated mucosa and pneumatized. 54 mucosal biopsies taken during the second stage of the operation showed a normal flat, cuboidal and pseudostratified ciliated epithelium with functional features (secretory granules, microvilli and cilia). It is concluded that the diseased middle ear mucosa can be removed whenever necessary during staged closed-tympanoplasty operations because under the Silastic sheeting the mucosa will be regenerated within 12 months.

Biopsy↗
PubMedDate not supplied

Serous otitis media and type 1 tympanoplasties in children. A retrospective study.

The prevalence of serous otitis media has caused a philosophical difference as to when a tympanoplasty should be performed in children. This retrospective study of 74 children (aged 3-17) who underwent 80 operations was undertaken to investigate this problem. The overall success rate for type 1 tympanoplasty was 66%. Age was not a reliable factor in predicting successful results. A history of recurrent serous otitis media was not an important indicator. Adenoidectomy did not influence the surgical outcome. The status of the nonoperated ear was probably a significant factor. Type 1 tympanoplasty has a reasonably good chance of success in children regardless of age and/or previous middle ear ventilation problems. However, a good clinical test of eustachian tube function is still needed to improve further the predictability of timpanoplasty in children.

Adolescent↗
PubMed1985

Cochlear hearing loss in tympanoplasty.

In tympanoplasty, trauma to the cochlea is usually caused by the transmission of vibration induced during the removal of cholesteatoma, granulation tissue, and tympanosclerosis surrounding the ossicular chain. In 100 sequential cases 20 showed evidence of cochlear trauma. Hearing was recovered in 10 of these cases during the immediate postoperative period. In nine the hearing was partially recovered but remained below the preoperative bone-conduction level, and in one there was a total cochlear hearing loss. When the stapes footplate was fractured or dislocated and a perilymphatic fistula developed, profound cochlear hearing loss occurred. This complication usually can be avoided by inspection of the round and oval windows under high magnification and by tissue grafts over the fistula. An unanticipated pathologic fistula of the semicircular canals is another common source of major cochlear damage. Despite all precautions and sometimes without apparent cause, a total cochlear hearing loss may result after a tympanoplasty. Although this is rare, as evidenced by the fact that there were only 15 cases in some 1000 tympanoplasties, before surgery the surgeon must inform the patient of the risks involved.

Cholesteatoma↗
PubMed1995

Comparison of total intravenous, balanced inhalational and combined intravenous-inhalational anaesthesia for tympanoplasty, septorhinoplasty and adenotonsillectomy.

Two hundred and thirty-five consecutive Saudi patients aged between two and fifty-three years undergoing elective tympanoplasty (n = 32), septorhinoplasty (n = 68) or adenotonsillectomy (n = 135) were studied. They were randomized to receive either a total intravenous anaesthetic (10 ears, 23 noses, 44 throats) consisting of propofol for induction of anaesthesia followed by a propofol infusion, a combined intravenous-inhalational anaesthetic (11 ears, 22 noses, 46 throats) consisting of the above with isoflurane in oxygen-enriched air, or a balanced inhalational anaesthetic (11 ears, 23 noses, 45 throats) consisting of thiopentone for induction of anaesthesia and oxygen in nitrous oxide with isoflurane for maintenance. During tympanoplasty, all three anaesthetic techniques produced stable heart rates and arterial pressures. During septorhinoplasty, blood pressure rose in patients who received total intravenous anaesthesia, while combined and balanced techniques produced haemodynamic stability. During adenotonsillectomy, total intravenous anaesthesia produced a rise in both heart rate and blood pressure, the combined technique produced a rise in heart rate alone while balanced anaesthesia produced haemodynamic stability. Postoperatively, vomiting, pain scores and analgesic requirements were similar following all three types of anaesthetic within each surgical site subgroup. Our findings support the choice of balanced inhalational anaesthesia for all three types of ENT surgery and, where cost and facilities permit, total intravenous anaesthesia for tympanoplasty and combined intravenous-inhalational anaesthesia for septorhinoplasty.

Adenoidectomy↗
PubMed2001

Stapedectomy following tympanoplasty.

The aim of this study was to evaluate the success of stapedectomy in patients who have previously had a tympanoplasty because of chronic otitis media (COM). Fourteen patients from a private otology practice had undergone tympanoplasty for COM and subsequently underwent stapedectomy. Measurements were taken of the air-bone gap (ABG) closure and pure tone average (PTA) which showed hearing improvement. Patients had a mean 36.9 dB PTA hearing gain with 79 per cent closing the ABG to within 20 dB. The need for stapedectomy alone is a rare occurrence for patients with a history of COM requiring a tympanoplasty. Hearing improvement following stapedectomy in these cases was significant, although somewhat less than following traditional stapedectomy in otosclerosis alone.

Adult↗
PubMed2004

Subjective evaluation and overall satisfaction after tympanoplasty for chronic simple suppurative otitis media.

A questionnaire survey was conducted in 324 patients with chronic, simple, suppurative otitis media who had undergone tympanoplasty 6 months or more previously to investigate post-operative hearing, tinnitus, vertigo, occlusive feeling of the ear and otorrhea. In addition, the overall satisfaction with tympanoplasty was assessed by VAS value. Subjective hearing improvement was observed in 73.1% of the patients whose hearing was poor and in 50% of those whose hearing was good before the operation. The degree of satisfaction assessed by VAS value corresponded with the subjective hearing assessment. As to tinnitus, 66.2% of the patients became aware of the disappearance or alleviation of symptoms. In the case of patients who had tinnitus before the operation, the degree of awareness of tinnitus and the degree of satisfaction assessed by VAS value coincided. However, no changes in the VAS value were observed in those who did not have tinnitus before the operation. As for vertigo, 30.5% of the patients who had vertigo preoperatively became aware of the disappearance of the symptoms after the operation. The degree of satisfaction assessed by VAS value corresponded with the presence or absence, severity and frequency of vertigo. As to the fullness of the ear, alleviation of the symptoms was subjectively noted by 85.9% of the patients who had symptoms before the operation. The degree of satisfaction assessed by VAS value corresponded with the severity of the symptoms in those who had symptoms before the operation. As for otorrhea, the disappearance of the symptoms was subjectively noted by 85.5% of the patients who had otorrhea before the operation. The degree of satisfaction assessed by VAS value corresponded with the post-operative changes in otorrhea. Based on the above results, it was assumed that the patients placed greatest expectation on hearing improvement when they underwent tympanoplasty. VAS is considered a useful method to evaluate the degree of satisfaction of patients after surgery.

Adolescent↗
PubMed1976

Symposium: contraindications to tympanoplasty. II. An exercise in clinical judgment.

The two primary symptoms of chronic ear disease are otorrhea and hearing loss. The goal of any tympanoplasty is to eradicate disease and improve hearing. These are the primary indications for this procedure. The success or failure of the surgery is influenced by many factors such as the age and general health of the patient, the extent and type of disease present, and whether the upper airway is functioning properly. Contraindications to tympanoplasty will vary from one surgeon to another depending upon his training, philosophy, experience, and surgical skill. It is helpful to think of these contraindications as being either absolute or relative. Absolute contraindications consist of: 1. uncontrolled cholesteatoma; 2. malignant tumors; 3. unusual infections and/or extenuating circumstances; and 4. complications of chronic ear disease, such as meningitis, brain abscess, or lateral sinus thrombosis. Relative contraindications are less well defined: 1. eustachian tube insufficiency or non-function; 2. the uncooperative patient; 3. the dead ear; 4. the better hearing or only hearing ear; 5. the elderly patient; 6. the young child; and 7. the repeated failure case. The otologic surgeon must exercise good clinical judgment in selecting patients for tympanoplasty. This paper deals with some of the more common problems in decision making.

Age Factors↗