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PubMed1981

[Surgical reconstruction of the sound conduction mechanism in congenital atresia of the ear (author's transl)].

125 congenital atresia of the ear have been operated from 1974 to 1980 in our O.L. department. Congenital atresia of the ear have a conductive type of 70 db which is stable. 45 had a lateral canal fenestration. 22 had an hearing improvement greater than 20 db. 45 had a tympanoplasty using a temporalis fascia graft and the ossicles when the malleo incus mass was mobile and had an adequate contact with the stapes. 25 out of these 45 cases had an hearing improvement greater than 20db. The other one had a tympanoplasty using tympano ossicular homograft with an hearing improvement greater than 20 db in 14 cases.

Child↗
PubMed1981

[A practical application of brainstem evoked response audiometry (author's transl)].

After a brief review of Brainstem Evoked Response Audiometry (BERA) for clinical diagnosis of middle and inner ear hearing losses (Fig. 2, 3) and retrocochlear damages a new practical application is presented: Brainstem Evoked Response Audiometry in Tympanoplasty. Recordings of acoustically evoked brainstem potentials have been made in middle ear surgery in order to get direct objective information about the mobility of the stapes (Fig. 4) and the sound conducting mechanism of the middle ear after tympanoplasty (Fig. 5). Because of the damping factor of the middle ear after tympanoplastic reconstruction quantitative evaluation of sound transmission to the internal ear. Via brainstem potentials evoked by loudspeakers or probe tubes is difficult. Therefore, a special mechanical vibrating system for direct stimulation of the middle ear apparatus at various locations will have to be developed.

Audiometry↗
PubMed1980

Incus reposition: goblet prosthesis.

A stainless steel goblet shaped prosthesis is used to attach the repositioned incus to the stapes. A two year follow-up was made of the first 116 patients in which the prosthesis was used for ossicular reconstruction. The incidence of extrusion and ankylosis is diminished, and 75% of all cases had closure within 10 db. An additional 20% had closure within 20 db of bone conduction thresholds. Revisions have been less with this technique than with others: 40% of 116 patients had an uncomplicated tympanoplasty; 60% had a tympanoplasty with mastoidectomy. The results are, of course, more favorable in the group without mastoidectomy. Of these, 86% had closure to within 10 db of bone conduction level. These findings suggest that the use of the goblet prosthesis results in improved hearing. These findings conclude that the use of the goblet prosthesis results in better hearing than that obtained with other methods of ossicular chain reconstruction.

Ear Ossicles↗
PubMedDate not supplied

[Long-term results of cholesteatoma surgery in children].

In the long-term results, a large percentage of failures of pediatric cholesteatoma surgery (recurrent and residual), as well with the open and closed (ICWT) techniques and motive for the low rates of functional results are a reflection for most authors about the best surgical technique for improving anatomical-functional results. A total of 57 cases of children's cholesteatoma (3-11 years) operated on in a five-year period (1983-1990) with follow-up surgery to 7 years was analyzed statistically. The location of the cholesteatoma in most cases was in the attic and mastoid (72%) with extension to middle ear in 77% and ossicular chain destruction in 80% of cases. In 54% of cases, radical mastoidoepitympanectomy was performed, in 40% mastoidectomy or attico-antrotomy with tympanoplasty and reconstruction of posterior wall with homologous and alloplastic materials, and only in 5.2%, intact canal wall tympanoplasty. Pathological failure (residual + recurrent cholesteatoma) occurred in 17.5% (12.9% with the radical mastoidepitympanectomy, 21% with the reconstructive techniques and 33% with ICWT). The hearing results were better in 17.5% of cases (average 20.2 dB) and hearing loss occurred in 10.5%. At the present time, in most cases the surgical technique used is radical mastoidoepitympanectomy (12.9% of failures).

Child↗
PubMed1994

Tympanomastoidectomy for chronic suppurative otitis media of irradiated ears of nasopharyngeal carcinoma patients.

Chronic suppurative otitis media (CSOM) and osteoradionecrosis of the temporal bone are common sequelae of nasopharyngeal carcinoma (NPC) after radiotherapy. Tympanomastoidectomies were carried out for CSOM in 16 patients who had completed radiotherapy for NPC. Eleven (69%) patients had successful tympanoplasty; in eight of them, the otorrhoea was controlled, and the other three patients had persistent otorrhoea due to exposed osteoradionecrotic bone in the external ear canal. Localized osteoradionecrosis of the external ear canal is often associated with CSOM in NPC patients. Adequate removal of necrotic bone is essential in addition to successful tympanoplasty to eliminate otorrhoea. Therefore, we recommended tympanomastoidectomy for NPC patients with active CSOM who fail to respond to conservative treatment.

Adult↗
PubMedDate not supplied

[Use of spectral luminescent analysis for objective evaluation of the state of tissues in surgical and laser effects].

An optic spectral multichannel analyzer demonstrated a stimulating effect of He-Ne laser on repair processes. For the first time the spectral luminescent analysis was used to determine viability of the transplanted tissue (temporal muscle fascia)in tympanoplasty. Spectral measurements gave grounds for designing policy of the post-tympanoplasty patients' management. The paper presents spectral characteristics of different tissues of the external and middle ear.

Animals↗
PubMedDate not supplied

[Considerations regarding functional cholesteatoma surgery. II. Open techniques].

A review was made of 128 canal wall-down tympanoplasties for chronic otitis media with cholesteatoma. The cholesteatoma was found in the attic (82.4%), antrum (71.7%), mastoid (45.8%), and mesotympanum (35.8%). In 89.1% of cases there was ossicular chain injury. In 39%, the ossicular chain was partially reconstructed (modified canal wall-down tympanoplasty). After one year, 84.4% of the operated ears were safe, dry and self-cleaning. The others (15.6%) had postoperative otorrhea. Canal wall-down modified mastoidectomy achieved closure of the air-bone gap from 40 to 24 dB (p < 0.001).

Cholesteatoma↗
PubMed2005

Regeneration of rat auditory ossicles using recombinant human BMP-2/collagen composites.

Tympanoplasty operations to improve hearing impairment require a wide middle ear cavity and reconstruction of columellar formations. There is no specific material for use in the reconstruction of columellar formations. Tissue response to BMP has been employed as regenerative material. To our knowledge, however, there are no reports of the reconstruction of columellar formations using recombinant human bone morphogenetic protein-2/bovine collagen composites in the middle ear. The purpose of this study is to investigate whether recombinant human bone morphogenetic protein-2/bovine collagen composites (rhBMP-2 composites) are appropriate for use as regenerative material for tympanoplasty. In the form of pellets, rhBMP-2 composites were implanted as columellae into the tympanic cavity. At 2, 4, 6, 8, and 12 weeks after surgery, the middle ear of the animals (n = 4 at each week) was stained with hematoxylin-eosin for light microscopic observation. All composites were in the process of ossification or had ossified according to their developmental stages and were covered with a single layer of squamous or cuboidal epithelium. The new bone formed in these composites was persistently stable and displayed some columellar conditions assessed by histological examination. This study led to the conclusion that rhBMP-2 composites make excellent regenerative material for auditory ossicles.

Animals↗
PubMed1977

Histopathological research on eardrum perforations.

Basic information on the healing process of tympanic membrane perforations is scarce and sometimes contradictory. So the histological and histopathological course of the closure of tympanic membrane perforations was studied in experiments on mice and hamsters. From this investigations it seems evident that traumatic tympanic membrane perforations close nearly always spontaneously in animals. This fact must be kept in mind in the evaluation of techniques and results of tympanoplasties in animal experiments. Furthermore the squamous epithelium of the eardrum plays an important role in the regeneration of tympanic perforations. The closure of the connective tissue defect has always a tendency to lay behind the healing of the epithelial layer. This mechanism differs from the normal healing process of skin wounds where the squamous epithelium migrates over a newly formed granulation tissue layer. On the basis of these findings some practical considerations can be made on tympanoplasties in human.

Animals↗
PubMed1989

Our experiences at Semmelweis University with different techniques and materials in the surgery of chronic otitis media.

Different techniques and materials used in the surgery of chronic otitis media have been evaluated in a large clinical experience at Semmelweis University, Budapest. Data from 1572 operations performed during the last 5 years (1983-1988) are summarized. In the 870 non-cholesteatomatous processes (55.3%), mastoidectomies and tympanoplasties were performed, with the latter primarily using temporalis fascia and cortical bone. Out of the 250 cholesteatoma cases (15.9%), one-fourth was solved by a primary wall-up technique followed by a second stage revision and tympanoplasty within 1.5 years later.

Child↗
PubMed2004

Short-term evaluation of over-under myringoplasty technique.

Over-under tympanoplasty is a technique aimed at eliminating the disadvantages of the two classical techniques of overlay and underlay myringoplasty, which are employed in repairing the tympanic membrane. In this retrospective study, a total of 104 patients underwent myringoplasty, which was performed by means of the underlay technique in 46 patients and over-under technique in 58 patients. The mean follow-up period was 11 months. In the first group of patients, the underlay technique was performed; the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the second group, the over-under technique was performed; the grafted membrane was placed under the remaining drum and over the malleus. The rate of success in the first group of 46 patients was 91.5%, and that of atelectasis was 19.5%. The rate of success in the second group of 58 patients was 94.9% and 12%, respectively. Lateralization of the graft was not observed in either of the groups. In the patients operated on by means of the underlay technique, the air-bone gap decreased by 16.55 dB this rate was 16.96 dB in those operated on by the over-under technique. The authors consider over-under tympanoplasty to be superior to the other two classical methods not only because of its effectiveness, but also because of the results achieved by this technique.

Adolescent↗
PubMed1991

Late results after cholesteatoma surgery in early childhood.

The incidence of cholesteatoma in children living in an urban area of western Sweden has been studied. The total population of this area is 470,000 out of which 100,000 are children, 16 years or younger. The charts of all the children undergoing cholesteatoma surgery during the time period from 1977 to 1986 were collected and analyzed. Only those patients who had not been exposed to cholesteatoma surgery before were included. In a follow-up study the clinical situation and hearing level have been evaluated 4 years or more after surgery. Nineteen patients, that is an incidence of 0.4 children out of 100,000 inhabitants each year, were found meeting these criteria with an irregular distribution over the 10 year period. During the first two years 11 cases were found, but in the following 8 years only 8 new cases were identified. Intact wall tympanoplasty was used in 10 cases and canal wall down operation in 9 cases. Residual cholesteatoma was detected in 6 cases and recurrent cholesteatoma in one case. Six of these had an intact wall tympanoplasty and all but one were later reoperated with a canal wall down approach. The study reveals a decrease in the incidence of cholesteatoma in children over a 10-year period. The more frequent use of tympanometry and otomicroscopy is a possible explanation.

Child↗
PubMedDate not supplied

[Myringoplasty: our results].

Tympanoplasty is the surgical technique used to restore the anatomy and function of the middle ear. The tympanoplasty type I or myringoplasty is performed when the ear only has a perforation of the tympanic membrane without any ossicular damage. We present a retrospective study started in 1997 and finished in 2000 with a total of 118 cases who had undergone a myringoplasty along this period of time. The percentage of closure was 85.59% (n = 101). The techniques used were underlay in a 60.16% of the patients (n = 71), overlay in 34.74% (n = 41) and sandwich in 5.08% (n = 6). In the paediatric patients (under 14 years of age) the percentage of a successful graft following surgery was 88% and in the adults 83.87%. More than fifty years have passed. Since Zöllner and Wullstein described for the first time this type of surgery important because of its good results.

Adolescent↗
PubMed1997

Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: is it necessary?

Chronic suppurative otitis media (CSOM) without cholesteatoma, the surgical treatment of which is still controversial, is a common diagnosis in otologic practice. A retrospective analysis of 323 patients who underwent surgery for noncholesteatomatous chronic otitis media in the Gruppo Otologica, Piacenza, Italy, between April 1983 and December 1993 is presented. Cases were separated into three groups according to different surgical treatment modalities and conditions of the ears at the time of operation. Group I (n = 53) consisted of cases of CSOM treated by tympanoplasty without mastoidectomy (TLWOM). Group II (n = 28) included cases of CSOM treated by tympanoplasty with mastoidectomy (TLWM). Intact canal wall technique was used in these cases. The ears in both these groups were discharging severely at the time of surgery. Group III (n = 242) included patients whose ears were dry at the time of surgery but who had had previous recurrent episodes of suppuration and who were treated by TLWOM. At the last follow-up, graft success rates for groups I, II, and III were 90.5%, 85.7%, and 89.2%, respectively, and mean residual gaps were 17.2 dB, 20.1 dB, and 19.4 dB, respectively. There was no statistically significant difference between the three groups either on graft success rates (p > 0.05) or on final functional hearing outcome (p > 0.05). TLWM is the preferable treatment modality for most surgeons in noncholesteatomatous CSOM. Nevertheless, in our experience TLWOM yields comparable results for this group of patients. In addition, we could not find any significant difference in results of graft success and final functional hearing rates between dry and discharging ears (p > 0.05).

Adolescent↗
PubMed1999

Fate of cartilage material used in middle ear surgery light and electron microscopy study.

OBJECTIVE: To evaluate the fate of autograft and homograft cartilage used in the middle ear. METHOD: Animal experimental study was carried out on 20 healthy guinea pigs by implanting small pieces of auto- and homograft costal cartilage in the middle ears for different periods of time (1, 3 and 6 months). The grafts were removed and examined by light and electron microscopy. Cartilage autografts, obtained from seven human cases at revision tympanoplasty, were also examined by light and electron microscopy. RESULTS: In the animal experimental study the chondrocytes were degenerated while the matrix was preserved in both auto- and homograft specimens. The homografts were as good as the autografts as in both cases the cartilage matrix was preserved. In the human specimens obtained after 10-15 months of implantation (six cases), the matrix was preserved, the lacunae were empty and the chondrocytes were degenerated. The specimen removed after 31/2 years (one case) showed viable chondrocytes of big size with defined cell organelles. CONCLUSION: This work provides evidence for the beneficial role of cartilage in middle ear surgery as the matrix retained its structure. There is also a possibility for the chondrocytes to remain viable for a long time after implantation. It seems also that homograft cartilage is a good option during tympanoplasty and is comparable to autografts. In the animal study the homografts were as good as the autografts as in both cases cartilage matrix was preserved.

Animals↗
PubMed1986

Surgical management of labyrinthine fistula with cholesteatoma.

From 684 cases of ear surgery for cholesteatoma performed by one surgeon, 35 had labyrinthine fistulae (incidence 5.1 per cent). Of these fistulae, 79 per cent involved the lateral semicircular canal only; the other sites involved were the other semicircular canals and the cochlea. The fistula test was positive in 54 per cent of cases overall, but in 80 per cent with an extended site fistula (ESF). Three surgical approaches were employed sequentially--staged combined approach tympanoplasty (CAT), open cavity tympanoplasty and attico-antrotomy. Surgically-induced deafness occurred in 3.3 per cent. All surgical groups showed similar hearing results, except for less conductive deafness in the CAT group. Surgical management is discussed with reference to current theories of the erosive effects of cholesteatoma.

Adolescent↗
PubMed1988

A prospective randomized trial of suture material in aural wound closure.

The aim of the study was to compare synthetic monofilament suture materials with chromic catgut and silk in aural wound closure. Forty patients undergoing mastoidectomy or tympanoplasty were randomized to closure with either 3o PDS (Polydioxanone) to fascia plus 3o Prolene to skin, or 2o chromic catgut to fascia plus 3o silk to skin. Known or suspected factors affecting wound healing were recorded. Nine patients had post-operative wound infections. The infection rate was significantly lower in wounds closed with PDS and Prolene (chi 2 = 6.05, p less than .05), and in tympanoplasty operations (chi 2 = 4.42, p less than .05). Four patients suffered wound dehiscence, all four had been closed with catgut and silk. No other complication of wound healing was noted in the trial. In conclusion, PDS and Prolene are superior suture materials to catgut and silk in the closure of aural wounds.

Adult↗
PubMed1989

Anthropological study of the mastoid air cell system in Pakistani races.

This is an anthropological study of the development of the mastoid process in the four ethnic groups of Pakistani races: Turko-Iranian, Indo-Aryan, Scytho-Dravidian, and Aryo-Dravidian. Cephalometric studies have established that the majority of Pakistanis are brachio to ultra-brachiocephalic (Cephalic Index 82-x). Radiological evaluation of normal mastoids and their planimetric measurements show that the mastoid process is smaller (Av: 10.24 sq.cm. +/- 0.8) than the Caucasian Western races (Av: 12-15 sq.cm.). Neither combined approach tympanoplasty, nor mastoid obliteration technique may be required, nor technically possible in a small mastoid. Natural epithelization of a small 'peanut size' mastoidectomy cavity does not justify these procedures. A modified radical mastoidectomy and tympanoplasty reconstruction provides a satisfactory result in chronic discharging ears.

Adolescent↗