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PubMed1985

[Changes in bone conduction in the surgery of chronic otitis and its sequelae (evaluation of 800 operations)].

The authors undertook a study of changes in bone conduction (BC) during 800 operations carried out over a 5 years period (1979-1984) for chronic otitis or sequelae of chronic otitis. After elimination of ears with deafness (47) and cases unsuitable for evaluation (39), they finally included 714 records in the study. Only comparison of free and post-operative BC was made and using 4 conversational frequencies, not taking into account a deviation of 5 DB for each of these 4 frequencies. The study involved 317 myringoplasties: In 271 (i.e. 85,5%) there was no change in BC. Amongst them, 37 patients nevertheless showed a transient fall in BC. Of particular importance is the fact that almost 1/3 (11 to be exact) recovered only during the 2nd semester following surgery, a period which was even exceeded in the other 5 cases. 46 (i.e. 14.5%) were classified as "permanent" falls in BC. Amongst these in only 17 (i.e. 5%) were there "only" the three standard aggression factors for the I.O.: aspiration--scraping--manipulation of the tympano-ossicular system, without it being possible to attribute a predominant role to one more than the other. With regard to reaming of the E.A.M., those cases in which this could be considered responsible appeared to be infinitesimal. Furthermore, there was no statistically significant difference (reduced deviation test--"chi"2 test) between the number of falls in BC seen following myringoplasty with or without reaming. 83 tympanoplasties by Piston-Malleus, study of which led to the same conclusions as for myringoplasties. 118 masto-atticotomies, including 23 with posterior tympanotomy. Despite peri-labyrinthine and peri-ossicular scraping, results were essentially identical. 196 evacuation cavities (227-31 deafness) of which somewhat less than half only (46%) were ears undergoing surgery for the first time. Percentage of unchanged BC was here much more unfavourable, with 49 "permanent" falls in BC, i.e. 25%, of which, it must be said, 5 were minimal falls, and with, in 25 cases, a follow-up of less than 3 months.

Bone Conduction↗

PubMed1978

The mastoid air cell system in ear surgery.

Despite the overall high success rate of myringoplasty, the long-term results in ears with preoperative dysfunction of the Eustachian tube and with a small mastoid air cell system are disappointing. In this communication, we report an 83% healing rate after myringoplasty that included mastoidectomy with posterior and anterior tympanotomy in a selected group of patients with poor tubal function and small mastoids.

Air↗

PubMed1981

Ear surgery and mastoid air cell system.

Opinion differ whether simple myringoplasty should be combined with mastoidectomy, which is claimed to provide a large air reservoir for the middle ear. Data are reported on 61 ears, 55 of which had reasonably normal tympanic mucosa but distinct chronic mastoid or epitympanic ear disease. Obliteration of the cavity was performed, combined with tympanoplasty, and the patients were followed up for an average of three years. Normal aeration of the middle ear was seen in all cases with normal middle ear mucosa regardless of whether the posterior canal wall was saved or reconstructed in connection with obliteration. It is concluded that there is no reason for mastoidectomies in small mastoid cell systems in simple myringoplasties.

Air↗

PubMed2005

Long-term follow-up evaluation of mastoidectomy in children with non-cholesteatomatous chronic suppurative otitis media.

OBJECTIVE: In spite of declining prevalence chronic suppurative otitis media without cholesteatoma (CSOM) still poses a significant health problem. Randomized clinical trials comparing medical and surgical intervention are not available. Hence, the treatment of CSOM is almost exclusively based on empirical experience. The purpose of the present study was to evaluate the long-term effects of mastoidectomy combined with myringotomy and exploration of the middle ear in children with CSOM. METHODS: 47 children with CSOM underwent surgery including mastoidectomy. Ear status was investigated peri-operatively and at a long-term follow-up (5-21 years post-operatively). MAIN OUTCOME MEASURES: Final success rate, FS (dry ears for several years) and the optimal final success rate, OFS (dry ears for several years without re-operations and without retractions/perforations) were estimated. RESULTS: No serious surgical complications occurred. Post-operatively re-mastoidectomy was performed in 13% and re-myringoplasty/tympanoplasty in 21%. At the long-term follow-up the FS rate was 94% and the OFS rate was 61%. CONCLUSIONS: Surgery alone did not entirely cure CSOM which may justify randomized studies comparing conservative treatment and myringoplasty with/without mastoidectomy. Finally, mastoidectomy in these patients must be considered as a last resort when intense conservative treatment fails.

Adolescent↗

PubMed1992

Importance of atticotomy in chronic otitis media with fixation of ossicles.

Seventy-seven patients with chronic otitis media were reviewed. Of the 77 patients, 42 underwent tympanoplasty with a columella, and 35 underwent myringoplasty and atticotomy. Twenty-five of the latter 35 patients showed less than 10 dB of hearing improvement with a patch test before operation. The ossicular chain was not disconnected in any of the 25 patients, but the mobility was severely restricted. It was interesting that fixation of the malleus was found at surgery in 80% (20/25) of the patients, whereas the stapes was immobilized in only 16% (4/25). Myringoplasty and atticotomy instead of tympanoplasty with a columella was sufficient to achieve hearing improvement in most of such cases. However, conventional atticotomy was not able to achieve improvement in the mobility of the ossicles because the mobility is usually severely restricted at the malleus. Removal of the anterior tympanic spine is the key to recovery of the mobility of the malleus, resulting in hearing improvement. Rate of success was obtained in 24 of 25 ears (96%).

Auditory Threshold↗

PubMed2000

Bilateral same day surgery for bilateral perforated chronic otitis media.

OBJECTIVE: Bilateral same day surgery has been performed rarely because of the risk of postoperative sensorineural hearing loss following conventional myringoplasty or tympanoplasty (CMT). Simple underlay myringoplasty (SUM) through the ear canal has been developed by Yuasa R, Saijo S, Tomioka Y, et al. Office closure of eardrum perforation with fibrin glue (in Japanese), Otolaryngol Head Neck Surg (Tokyo) 1989;61:1117-1122, which has little risk of sensorineural hearing loss. We tried bilateral same day surgery using this technique and evaluated its outcome. METHODS: Of 86 cases with bilateral perforated chronic otitis media that we treated between 1995-1997, 25 cases underwent bilateral same day surgery. Bilateral SUMs was performed on seven patients, SUM and CMT on 16 patients, and bilateral CMTs on two patients. RESULTS: Closure of perforation was successful in 18 patients (72%) on both sides and in seven patients (28%) on one side. Postoperative air-bone gap of less than 20 dB was achieved in 15 cases (60%) on both sides and in 23 cases (92%) on one side. CONCLUSION: Bilateral same day surgery for bilateral perforated chronic otitis media is possible if the operative indications are considered.

Adolescent↗

PubMed1993

Tympanic membrane ossification.

Ossification of the tympanic membrane after myringoplasty is recorded for the first time. Myringoplasty was performed for closure of a perforation which followed the surgical treatment of otitis media with effusion and had included the insertion of a long-term T-tube.

Audiometry, Pure-Tone↗

PubMed1993

Hyaluronic acid in middle ear surgery.

The efficacy of hyaluronic acid when utilized in tympanoplasty was investigated in a multicenter, randomized, prospective patient blinded study. Of the 117 patients who completed the study, a majority (76) were treated with myringoplasty, 26 with myringoplasty combined with ossiculoplasty, and 15 with ossiculoplasty alone. The patients were evaluated by the operating surgeon up to 3 months following surgery, when the final assessment was made. The patients were divided into three groups: group 1 was treated with hyaluronic acid, 1 percent; group 2 with hyaluronic acid, 1.9 percent; and group 3 constituted the control where no hyaluronic acid was used at all. In the two test groups, utilizing hyaluronic acid, no gelatinous sponge was allowed to be left in the middle ear after surgery, whereas the control group was operated according to standard principles. The three groups were compared after the termination of the study as regards quality of healing and their hearing results. It could be concluded that the healing process within the middle ear and the tympanic membrane, as well as the hearing ability, was similar in all three groups. Thus no statistically significant differences could be obtained between the patient groups in which hyaluronic acid had been utilized in any concentration and the control group operated according to standard routine. This finding does not exclude, however, that hyaluronic acid might have a place in tympanoplastic surgery of today, since the long-term results were not evaluated here.

Adolescent↗

PubMed2005

Reevaluation of bilateral same-day surgery for bilateral perforated chronic otitis media.

OBJECTIVE: To evaluate the results of bilateral same-day surgery for bilateral perforated chronic otitis media in comparison with our previous report. STUDY DESIGN: Prospective study. PATIENTS: Seventeen patients ranging in age from 5 to 70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media. METHODS: Two hundred cases of chronic otitis media were operated on at the Department of Otolaryngology, Hyogo College of Medicine from December 1998 to November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients (8.5%) underwent bilateral same-day surgery. RESULTS: The postoperative air-bone gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 (59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple underlay myringoplasty series and 9 of 12 (75%) in the conventional myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both sides was successful in 4 of 5 (80%) that underwent simple underlay myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas that on at least one side was successful in 100%. CONCLUSION: Bilateral same-day surgery for bilateral perforated chronic otitis media is possible if operative indications are considered. Furthermore, it will help patients save time and money.

Adolescent↗

PubMed1988

Tympanoplasty surgery and prophylactic antibiotics: surgical results.

This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. A total of 130 individuals were randomly allocated to either an antibiotic or a non-antibiotic group. Each individual was clinically and audiometrically assessed preoperatively, and 8 weeks postoperatively. It was found that systemic prophylactic antibiotics did not influence either the success rate of myringoplasty surgery or the audiometric result.

Adolescent↗

PubMed1989

Tests of eustachian tube function and ear surgery.

Few objective measures exist to predict the outcome of ear surgery. Clinical and experimental experience has shown the key role of the Eustachian tube in this respect, but clinical testing is seldom performed. The present study confirms that Eustachian tube testing may be of clinical significance by comparing preoperative test results before myringoplasty with the late results of this operation. In 157 patients the ability to equilibrate a static air pressure of plus or minus 200 mm of water passively or actively was tested. It turned out that in those 15% who could equilibrate minus 200 mm passively a 7 times higher rate of successful myringoplasty was found. Ears with cholesteatoma showed less ability to equilibrate actively. Despite these findings it is concluded that the present tests are insufficient for clinical use.

Acoustic Impedance Tests↗

PubMed1993

Royal College of Surgeons comparative ENT audit 1990.

The Royal College of Surgeons Comparative Audit Service was set up in 1990 so that surgeons could pool their audit data, to provide 'standards' with which to compare their own figures. A total of 405 consultant otolaryngologists were circularized in December 1991 inviting them to return data about their resources, workload, case-mix and complications, and about two specific audit topics-Myringoplasty and Carcinoma of the Larynx--for the calendar year 1990. A total of 65 consultants returned proformas with data on 52208 admissions and 31240 surgical procedures. The 'average' respondent admitted 829 patients in the year (19% of these day cases and 14% emergencies) and performed 744 surgical procedures with a mean complication rate of 1.39% using three theatre sessions per week. Cancelled theatre sessions per annum per consultant ranged from 0 to 71. The mean known success rate after myringoplasty was 65%, with hearing improvement in 53%. The 'average' ENT surgeon saw 3.5 new cases of invasive carcinoma of the larynx and treated 69% of these with radiotherapy alone, compared with 14% surgery alone. As well as allowing a profile to be drawn up of the 'average' respondent, this audit allowed individual consultants returning data to compare their own figures in detail with the pooled data, which were presented graphically at a meeting in April 1992.

Carcinoma↗

PubMed1988

The effect of fibrin tissue adhesive on the middle and inner ears of chinchillas.

The purpose of this study was to examine potential toxic effects of fibrin tissue adhesive to the middle and inner ears. Using the chinchilla as our experimental model, we placed fibrin sealant on either the footplate or the round window membrane in one ear, and placed similar amounts of normal saline in the same area of the opposite ear. In addition, the fibrin adhesive was used to anchor a fascia lata graft for myringoplasty. Both fibrin adhesive and normal saline produced mild reactions in the middle and inner ears when they were placed on the round window membrane; little reaction occurred when fibrin adhesive was placed on the oval window or when it was used for myringoplasty.

Animals↗

PubMed2005

A study of chorda tympani nerve injury and related symptoms following middle-ear surgery.

This is a prospective study that looks into the prevalence of chorda tympani nerve (CTN) injury and related symptoms following varying degrees of trauma to the nerve during three common types of middle-ear operation: myringoplasty, tympanotomy and mastoidectomy. The number of patients with CTN-related symptoms varied widely between the three groups. Increased occurrence of the nerve related symptoms and a prolonged recovery time were observed in the tympanotomy group. Stretching of the nerve produced more symptomatic cases than cutting it in the myringoplasty and mastoidectomy groups. Recovery was complete in 92 percent of the symptomatic patients by 12 months. It is important to inform patients about the possibility of CTN injury during middle-ear operations, and it should also be emphasized that symptoms related to CTN injury can occur irrespective of the type of damage to the nerve.

Adolescent↗

PubMedDate not supplied

Histology of the tympanic perforation and the replacement membrane.

This study shows that the mucocutaneous junction of a perforation of the tympanic membrane may be located at the margin, in the middle ear, or in the ear canal. It is incumbent upon the surgeon performing myringoplasty to identify this junction in order to optimize the success of surgery. About one-third of the healed area following perforation has an intermediate fibrous layer. The membranes in 2 cases of myringoplasty evidenced thicker-than-normal intermediate layers.

Humans↗

PubMed1999

[Barofunction of auditory tube in patients with central perforation of tympanic membrane].

Patients with otitis media chronica with central tympanic perforation underwent glue myringoplasty or radical operation. In 52.2 and 33.3% of them an original technique developed by the authors, has discovered defect of barofunction of the auditory tube named inflation effect of the auditory tube. High intratympanic pressure observed in this effect should be taken into consideration in tympanoplasty as it underlies rupture or dislocation of the transplant in myringoplasty or dislocation of the neotympanic membrane in reconstructive surgery on the middle ear.

Adolescent↗

PubMed1999

[Results of the surgical management of congenital malformations of the external auditory canal and of the middle ear in children with special reference to vein xenografts].

The paper deals with the possibility of surgical reconstruction of congenital malformations of the ear, the choice of a proper surgical method with the utilization of calf-vein xenografts, and with postoperative effects of the employed operative technique modified by the authors. The research material comprised 70 children between 3 and 17 years of age treated in years 1992-1995. Reconstructive surgery was performed in 24 children (29 ears). Calf-vein xenografts were used for myringoplasty and for the lining of the bony walls of the postoperative cavity (of the created external auditory canal and of the mastoid cavity). Hearing improvement was gained in 79% of cases, and in 55% of patients it was 24 dB or higher. Patent and epithelilized external auditory canals were obtained in 81% of the operated "atretic" ears. Failures referred to fibrodermal restenosis and lack of hearing improvement. Surgical treatment of bilateral congenital aural "atresia" can be performed in children at 4-6 years of age. Vein xenografts are a good reconstructive material recommended in congenital aural malformations for myringoplasty and canaloplasty.

Adolescent↗

PubMed1992

[Comparison of 2 materials in the reconstruction of the tympanic membrane. Our experience in 300 patients].

The authors evaluated the results obtained from the tympanic membrane reconstruction in 300 patients affected by simple, purulent or cholesteatomatous chronic middle ear otitis. In this tympanic membrane reconstruction they used: jugular vein strip of a calf and temporal muscle fascia in 150 cases. On pathological basis (simple, purulent and cholestéatomatous otitis) they used the overlay or the underlay method. In 5 years that follows, the materials (vein and fascia), if properly used, would give similar results. For such reasons the authors proposed: temporal muscle fascia autotransplantation with underlay method in partial myringoplasty; heterotransplantation of modelled jugular vein strip with overlay method in subtotal or total myringoplasty.

Fascia↗