Tympanoplasty

The study comprises of 164 ears of modified radical mastoidectomy with tympanoplasty performed as one stage operation in our hospital. The ears were followed up for 5 years. Out of these 164 ears, postaural approach was performed in 90 ears and endaural with removal of bone from inside out in 74 ears. Tympanoplasty was performed in all the cases as one stage operation with incus transposition in 42 cases, autogenous cortical bone columella between malleus handle and stapes head in 80 cases, between stapes footplate and graft material in 30 cases and preserved homograft ossicles between stapes footplate and graft in 12 cases. Dry ears with graft take up occurred in 92% cases within 6 to 10 weeks. No recurrence of cholesteatoma was seen. Ossiculoplasty using autogenous cortical bone columellas resulted in somewhat greater improvement in the post operative airbone gap than ossiculoplasty with auto or homograft ossicles. Similarly the post operative gap improved more with an intact stapes superstructure than in ears where the stapes superstructure was absent. The use of a cortical bone can be recommended in cases where the patient’s own ossicles are affected by disease and cannot be used.     

Tympanoplasty

We review many aspects of tympanoplasty, including physiologic principles and our philosophy regarding the treatment of chronic otitis media. We then describe the various techniques of tympanoplasty that we currently use and indications for each technique. Hearing results after 388 tympanoplasty procedures in which the middle ear was judged as being aerated postoperatively are presented. The best hearing results occurred after type I tympanoplasty. An intact stapes was a positive prognostic indicator when the ossicular chain had to be reconstructed. There were no differences in hearing outcomes between canal wall-up and canal wall-down procedures.     

Tympanoplasty in children

Closure of uncomplicated tympanic membrane perforation (tympanoplasty) is usually a straightforward procedure with a good success rate. Many studies report a success rate from 60 to 99% in adults, whereas a 35–94% success rate in children. The definition of successful tympanoplasty varies from one author to other. Some authors report that an intact tympanic membrane considered a successful surgical result, whereas the other authors may also consider the postoperative hearing, as well as middle ear aeration, as a part of good outcome. This review is an insight into the recent and as well as the past literature on prognostic factors in pediatric tympanoplasty. This article reports an overview of the commonly reported factors which are thought to affect the tympanoplasty in children. Age is considered as one of the most important factor determining the successful outcome of tympanoplasty. Most of the studies did not reveal any significant difference in result between pediatric tympanoplasty from those of adult ones. Interestingly, in one study; it was found that patients younger than 16 years had decreased graft uptake compared with adults. However, in this same study; it was found that the younger patients had better postoperative hearing with better postoperative AB gap closure. The other factors which seem to influence the success rate of tympanoplasty are the size of perforation, technique used, presence or absence of otorrhoea, eustachian tube function and status of the contralateral ear. A study has revealed that posterior perforation had poorer results but it may be a distorted finding as the surgical method was not controlled. Regarding the size of perforation and its influence on the success rate of tympanoplasty, there is again difference of opinion. In one study, it was found that perforations greater than 50% had poorer results, but other studies contradict this statement stating that the success of tympanoplasty has no bearing with the size of perforation. Poor eustachian tube function has been offered as an explanation by some authors as younger age may be correlated with lower tympanoplasty success rates, but some authors refute this by stating that poor eustachian tube function not necessarily an indicator of poor surgical outcome. In conclusion, the success of tympanoplasty in children, with little doubt, depends on a number of factors. The past and recent literature has not produced a consensus of convincing evidence supporting any one parameter.     

Tympanoplasty in children

In this, study, an attempt has been made to find out if the age of the child is a factor in influencing the surgical outcome of tympanoplasty. The study group comprises 52 children, divided into two subgroups; 8-11 years and 12-15 years. The success is defined as an intact tympanic membrane after 6 months of surgery. The success rate is slightly higher in 12-15 year age group (90.24%) than in 8-11 year age group (81.8%). The overall success rate in 86.54% in this series.     

Tympanoplasty in children

Tympanoplasty in childhood is not always the same as in adults. This applies to the indication for the operation, to the operation itself and also to the pre- and postoperative treatment. The rapidly growing and expanding juvenile cholesteatoma offers special problems, and probably has a different cause than the slow growing pearl tumour found in adults. Traumatic cholesteatomas also give the impression of growing faster in childhood. The prognosis for tympanoplasty in cases of mesotympanic chronic otitis media must not be too optimistic because the condition of the mucosa in juveniles is different to that in adults. Pre-operative treatment may take a long time and postoperative treatment may be difficult.     

Tympanoplasty: problems and realization

The authors describe how to provide safety and effectiveness of tympanoplasty, the principle of standard preparation and performance of the operation. They think it necessary to thoroughly assess stability of intralabyrinthine pressure and retrochochlear functions, to normalize humoral immunity and rheological blood properties, function of the acoustic tube, to choose optimal preserver and technique of reconstruction, how to evaluate postoperative outcome. Adequate use of the techniques widens the spectrum of reparative operations on the middle ear applied in practice.     

Tympanoplasty with calcium phosphate

A new approach to the problems of chronic middle ear disease using the hydroxyapatite prosthesis is described. Open surgery is preferred and, independent of the eradication, reconstruction is possible. The posterior canal wall is reconstructed with a canal wall prosthesis of porous hydroxyapatite. The middle ear chain defects are reconstructed with a prosthesis of dense hydroxyapatite. In the case of a cavity with a mobile bare footplate a total alloplastic middle ear of hydroxyapatite is used.