Hearing results of canal wall reconstruction tympanoplasty for middle ear cholesteatoma in children.

OBJECTIVE: To investigate post-operative hearing results in children with middle ear cholesteatoma, and to analyze the correlation between hearing results and clinical factors and findings before and during the operation. PATIENTS AND METHODS: One hundred and twenty-four ears of 123 children were operated on for middle ear cholesteatoma at the age of 10 years or younger by canal wall reconstruction tympanoplasty and were followed up more than 1 year after the final operation. We evaluated the average air and bone conduction hearing levels at the speech ranges before the first operation (pre-operative hearing) and after the final operation (post-operative hearing). RESULTS: The mean of the average air conduction hearing level of 124 ears was significantly improved from 34.7 to 27.1 dB after the final operation. Among them, 84 ears (67.8%) showed a hearing level of 30 dB or less post-operatively. Post-operative hearing was better in the one-stage group than in the staged group. However, more than one-half of the ears which underwent type IV tympanoplasty in the staged group showed post-operative air conduction hearing level of < or =30 dB. Significant improvement in post-operative hearing was noted in ears with normal middle ear mucosa or middle ear effusion at the final operation. No correlation between hearing improvement and clinical factors such as age, type of cholesteatoma or presence of otitis media with effusion at the first operation was found. CONCLUSIONS: Children with middle ear cholesteatoma at the age of 10 years or younger exhibited good hearing post-operatively. Satisfactory hearing improvement is expected even in ears without the superstructure of the stapes if staged tympanoplasty is conducted. Canal wall reconstruction tympanoplasty for pediatric cholesteatoma was successful in terms of hearing results and the success was unrelated to various clinical factors.     

Evaluation of canal wall down tympanoplasty with canal reconstruction for draining ear with middle ear cholesteatoma

OBJECTIVES: We studied the postoperative stability of canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma with preoperative otorrhea. SUBJECTS AND METHODS: 155 ears with middle ear cholesteatoma treated with canal wall down tympanoplasty with canal reconstruction were evaluated retrospectively. A comparison was made between the group of 80 ears which showed otorrhea, preoperatively, and the group of 75 without preoperative otorrhea. Problems observed in the tympanic membrane or reconstructed external auditory canal were evaluated both at the postoperative initial stage and more than 1 year after surgery. Postoperative hearing prognosis was also studied. RESULTS: 1) In the postoperative initial stage, local infection and necrosis of materials for canal reconstruction were significantly more likely to be observed in ears with preoperative otorrhea. 2) In ears with postoperative local infection, necrosis of materials for canal reconstruction occurred more frequently, and the period until drying of the reconstructed external auditory canal was significantly extended. 3) No significant difference was seen in postoperative status of the tympanic membrane and reconstructed ear canal at least 1 year after surgery. 4) The presence of preoperative otorrhea had no influence on hearing prognosis. CONCLUSIONS: When canal wall down tympanoplasty with canal reconstruction is used for ears with preoperative otorrhea, careful attention should be paid to local treatment at the postoperative initial stage. However, no significant problem occurred in the outcome of preoperative ear draining at least 1 year after surgery.     

Incidence of attic retraction after staged intact canal wall tympanoplasty for middle ear cholesteatoma.

Incidence of retraction pocket and recurrent cholesteatoma in the attic after surgery for middle ear cholesteatoma using the staged intact canal wall technique were investigated in 95 ears of 91 patients, all of which had various degrees of bone defect in the tympanic scutum. Surgical procedures employed in the second stage for prevention of attic retraction were classified into three types: Type I, no scutumplasty; Type II, scutumplasty; Type III, scutumplasty plus mastoid obliteration. In 83 ears followed up for more than 1 year after the second stage, such retraction troubles occurred in 2 of 13 ears (15%) in Type I, 8 of 20 ears (40%) in Type II, and 24 of 50 ears (48%) in Type III. Incidence of retraction troubles was higher in Types II and III, probably because these procedures were indicated in ears with large scutum defects. Dislocation and atrophy of the graft materials, together with bone resorption around the bone defect were the main reasons for failure in scutumplasty. Dysfunction of the eustachian tube and traction of the eardrum by the scar tissue behind it may have also contributed to attic retraction. Mastoid obliteration with small blocks of hydroxyapatite was more effective in prevention of retraction troubles than that with pedicled temporalis muscle flap.     

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma

ObjectiveThe aeration status of the middle ear is presumed to be one of the factors affecting the outcome in acquired cholesteatoma. The present study investigated the impact of postoperative middle ear aeration on hearing and recurrence after intact canal wall tympanoplasty.MethodsWe conducted a retrospective chart review of 127 pars flaccida cholesteatoma patients who underwent primary intact canal wall tympanoplasty at a tertiary academic medical center. We collected data on clinical characteristics, including extent of cholesteatoma, surgical procedure, pre- and postoperative middle ear aeration, hearing level, and recurrence. The aeration was measured before and at one year after operation on two axial computed tomography (CT) planes: at the lateral semicircular canal (mastoid cavity) and at the oval window (tympanic cavity). Based on the postoperative air-bone gap (ABG), patients were categorized into two groups: the successful hearing (ABG ≤15 dB) group and the unsuccessful hearing (ABG >15 dB) group. We used aeration ratio to assess the relationship between postoperative aeration improvement and hearing outcome or recurrence. Multivariate logistic regression analysis was used to identify the factors associated with hearing outcome.ResultsAt one year after operation, aeration ratio in both mastoid and tympanic cavities was significantly improved than the preoperative status (p < 0.001, p < 0.001, respectively, Wilcoxon signed-rank test). The positive correlation was found between postoperative aeration ratios of mastoid cavity and tympanic cavity (r = 0.348, p < 0.001, Spearman's rank-correlation coefficient). In mastoid and tympanic cavities, the postoperative aeration ratio in successful hearing group (n = 57) was significantly higher than that in the unsuccessful hearing group (n = 45) at one year after operation (p < 0.001, p = 0.028, respectively, Mann-Whitney U test). Multivariate logistic regression analysis demonstrated that postoperative aeration ratio in mastoid cavity and preoperative ABG were significant independent prognostic factors for successful hearing (odds ratio [95% confidence interval]: 2.630 [0.985 - 7.024], p = 0.045; 0.891[0.840 - 0.944], p < 0.001, respectively). However, postoperative aeration ratios did not significantly differ between with (n = 14) and without recurrence (n = 113) groups in both cavities.ConclusionOur results suggest that better postoperative aeration in mastoid cavity is independently associated with satisfactory hearing outcome after intact canal wall tympanoplasty in pars flaccida cholesteatoma. However, no significant differences were observed between middle ear aeration at one year after operation and recurrence.     

完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎

目的:探讨完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的临床效果和相关的经验教训.方法:对57例胆脂瘤中耳炎患者实施完壁式乳突根治鼓室成形术.结果:随访1～8年,平均3.7年.术后5例感染流脓,其中3例经及时处理得到控制并愈合,2例二次手术处理后愈合;3例术后因胆脂瘤复发行开放式乳突手术获干耳;鼓膜完整但有内陷者29例,其中2级内陷者13例;术后8个月及1年人工听骨脱出各1例.术后言语频率气导听阈降低>10 dB HL为72.2%(39/54),气骨导差<20 dB HL为53.7%(29/54),气骨导差缩小25 dB HL以上占42.6%(23/54).结论:施行完壁式乳突根治鼓室成形术,如果适应证掌握得当,技术条件许可,患者能按时随访.可以有效保留原中耳乳突解剖结构和改善听力,提高患者生活质量,应予优先选择该术式.     

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.     

Surgical results of modified canal wall down tympanoplasty

Conclusion: Patients with mastoiditis and chronic suppurative otitis media which has small mastoids that make them ideal candidates for modified canal wall down mastoidectomy (MCWD) which contributes to a dry and spacious ear and the maintaining and improving hearing.

Objectives: To evaluate surgical outcomes for chronic otitis media underwent MCWD.

Methods: A clinical retrospective study was performed on 47 ears with chronic otitis media which has relatively limited attic lesions have the small, sclerotic and hypocellular mastoids according to the preoperative high-resolution CT scan of the temporal bone that underwent MCWD and 32 ears with typical canal wall down operation form January 2010 to January 2016.

Results: In the MCWD group, the mean preoperative air conduction (AC) threshold of 38.2?±?1.1?dB was lowered to 31.0?±?0.8?dB postoperatively (p?p?p?p?相似文献   

乳突根治加鼓室成形术临床疗效观察

目的 :在传统乳突根治术的基础上 ,探讨保留部分外耳道后壁鼓室成形术的方法 ,以期提高化脓性中耳乳突炎病人的干耳率 ,提高听力的可能性。方法 :对 2 6例 (2 9耳 )化脓性中耳乳突炎患者进行乳突根治术 ,保留部分外耳道后上壁 ,一期重建中耳传音结构。结果 :2 6例 (2 9耳 )术后 8个月～ 2 4个月随访 ,术后干耳并听力提高达实用听力水平 (2 5d B以上 ) 2 6耳 ,治愈率达 89.7% ,复发 3耳 ,复发率为10 .3%。结论 :对于耳咽管功能良好的化脓性中耳乳突炎病人在彻底清除乳突中耳病变的同时 ,行保留部分外耳道后壁及鼓环的鼓室成形术 ,更接近中耳生理结构 ,即清除炎性病变 ,又提高听力 ,值得推广。     

Intact canal wall tympanoplasty in the management of cholesteatoma

There are presently two schools of thought on the proper surgical management of cholesteatoma associated with chronic ear disease: one feels that the ear should be exteriorized and left “open”; the other takes the position that the disease can be removed, and the ear left in its normal anatomical and functional state. The latter group are known to favor a “closed” or more conservative procedure. The purpose of this paper is to review a, series of patients who have had cholesteatoma managed by an intact canal Avail procedure that prevents a postoperative cavity. Out of a series of 590 chronic ear surgeries performed between January 1, 1970, and December 31, 1974, there were 179 done for cholesteatoma (30 percent). There were 153 patients, 26 of whom had bilateral disease. Twenty-three patients were lost to folloAV-up, giving an overall total of 154 surgeries with from one to five-year information. The overall follow-up rate was 85 percent. Recurrent cholesteatoma was the most bothersome complication and occurred in 14 percent of the series. Residual cholesteatoma was managed by doing all procedures in two stages. The authors feel that the intact canal wall tympanoplasty is a procedure that will gain acceptance and will be more widely used in the future.     

Enlarging the ear canal in intact canal wall tympanoplasty

In chronic otitis media, the external meatus and ear canal are often small and tortuous. Gill reported that a third of_250_ears with. congenital atresia had chronic otitis media, often unsuspected. Bellucci has emphasized the role of the Eustachian tube in determining the extent of chronic otitis media, so it follows that the small and tortuous ear canal are part of the congenital defects in this disease. Farrior and Caparosa have previously mentioned enlarging the ear canal in intact canal wall tympanoplasty. The usual post-aural incision is made and the soft tissue of the canal dissected forward off the bone. A first vertical incision is made through the canal wall skin near the annulus, a second through the concha, and the two are connected by a longitudinal incision. The flaps are shifted apart to enlarge the canal, and an elipse of conchal cartilage is excised. The intact tympanoplasty is completed in the usual fashion, and the defect in the drum and canal is closed with a large tongue-shaped piece of fascia which is brought out over the concha through the second incision. The canal is packed with strips of silk and cotton balls for two weeks. The result is a meatal opening and canal with a trumpet shape and adequate size.     

Computed tomographic evaluation of middle ear aeration following intact canal wall tympanoplasty

The condition of the mastoidectomy cavity following intact canal wall tympanoplasty (ICWT) is always of great interest to the otosurgeon. We evaluated the status of postoperative aeration in a stable ear following ICWT for various types of chronic otitis media using high-resolution computed tomography (CT). The mastoidectomy cavity in all the cases of simple suppurative otitis is totally aerated and that in over 60% of the cases of adhesive otitis, attic type cholesteatoma and adhesive type cholesteatoma is obliterated by a soft tissue density mass. The size of aerated spaces in the postoperative middle ear cavity not only depends on the type of chronic otitis media but also tends to correlate with the degree of mastoid pneumatization in the opposite ear. CT is useful for the postoperative assessment of middle ear aeration.     

先天性外耳道狭窄伴外耳道或中耳乳突胆脂瘤的手术治疗

目的 :探讨先天性外耳道狭窄及伴中耳畸形外耳道、中耳乳突胆脂瘤病人的手术治疗方法。方法 :31例病人中 9例为单纯先天性外耳道狭窄伴发外耳道胆脂瘤 ,进行外耳道胆脂瘤根治术 ,并行外耳道成形术 ,其中 7例行外耳道成形 +鼓室成形术 ;2 2例为先天性外耳道狭窄伴发中耳畸形和中耳乳突胆脂瘤 ,在根治胆脂瘤的同时 ,行外耳道成形术 ,其中 13例进行鼓室成形术 ,随访 3个月到 1年。结果 :7例外耳道成形 +鼓室成形术者 ,成功率为 85 .7% (6 / 7) ;13例进行乳突根治术 +鼓室成形术者 ,成功率为 76 .9% (10 / 13)。凡鼓室成形术成功者听力均提高 15 d BHL(语言频率 5 0 0～2 0 0 0 Hz)以上。结论 :先天性外耳道狭窄伴发外耳道胆脂瘤或中耳胆脂瘤病人 ,在彻底清除胆脂瘤的基础上进行鼓室成形术 ,可以提高病人的听力 ;术中发现中耳畸形常有面神经遮盖卵圆窗或无卵圆窗者 ,对该类病人应在控制感染后再行前庭或半规管开窗术     

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.     

Bioactive glass in canal wall reconstruction tympanoplasty

The purpose of this Technical Note is to describe the surgical technique to transform canal wall down tympanoplasty into canal wall up tympanoplasty, that is, to rehabilitate a recess cavity by filling the mastoid and epitympanic cavities with synthetic tissue (bioactive glass) and recreating a normal-caliber external auditory canal. Mastoid cavity obliteration leads to a clinically significant improvement in health-related quality of life without increasing risk of recurrent or residual cholesteatoma, conditional upon technically impeccable surgery.     

Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children

Objective/Hypothesis: Cases of cholesteatoma in pediatric patients were reviewed to determine which factors influence the outcome of surgical treatment. Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) mastoidectomy and canal wall down (CWD) mastoidectomy were assessed, as comparisons of different surgical technique. Study Design: A retrospective analysis of all cases of pediatric cholesteatoma treated at a single institution by the senior author (P.R.L.) over a period of 11 years was conducted. Methods: Patient information was collected from an otology database, patient records, and audiology files. Results: Sixty-six patients, aged 10 months to 18 years, were treated and followed for an average of 37.7 months (range 12.2 months to 12. 5 y). ICW mastoidectomy with tympanoplasty was the primary surgical treatment in 41 patients. Nineteen percent had residual disease at a planned second stage surgery and 22% developed recurrent cholesteatoma for a total recidivism rate of 41%. A SRT of less than 30 dB HL was achieved in 75% of these patients. Seventeen patients underwent CWD mastoidectomy with tympanoplasty initially. Two patients (12%) had residual cholesteatoma found at a planned second state procedure, and no recurrent cholesteatoma was encountered. Seventy-two percent maintained a SRT of less than 30 dB HL. Conclusions: These results support the continued use of ICW mastoidectomy with tympanoplasty for pediatric cholesteatoma. If planned second stage surgery is necessary, the long-term results of an ear with useful hearing and few problems with chronic medical care are gratifying. For reasons of anatomy or in an only hearing ear, CWD mastoidectomy with tympanoplasty provides a safe ear and good hearing results. Mastoid cavity care must be maintained indefinitely in many cases.     

侵及中耳的III期外耳道胆脂瘤的手术方法探讨

目的探讨侵及中耳的Holt III期外耳道胆脂瘤的手术方法。方法回顾性分析35例侵及中耳的III期外耳道胆脂瘤患者的临床资料,35例患者中男15例,女20例;年龄15~66岁,平均年龄45岁。所有患者均在全麻显微镜下经外耳道入路单纯行外耳道胆脂瘤切除术。结果术后随访6个月以上,所有患者均无复发或外耳道狭窄等并发症,纯音测听（23.3±1.3）dB,听力恢复至正常水平。结论临床中可以选择单纯行外耳道胆脂瘤切除术治疗III期外耳道胆脂瘤,但需要密切随访。     

Surgical results of external canal cholesteatoma

Conclusion. The treatment plan should be adapted in accordance with the individual cause for each patient with external canal cholesteatoma (EACC). Outpatient surgery with eradication of the cholesteatoma and canal reconstruction at an early stage to enable epithelial recovery and migration was proved to be the choice that was effective, low cost, and produced less suffering for the patient to achieve optimal results for most primary EACCs. Objectives. To assess the indications, operation methods, and results of surgery for EACC. Patients and methods. This retrospective case review was conducted in a tertiary referral center, Chi Mei Medical Center, from 1989 to 2007. Outpatient surgery to eradicate diseased canal epithelium and reconstruct a funnel-shaped canal was performed in the cases with primary EACC at an early stage, while inpatient surgery was conducted in the advanced cases. Assessments of cause and outcome were based on the combination of clinical history, physical examination, and radiographic appearance. Results. Clinical records of 45 patients (7 with bilateral lesions) were reviewed; 34 patients were noted with primary EACC and 11 patients with secondary EACC. Surgery was conducted in 42 ears to restore normal epithelial migration. Successful results on an outpatient basis were obtained in most patients.