scholarly journals Correlation of intraoperative middle ear status and hearing results in single-stage canal wall down tympanomastoidectomy with PORP—a prospective study

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Nirmala Tamang ◽  
Dipesh Shakya ◽  
Rabindra Pradhananga ◽  
Pabina Rayamajhi ◽  
Hari Bhattarai
Keyword(s):  
Middle Ear ◽  
Chronic Otitis Media ◽  
Single Stage ◽  
Canal Wall ◽  
Middle Ear Mucosa ◽  
Intact Group ◽  
Pars Tensa ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
The Mean

Abstract Background Mastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages. A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP. Results Forty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups. Conclusion There was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

Synchronous ossiculoplasty with titanium prosthesis during canal wall down surgery for advanced cholesteatoma: anatomical and hearing outcomes

2011 ◽  
Vol 126 (2) ◽  
pp. 131-135 ◽  
Author(s):  
M Iseri ◽  
E Ustundag ◽  
A Ulubil ◽  
M Ozturk ◽  
O Bircan
Keyword(s):  
Bone Conduction ◽  
Functional Results ◽  
Ossicular Chain ◽  
Single Stage ◽  
Canal Wall ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
The Mean ◽  
Hearing Outcomes

AbstractObjective:To analyse patients with cholesteatoma undergoing canal wall down mastoidectomy together with ossicular reconstruction with a titanium prosthesis, in order to identify factors associated with hearing outcomes.Study design:Retrospective review of 97 cases undergoing single-stage surgical management.Methods:All patients underwent canal wall down mastoidectomy. Kurz titanium ossicular prostheses were used for ossicular chain reconstruction. Pre-operative and post-operative air conduction and bone conduction hearing thresholds were obtained at 500, 1000, 2000 and 3000 Hz.Results:The mean pure tone average improved from 46.02 ± 14.54 dB pre-operatively to 29.32 ± 14.64 dB post-operatively, for both total and partial ossicular replacement prosthesis groups combined. The mean air–bone gap improved from 30.38 ± 11.12 dB pre-operatively to 15.62 ± 9.65 dB post-operatively, for both groups combined.Conclusion:Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure.

Autologous total ossicular replacement prosthesis

2014 ◽  
Vol 128 (12) ◽  
pp. 1050-1055 ◽  
Author(s):  
M Malhotra ◽  
S Varshney ◽  
R Malhotra
Keyword(s):  
Pure Tone ◽  
Chronic Otitis Media ◽  
Canal Wall ◽  
Hearing Improvement ◽  
Hearing Results ◽  
Replacement Technique ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
Replacement Prosthesis ◽  
Air Conduction

AbstractObjective:To develop an autologous total ossicular replacement prosthesis with sustainable hearing results.Methods:The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air–bone gap measured at 0.5, 1, 2 and 3 kHz.Results:Successful rehabilitation of pure tone average to 30 dB or less was achieved in 75 per cent of patients, and air–bone gap to 20 dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air–bone gap was 23.9 ± 8.5 dB (p < 0.001). Mean improvements in air–bone gap were significantly greater (p < 0.05) in the tympanoplasty only group (27.3 ± 6.6 dB) and the intact canal wall tympanoplasty group (25.9 ± 6.3 dB) than in the canal wall down tympanoplasty group (16.3 ± 8.9 dB).Conclusion:This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

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

2006 ◽  
Vol 121 (4) ◽  
pp. 324-328 ◽  
Author(s):  
E De Corso ◽  
M R Marchese ◽  
B Sergi ◽  
M Rigante ◽  
G Paludetti
Keyword(s):  
Middle Ear ◽  
Bone Conduction ◽  
Consecutive Series ◽  
Canal Wall ◽  
Hearing Results ◽  
Middle Ear Cholesteatoma ◽  
Canal Wall Down ◽  
The Mean ◽  
Air Conduction ◽  
Cholesteatoma Surgery

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.

Single Stage Management of Cholesteatoma

1995 ◽  
Vol 112 (5) ◽  
pp. P26-P26
Author(s):  
Donald B. Kamerer ◽  
Barry E. Hirsch
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Operative Management ◽  
Single Stage ◽  
Stage Management ◽  
Canal Wall ◽  
Educational Objectives ◽  
Posterior Canal ◽  
Canal Wall Down ◽  
Methods Of Reconstruction

Educational objectives: To understand the alternatives for operative management of chronic otitis media with cholesteatoma and to know the indications and advantages of canal wall-down procedures along with methods of reconstruction of the posterior canal wall.

Single-Stage Management of Cholesteatoma

1992 ◽  
Vol 106 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Barry E. Hirsch ◽  
Donald B. Kamerer ◽  
Sal Doshi
Keyword(s):  
Recurrent Disease ◽  
Chronic Otitis Media ◽  
Single Stage ◽  
Stage Management ◽  
Canal Wall ◽  
Hearing Results ◽  
Modified Radical Mastoidectomy ◽  
Canal Wall Down ◽  
Second Procedure ◽  
Canal Wall Up

Surgical management of chronic otitis media with cholesteatoma can be performed in a single-stage procedure, with revision surgery necessary because of recurrent disease or electively with unsatisfactory hearing results. We retrospectively reviewed 164 cases with cholesteatoma surgically managed from 1980 through 1986. In total there were 11 tympanoplasties, 36 canal wall-up mastoidectomies, 81 canal wall down modified radical mastoidectomies, and 36 radical mastoidectomies. The recidivistic rate for cholesteatoma in patients available for 5-year followup was 11% for tympanoplasties, 19% for canal wall-up mastoidectomies, 5% for canal wall-down modified radical mastoidectomies, and 0% for radical mastoidectomies. Hearing results were best in patients who required tympanoplasty alone, followed by those who underwent canal wall-down procedures. Single-stage management of cholesteatoma with modified radical mastoidectomy (canal wall-down) required fewer revisions for recidivistic cholesteatoma and achieved better hearing results than canal wall-up procedures. We conclude, therefore, that staging is not necessary, improved hearing may likely be achieved with a second procedure, but this is at the patient's discretion.

scholarly journals Functional outcomes of middle ear cholesteatoma surgery

2018 ◽  
Vol 71 (3-4) ◽  
pp. 109-113
Author(s):  
Dalibor Vranjes ◽  
Sanja Spiric ◽  
Slobodan Spremo ◽  
Dmitar Travar ◽  
Predrag Spiric ◽  
...  
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Lower Incidence ◽  
Functional Outcomes ◽  
Pure Tone ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Canal Wall ◽  
Canal Wall Down ◽  
Canal Wall Up

Introduction. Chronic otitis media is defined as a persistent inflammation of the middle ear with signs of an infection lasting for three months or longer. Chronic otitis media may occur either with or without cholesteatoma. For both types of conditions, surgical treatment with closed canal wall-up or open canal wall-down techniques of tympanoplasty are considered. Our aim was to evaluate functional outcomes in two groups of patients (chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma) treated with various tympanoplasty techniques. Material and Methods. This retrospective study included 100 patients who underwent canal wall-down and canal wall-up tympanoplasty for the treatment of chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma from 2015 to 2016. All study patients underwent routine clinical and audiometric examinations. The study evaluated preoperative and postoperative functional results (evaluation of pure-tone audiogram screening). Results. A statistically significant lower incidence (p < 0.05) of postoperative air-bone gap < 20 decibels was established in patients with chronic otitis media with cholesteatoma, but there were no statistically significant differences between the two groups. There was a statistically lower incidence (p < 0.05) of patients with postoperative pure tone audiometry < 40 decibels in patients with chronic otitis media with cholesteatoma, but the difference between the two groups was not statistically significant. When analyzing the mean postoperative pure tone audiometry and air-bone gap in the study patients, canal wall-up tympanoplasty was found to be statistically more effective (p < 0.05). Conclusion. Various pathomorphological and pathophysiological changes in the middle ear, presence of extensively different forms of cholesteatomas, the choice of surgical procedures and poor preoperative hearing are in direct correlation with postoperative hearing.

scholarly journals Synchronous Ossiculoplasty with Ossicular Replacement Prosthesis during Canal Wall Down Mastoidectomy for Advanced Cholesteatoma: Anatomical and Audiological Outcomes

2015 ◽  
Vol 7 (3) ◽  
pp. 109-113
Author(s):  
Deepak Verma ◽  
Mohamed Shareef ◽  
Gul Motwani ◽  
Noor Ul Din Malik ◽  
Santosha Ram Choudhary
Keyword(s):  
Pure Tone Audiometry ◽  
Functional Results ◽  
Canal Wall ◽  
Tertiary Referral ◽  
Ossicular Reconstruction ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
The Mean ◽  
Replacement Prosthesis

ABSTRACT Objectives To evaluate the anatomical and audiological outcomes of synchronous ossiculoplasty with ossicular replacement prosthesis during canal wall down mastoidectomy for advanced cholesteatoma. Methods The prospective study was done at a tertiary referral institute included 30 patients of cholesteatoma who underwent canal wall down mastoidectomy. Ossicular reconstruction was performed using polytetrafluoroethylene (PTFE) (teflon) partial or total ossicular replacement prosthesis. Patients were assessed at 1st, 3rd and 6th postoperative months for graft uptake and hearing evaluation using pure tone audiometry (PTA) in which air bone gap (ABG) closure and mean ABG was calculated and compared with the mean preoperative ABG. Results The mean ABG [both total occicular replacement prosthesis (TORP) and partial occicular replacement prosthesis (PORP) groups combined] considerably reduced from 34.33 ± 4.10 dB preoperatively to 15.47 ± 7.65 dB postoperatively at 6 months. There was a 46.29% of closure of ABG in 1st month, which closed more (53.89%) in 3rd month and even more (55.34%) in 6th postoperative month. p < 0.001 showed the ABG closure ratio and reduction in the mean ABG was statistically significant in the postoperative period. Conclusion Ossicular reconstruction with ossicular replacement prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure. How to cite this article Shareef M, Motwani G, Verma D, Malik NUD, Choudhary SR. Synchronous Ossiculoplasty with Ossicular Replacement Prosthesis during Canal Wall Down Mastoidectomy for Advanced Cholesteatoma: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):109-113.

scholarly journals Is Ossiculoplasty Necessary in Canal Wall Down Mastoidectomy? Comparison of Clinical Outcomes Between Type 0 Tympanoplasty and Ossiculoplasty

2021 ◽  
Vol 25 (2) ◽  
pp. 104-109
Author(s):  
Michelle J. Suh ◽  
Jin-A Park ◽  
Hee Jun Yi ◽  
Chan Il Song
Keyword(s):  
Clinical Outcomes ◽  
Chronic Otitis Media ◽  
Canal Wall ◽  
Success Rates ◽  
Significant Difference ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
The Difference ◽  
Replacement Prosthesis

Background and Objectives: To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM).Subjects and Methods: This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed.Results: Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups.Conclusions: The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.

scholarly journals Correlation between functional outcome and the SAMEO-ATO framework

2021 ◽  
Author(s):  
Vito Pontillo ◽  
Marialessia Damiani ◽  
Giusi Graziano ◽  
Nicola Quaranta
Keyword(s):  
Functional Outcome ◽  
Middle Ear ◽  
Petrous Bone ◽  
Canal Wall ◽  
Hearing Results ◽  
Tertiary Referral Center ◽  
Ossicular Reconstruction ◽  
Canal Wall Down ◽  
Mastoid Surgery ◽  
Canal Wall Up

Abstract Purpose To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center. Methods We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis. Results 282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox. Conclusion Our results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

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