Treatment of cholesteatoma with intact ossicular chain: anatomic and functional results

AbstractObjective:Ossicular chain damage from chronic ear disease is a significant problem in the Australian population. The ideal ossicular chain reconstruction prosthesis has yet to be defined. This paper examines, for the first time, the use of a titanium prosthesis for ossicular chain reconstruction in Australian patients.Study design:Retrospective chart review.Subjects and methods:All patients undergoing ossicular chain reconstruction with a titanium prosthesis between 1 February 2002 and 31 March 2007.Results:Results showed a low complication rate, with only one extrusion out of 55 cases (1.8 per cent). Successful rehabilitation of conductive hearing loss (i.e. to ≤20 dB air–bone gap) was obtained in 85 per cent of the partial ossicular chain reconstruction group and 77 per cent of the total ossicular chain reconstruction group. Pure tone thresholds improved by an average 18 dB in the partial reconstruction group and 25 dB in the total reconstruction group.Conclusion:Titanium is an ideal material for ossicular chain reconstruction due to its ease of insertion, low rate of extrusion and good functional results.

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Allograft Tympanoplasty Type 1 in the Childhood Population

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610501106 ◽

1996 ◽

Vol 105 (11) ◽

pp. 871-876 ◽

Cited By ~ 11

Author(s):

Evert P. P. M. Hamans ◽

Thomas Somers ◽

Paul J. Govaerts ◽

F. Erwin Offeciers

Keyword(s):

Functional Results ◽

Ossicular Chain ◽

Statistical Correlation ◽

Tympanic Membrane Perforation ◽

Short Term ◽

Membrane Perforation ◽

Childhood Population

Seventy allograft type 1 tympanoplasties in children under 16 years of age were studied retrospectively. Only patients with a tympanic membrane perforation without cholesteatoma and a normal ossicular chain were included. Short-term and long-term anatomic and functional results were analyzed after a mean follow-up of 40 months. The overall short-term take rate was 97% and the long-term take rate was 88%. A number of variables with alleged prognostic value for surgical outcome were analyzed, but none showed statistical correlation with either anatomic or functional results. A median hearing gain of 10 dB was achieved, which was stable over time. We conclude that allograft tympanoplasty type 1 in this group of children is anatomically and functionally successful regardless of age.

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Pediatric Tympanoplasties: Anatomical and Functional Results

Otolaryngology ◽

10.1016/j.otohns.2008.05.216 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P67-P67

Author(s):

João Ribeiro ◽

Rui Cerejeira ◽

Vera Soares ◽

Carla Gapo ◽

Jose Romao ◽

...

Keyword(s):

Postoperative Complications ◽

Functional Outcome ◽

Functional Results ◽

Ossicular Chain ◽

First Year ◽

Hearing Results ◽

Surgeon Experience ◽

Contralateral Ear ◽

Air Conduction

Objective The purpose of this study was to analyze the anatomical and functional results in 167 tympanoplasties performed in children. Methods A retrospective study of the anatomical and functional results of 167 tympanoplasties in children was performed. 91 ears had full records and were included in the study. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels, postoperative follow-up time, and postoperative complications were recorded. Hearing results were reported using a 5-frequency (500,1,000, 2,000, 3,000, 4000 Hz) pure-tone average air-bone gap. Results Anatomical success was achieved in 85% of cases. 71% of the reperforations occurred during the first year of follow-up. The anatomical and functional success was 76% after a mean follow-up of 26.4 ± 16.2 months. The mean postoperative air conduction threshold significantly improved in the successful cases, with a mean audiological improvement of 12.54 ±7.3dB (p<0.05). The maximum mean postoperative gain was seen at 500 Hz 14.9 ±10.1 dB (P<.05). No postoperative sensorineural hearing loss was observed. 18% of minor postoperative complications were seen. Surgeon experience, intact and mobile ossicular chain, dry ear, and follow-up longer than 12 months (p<0.05) improves functional outcome. Conclusions We conclude that tympanoplasty in children is safe with anatomical and functional results comparable to that reported for adults. Dry ear over 6 months, surgeon experience, intact and mobile ossicular chain and follow-up >12 months significantly improves functional outcome.

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Titanium ossicular chain replacement prostheses: Prognostic factors and preliminary functional results

European Annals of Otorhinolaryngology Head and Neck Diseases ◽

10.1016/j.anorl.2010.11.005 ◽

2011 ◽

Vol 128 (2) ◽

pp. 53-58 ◽

Cited By ~ 31

Author(s):

A. Mardassi ◽

A. Deveze ◽

M. Sanjuan ◽

J. Mancini ◽

B. Parikh ◽

...

Keyword(s):

Prognostic Factors ◽

Functional Results ◽

Ossicular Chain

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215111002520 ◽

2011 ◽

Vol 126 (2) ◽

pp. 131-135 ◽

Cited By ~ 5

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.

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Impact of otorrhoea and ossicular status on the effect of tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20184204 ◽

2018 ◽

Vol 4 (6) ◽

pp. 1366

Author(s):

M. Rama Sridhar

Keyword(s):

Middle Ear ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Functional Results ◽

Ossicular Chain ◽

Risk Category ◽

Hearing Improvement ◽

Number Of Patients ◽

General Physical ◽

A Prospective Study

Background: The objective of the study was to assess the effect of otorrhoea, osscicular and middle ear status on anatomical and functional results in patients undergoing tympanoplasty with or without mastoidectomy for chronic otitis media mucosal diseaseMethods: This was a prospective study conducted on 100 patients with otological complaints (otorrhoea, hearing loss) attending the out-patient Department of ENT, at Mamata Medical College and Research Hospital, Khammam Telangana state during the period from December 2015 to July 2017. All the patients underwent a detailed general physical, otoneurological evaluation, hearing assessment by pure-tone audiometry prior to surgery. As per MERI the patients were evaluated for factors preoperatively and intraoperatively. Postoperatively the patients were followed up at 3 and 6 months to ascertain the structural (graft take up) and functional (hearing improvement) success.Results: Otorrhoea was the most common complaint observed (48%). As per Belluci's classification of otorrhoea, maximum number of patients (52%) had a dry ear, wet ears (48%) and persistently wet ears (8%). According to Austin-Kartush classification 50 patients had an intact ossicular chain, defects of the incus in 36 patients, defects in both malleus and incus, stapes and incus was seen in 7 patients each. Majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present. Majority of the patients belonged to the group of mild risk MERI (l-3) (n=69) patients, moderate risk category MERI (4-6) (n=26) severe risk (7-12) (n=5). Graft uptake was successful in 78 patients and failure in 22 patients. Hearing Improvement was noticed in 78 patients.Conclusion: Otorrhoea and middle ear cleft status have an impact on the success of the tympanoplasty, while ossicular status did not have a significant effect on the outcome.

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Congenital Middle Ear Anomalies: Anatomical and Functional Results of Surgery

Audiology and Neurotology ◽

10.1159/000380940 ◽

2015 ◽

Vol 20 (4) ◽

pp. 237-242 ◽

Cited By ~ 5

Author(s):

Stéphanie Quesnel ◽

Tarik Benchaa ◽

Sophie Bernard ◽

François Martine ◽

Paul Viala ◽

...

Keyword(s):

Middle Ear ◽

Retrospective Chart Review ◽

Functional Results ◽

Ossicular Chain ◽

Class Ii ◽

Class I ◽

Consecutive Series ◽

Class Iii ◽

Ear Anomalies

The aim of this study was to describe the audiometric results following surgery in a consecutive series of pediatric patients with a congenital middle ear disorder. Retrospective chart review was performed for 29 consecutive children who underwent 33 middle ear surgeries for congenital ossicular chain anomaly between 1990 and 2012. Anomalies were classified into four groups according to the Teunissen and Cremers classification. Audiological parameters using four frequency averages (0.5, 1, 2 and 4 kHz) were assessed pre- and postoperatively. Clinical and audiometric follow-up times were, respectively, 49 ± 8 and 35 ± 5 months (mean ± SEM). Fifty-eight percent of all patients achieved an air-bone gap (ABG) ≤20 dB, 62.5% in class I, 50% in class II and 57.9% in class III. The improvement of the mean ABG was 13.6 dB, 19.2 dB for class I, 0.2 dB in class II and 15.4 dB in class III. Overall mean pure-tone averages improved 14.8 dB with 13.9 dB for class I; there was no improvement for class II and 20.2 dB for class III. The sensorineural hearing loss rate was 9%. This pediatric series showed that hearing results depend on type of anomaly. Class I and class III showed better hearing improvement than class II.

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