Mastoidectomy: retrospective analysis of 137 cases in a tertiary care hospital

Background: Mastoidectomy is a common otologic surgery and at times can be a lifesaving procedure. The aim of the study is to analyze surgical indications, operative parameters and per-operative findings encountered. Methods: This is a retrospective study done in patients who had undergone mastoid surgeries between 1st Jan 2016 to 31st Dec 2016 in the Department of Otorhinolaryngology, Govt. Medical College hospital, Trivandrum. Results: Of the 137 patients the peak age incidence was 16 – 30 years. Cholesteatoma was present in 32% of which 91% had canal wall down mastoidectomy. 64% patients, mostly chronic otitis media- mucosal and inactive squamosal, underwent canal wall up procedure. In 62% cases the ossicular chain was eroded, which was mainly incus (87%). Abnormalities encountered within the mastoid during surgery were mainly dehiscent facial canal (17.5%), low lying dura (16.8%) and contracted antrum (15.3%). A positive association could be noted between contracted antrum and the position of sinus and dural plates, and was statistically significant. Co-existence of facial canal dehiscence with lateral canal fistula and dural plate dehiscence were also noted. The tympanoplasty procedures commonly employed in canal wall up procedures was Type I and 2, and in canal wall down procedure was Type 3. Conclusions: Adequate skill development of the ear surgeons in the tertiary centre should be ensured, to individualize the procedure appropriate for each patient and optimize the outcome of surgery. Early referral to the nearby otological centre should be promoted not only to prevent complications but also for better post-surgical functional outcome.

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Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

International Archives of Otorhinolaryngology ◽

10.1055/s-0036-1592417 ◽

2016 ◽

Vol 21 (03) ◽

pp. 239-242 ◽

Cited By ~ 2

Author(s):

Suphi Bulğurcu ◽

İlker Arslan ◽

Bünyamin Dikilitaş ◽

İbrahim Çukurova

Keyword(s):

Facial Nerve ◽

Otitis Media ◽

Chronic Otitis Media ◽

Semicircular Canals ◽

Ossicular Chain ◽

Facial Canal ◽

Canal Wall ◽

Radical Mastoidectomy ◽

Canal Wall Down ◽

Canal Wall Up

Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8–72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant (p < 0.05). Conclusion Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

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Long-term outcome of ossiculoplasty using autogenous mastoid cortical bone

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002023 ◽

2014 ◽

Vol 128 (10) ◽

pp. 866-870 ◽

Cited By ~ 3

Author(s):

Z Yu ◽

L Zhang ◽

D Han

Keyword(s):

Cortical Bone ◽

Otitis Media ◽

Chronic Otitis Media ◽

Prosthetic Material ◽

Canal Wall ◽

Term Outcome ◽

Long Term Outcome ◽

Canal Wall Down ◽

Canal Wall Up

AbstractObjective:To observe the long-term outcome of ossiculoplasty using autogenous mastoid cortical bone in chronic otitis media in-patients.Methods:Sixty-one ears of 57 in-patients with chronic otitis media, with or without cholesteatoma, underwent type III tympanoplasty using autogenous mastoid cortical bone as the prosthetic material. Twenty-one ears were treated by canal wall down mastoidectomy and 40 ears by canal wall up mastoidectomy. The follow-up period was 3 to 6 years (average 4.2 years). Pure tone averages for thresholds at 0.5, 1, 2 and 3 kHz were calculated using standard conventional audiometry.Results:The pre-operative mean air–bone gap of 31.6 dB, for all ears, was reduced to 20.3 dB post-operatively. For the 40 canal wall up ears, this value decreased from 30.8 dB to 19.9 dB, and for the 21 canal wall down ears it decreased from 33.0 dB to 21.0 dB. The differences between the pre- and post-operative mean air–bone gap values were significant.Conclusion:No cases of extrusion, necrosis or resorption were exhibited for the autogenous mastoid cortical bone prosthesis. A significant hearing improvement was obtained in the majority of cases and this remained stable over time.

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Single-Stage Management of Cholesteatoma

Otolaryngology ◽

10.1177/019459989210600406 ◽

1992 ◽

Vol 106 (4) ◽

pp. 351-354 ◽

Cited By ~ 30

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.

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Myringostapediopexy: surgical expectation

The Journal of Laryngology & Otology ◽

10.1258/002221503321192467 ◽

2003 ◽

Vol 117 (3) ◽

pp. 182-185

Author(s):

P. J. D. Dawes

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Hearing Level ◽

Canal Wall ◽

Similar Range ◽

Canal Wall Down ◽

Canal Wall Up

Myringostapediopexy may occur as a result of incus erosion with medialization of the tympanic membrane and is recognized as often producing serviceable hearing. The technique may be used as part of tympanoplasty following either canal wall up or canal wall down surgery for chronic otitis media. The use of this type of reconstruction is influenced by the anatomy of the ear after disease excision. This review of the hearing levels associated with myringostapediopexy shows that there is a similar range of hearing level both for naturally formed as well as surgically fashioned myringostapediopexy. For both ’naturally formed’ and following canal wall up surgery about 80 per cent of patients will have an air-bone gap of 20 dB or less compared to 60 per cent of those who undergo canal wall down surgery.

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Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media

International Archives of Otorhinolaryngology ◽

10.7162/s1809-97772013000300002 ◽

2014 ◽

Vol 17 (03) ◽

pp. 242-245

Author(s):

Anna Soares ◽

Henrique Garchet ◽

Nicodemos Sousa ◽

Alexandre Azevedo

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Canal Wall ◽

Canal Wall Down ◽

Canal Wall Up

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Functional outcomes of middle ear cholesteatoma surgery

Medicinski pregled ◽

10.2298/mpns1804109v ◽

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.

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The role of autologous conchal cartilage in ossiculoplasty during canal wall down mastoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175611 ◽

2017 ◽

Vol 4 (1) ◽

pp. 123

Author(s):

Roshan Jalisatgi ◽

Santosh S. Garag ◽

Arunkumar J. S.

Keyword(s):

Developing Countries ◽

Retrospective Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Canal Wall ◽

Hearing Outcome ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy

Background: This study was done to evaluate the hearing outcome in patients undergoing ossiculoplasty using autograft cartilage in canal wall down surgery for cholesteatoma.Methods: This is a retrospective study. This was conducted in a tertiary care hospital from January 2011 to January 2014. This study included 54 patients who underwent canal wall down mastoidectomy with tympanoplasty during this period. Results: Preoperative and postoperative ABG for short columella were 23.13 dB (±11.21) and 12.66 dB (±8.92) respectively. Preoperative and post-operative ABG for long columella were 36.96 dB (±6.73) and 24.77 dB (±10.36) respectively. This is statistically significant.Conclusions: The use of autologous cartilage in ossiculoplasty during canal wall down mastoidectomy gives excellent hearing gain. It is also a cheaper option which is financially feasible in developing countries.

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Surgical management of only hearing ears with positive indications

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002556 ◽

2006 ◽

Vol 120 (11) ◽

pp. 972-975 ◽

Cited By ~ 3

Author(s):

M Sakagsami ◽

T Muto ◽

O Adachi ◽

Y Mishiro ◽

K Fukazawa

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Hearing Aid ◽

Chronic Otitis Media ◽

Canal Wall ◽

Surgical Indications ◽

The Past ◽

Canal Wall Down ◽

Canal Wall Up

Positive surgical indications for an only hearing ear were evaluated in order to improve patients' quality of life. Fifteen cases of surgery involving an only hearing ear over the past eight years were retrospectively reviewed. Of eight perforated chronic otitis media cases, seven underwent type one tympanoplasty and one underwent simple underlay myringoplasty regardless of otorrhoea at the time of surgery. Of six cholesteatoma cases, two received the canal wall up method and four received the canal wall down method. Ossiculoplasty was carefully performed in six cases. Hearing was improved in seven cases, whereas it remained unchanged in seven cases and deteriorated in one case. Of nine patients, two did not need a hearing aid after surgery. Five patients with severe combined hearing loss (>90 dB) were able to communicate with a hearing aid, alleviating their anxiety regarding hearing loss. Only hearing ears with chronic otitis media and cholesteatoma can be successfully treated by tympanoplasty with or without ossiculoplasty.

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Hearing gain after tympanoplasty: a prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202206 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1096

Author(s):

Manzoor Ahmad Latoo ◽

Romesh Bhat ◽

Aleena Shafi Jallu

Keyword(s):

Hearing Loss ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Type I ◽

Type Ii ◽

Canal Wall ◽

Type Iv ◽

Canal Wall Down ◽

Type I Tympanoplasty ◽

Canal Wall Up

Background: The aim of the present study was to determine hearing improvement in different types of tympanoplasties by comparing mean preoperative air bone (AB) gap with mean postoperative AB gap. The study focused on reconstruction of tympanic membrane and ossicular apparatus by tympanoplasty alone or tympanoplasty with mastoid surgeries (canal wall up or canal wall down).Methods: 60 patients of either sex having chronic otitis media with conductive hearing loss of >20 dB were included in the study. Each patient had to undergo preoperative and postoperative pure tone audiometry to calculate average AB gap. Patients underwent tympanoplasty, with or without mastoid exploration depending on the disease status. Pure tone audiometry (PTA) was done at 3 months and 6 months and compared with pre-operative PTA. Results: Preoperatively PTA showed 29 (48.33%) patients had mild degree of hearing loss, followed by moderate degree of hearing loss in 18 (30.0%) patients. 10 (16.67%) patients had minimal hearing loss and moderately severe hearing loss was seen in 3 (5%) patients. Tympanoplasty alone was done in 52 patients (86.67%). Tympanoplasty with canal wall up mastoidectomy was done in 6 (10%) and tympanoplasty with canal wall down mastoidectomy was done in 2 (3.33%) patients. Type I tympanoplasty was performed in 37 (61.6%) patients, type-III tympanoplasty was the type of surgery in 15 (25.0%) patients. Type II and type IV tympanoplasties were performed in 4 (6.7%) patients each separately.Conclusions: Hearing gain is better in type I tympanoplasty than in tympanoplasty type II, type III and type IV with or without mastoid surgeries.

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Causes of Epilepsy in Elderly Patients Presenting in a Tertiary Care Hospital of Karachi

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd9-4/009 ◽

2020 ◽

Keyword(s):

Elderly Patients ◽

Cerebrovascular Disease ◽

Neurodegenerative Disorder ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

Traumatic Head Injury ◽

Keywords Epilepsy ◽

College Hospital ◽

Cross Sectional

Background: Epilepsy is fairly a frequent occurrence in the elderly. It is commonly diagnosed after the episode of two or more unprovoked seizures. Unprovoked seizures in elderly are recurrent rather than younger individuals. This study was designed to estimate the concrete burden of frequent causes of epilepsy. Methods: A descriptive cross-sectional study with a total of 153 patients diagnosed case of epilepsy were included in this study at Jinnah Medical College Hospital from February 2018-August 2018. Mean was calculated for age, duration of disease of the patients. Causes of epilepsy, gender, and education was calculated and presented as percentages. Electrolyte readings were taken i.e., Sodium, Calcium and Magnesium levels and imaging was planned to rule out stroke, primary neurodegenerative disorders and tumors. Post stratiﬁcation Chi square test was applied and p-value less than or equal to 0.05 was considered signiﬁcant. Results: The mean age of the patients was 63.91±5.68 years and mean duration of the disease was 4.61± 1.07 months. The common causes of epilepsy were found to be cerebrovascular disease 56.9%, cryptogenic 54.2%, neurodegenerative disorder 20.3%, traumatic head injury 11.8%, metabolic abnormalities or electrolyte disturbances 10.5% and brain tumor 7.8%. Conclusion: Elderly patients with ﬁrst seizure should present to a facility designed in a way that neurologist, cardiologist, rehabilitation and geriatrics work together to identify and treat the condition in a better way. Keywords: Epilepsy; Seizures; Cerebrovascular Disease; Neurodegenerative Disorder.

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