scholarly journals Outcomes of type III tympanoplasty: our experience

2020 ◽  
Vol 6 (2) ◽  
pp. 287
Author(s):  
Ravishankar C. ◽  
Ramya Bandadka
Keyword(s):  
Middle Ear ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Canal Wall ◽  
Type Iii ◽  
Hearing Gain ◽  
Middle Ear Prosthesis ◽  
Canal Wall Down ◽  
Middle Ear Cleft ◽  
Canal Wall Up

<p class="abstract"><strong>Background:</strong> Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement and healing of cavity in patients who underwent type III tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> A retrospective chart review of 21 patients who underwent type III tympanoplasty at Bowring and Lady Curzon Hospital from January 2018 to December 2018 was done. In 7 patients autologous incus, 6 tragal cartilage and 8 teflon prosthesis was used for ossiculoplasty. Intra and postoperative events were assessed. Pure tone audiograms done after 3 and 6 months were compared.  </p><p class="abstract"><strong>Results:</strong> 15 patients who underwent canal wall down procedure (CWDP) had a mean hearing gain of 20.33 dB and 26.67 dB while in 5 patients of canal wall up procedure (CWUP) group mean hearing gain was 22.5 dB and 27.5 dB at 3 and 6 months after surgery respectively. Hearing gain was similar in both groups irrespective of the prosthesis used. Autologous materials were used in most of the CWUP with intact stapes and teflon prosthesis was used in majority of CWDP where only mobile stapes foot plate was present. Prosthesis extrusion was not encountered in any of our cases so far in this series.</p><p class="abstract"><strong>Conclusions:</strong> The post-operative hearing gain with autologous incus, tragal cartilage and teflon middle ear prosthesis are similar. Teflon prosthesis is an effective material for ossiculoplasty, especially useful when incus and stapes are absent while autologous incus or tragal cartilage are preferred in cases with intact stapes head.</p>

scholarly journals TYPE III TYMPANOPLASTY: A COMPARATIVE STUDY BETWEEN AUTOLOGOUS INCUS AND TRAGAL CARTILAGE AS OSSICULOPLASTY MATERIAL – OUR EXPERIENCE

2020 ◽  
pp. 1-3
Author(s):  
Arjun S Doshad ◽  
Ravindra Singh Bisht ◽  
Nitin Sharma ◽  
Amit Shah
Keyword(s):  
Middle Ear ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Type Iii ◽  
Hearing Gain ◽  
Medical College ◽  
Middle Ear Prosthesis ◽  
Additional Role ◽  
Middle Ear Cleft

Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement in patients who underwent type III tympanoplasty using autologous incus and tragal cartilage as ossiculoplasty material. Method: A retrospective chart review of 30 patients who underwent type III tympanoplasty at medical college Srinagar Pauri Garhwal from January 2019 to December 2019 was done. In 10 patients autologous incus and in 20 tragal cartilage was used for ossiculoplasty. Those patients who required wall down were excluded from the study and only patient with limited atticotomy and complete mastoidectomy requiring type III tympanoplasty were included in the study. Pure tone audiograms done after 3 months were compared with the pre operative audiogram. Result: 10 patients who underwent type three tympanoplsty with use of autologous incus for ossiculoplasty had a mean hearing gain of 17.08dB and 20 pateint underwent type three tympanoplasty with use of tragal cartilage for ossiculoplasty had mean hearing gain of 18.26 dB at 3 months after surgery. Hearing gain was similar in both groups irrespective of the material used. The tragal cartilage was used as strut extending from stapes head to the anteroinferior part of annulus supporting the graft throughout and additionally helping in maintaining the middle ear space. Conclusion: The post-operative hearing gain with autologous incus and tragal cartilage as middle ear prosthesis are similar but the additional role of cartilage supporting the graft and maintaining the middle ear space overrule the use of tragal cartilage for ossiculoplasty in type three tympanoplasty. So by this study we recommend the use of tragal cartilage as ossiculoplasty material for type III tympanoplasty over other material.

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.

scholarly journals Canal wall down versus canal wall up surgeries in the treatment of middle ear cholesteatoma

2019 ◽  
Vol 49 (5) ◽  
pp. 1426-1432
Author(s):  
Recep KARAMERT ◽  
Fakih Cihat ERAVCI ◽  
Süleyman CEBECİ ◽  
Mehmet DÜZLÜ ◽  
Mehmet Ekrem ZORLU ◽  
...  
Keyword(s):  
Middle Ear ◽  
Canal Wall ◽  
Middle Ear Cholesteatoma ◽  
Canal Wall Down ◽  
Canal Wall Up

scholarly journals Comparative Study of Autologous Ossicular Graft versus Titanium Prosthesis (TORP & PORP) in Ossiculoplasty

2017 ◽  
Vol 25 (1) ◽  
pp. 1-7
Author(s):  
P Thamizharasan ◽  
K Ravi
Keyword(s):  
Ossicular Chain ◽  
Canal Wall ◽  
Hearing Results ◽  
Hearing Gain ◽  
Pure Tone Audiogram ◽  
Conductive Deafness ◽  
Middle Ear Prosthesis ◽  
Short Period ◽  
History Of ◽  
Canal Wall Down

Introduction This prospective cohort study aims to analyze and compare the outcomes of ossiculoplasty in terms of hearing results, intra and post operative course, using autograft incus and titanium middle ear prosthesis. Materials and Methods Patients with a history of chronic ear discharge and conductive deafness were included in the study. Out of 21 patients with ossicular chain defect included in the study, 10 patients underwent ossiculoplasty with autograft incus and 11 with titanium prosthesis. Pure tone audiogram was done after three months. Result In patients with incus ossiculoplasty, average Post operative PTA was 43.5 dB ± 7.934SD and Net gain in hearing was 10.7 decibels ± 15.478SD. In patients with titanium prosthesis ossiculoplasty, average Post operative PTA was 41.4 dB ± 4.789SD and Net gain in hearing was 16 decibels ± 11.981SD. Discussion Three patients underwent only Tympanoplasty post operative PTA was 42 ± 5.292 dB (incus- 39 dB, titanium- 48dB) and hearing gain was 13.33 ± 12.583 (incus-20dB, titanium-0dB). Five patients underwent intact canal wall with Tympanoplasty: Post operative PTA was 35 ± 3 dB (incus-35dB, titanium-30dB) and hearing gain was 23 ± 15.379 (incus-18.33dB, titanium-30dB). Thirteen patients underwent canal wall down procedure with Tympanoplasty: Post operative PTA was 45.67 ± 5.228 dB (incus-50.4dB, titanium-41.8dB) and hearing gain was 9.33 ± 12.309 (incus-2.4dB, titanium-14.285dB). Complications in the short period studied were nil in both groups. Conclusion Incus and titanium have equal postoperative hearing but in terms of hearing gain Titanium prosthesis gave a better hearing gain than incus. 

scholarly journals Comparison of hearing outcome using ossiculoplasty with autologous incus versus titanium prosthesis

2021 ◽  
Vol 7 (3) ◽  
pp. 481
Author(s):  
Udayachandrika Gangadaran ◽  
Muthuchitra S. ◽  
Mary Nirmala S. ◽  
Ramya Devi K.
Keyword(s):  
Canal Wall ◽  
Hearing Gain ◽  
Medical College ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
The Cost ◽  
Postoperative Improvement ◽  
Canal Wall Up ◽  
Air Conduction ◽  
Ethical Clearance

<p><strong>Background: </strong>The aim of the study is to compare the efficacy of autologous incus versus allogenic titanium prosthesis in terms of anatomical results, hearing gain after surgery, operative course and complications.</p><p><strong>Methods:</strong> This is a prospective interventional study of 20 patients out of which 10 underwent autologus incus and 10 underwent titanium prosthesis ossiculoplasties performed between April 2018 To April 2019 in Government Kilpauk medical college and hospital, Chennai after ethical clearance. The postoperative improvement of mean air-bone gap and air conduction over same frequencies between the two groups were studied. A improvement in pure tone average more than 10 dB was considered successful.</p><p><strong>Results:</strong> In current study, 10 patients underwent ossiculoplasties using titanium ossicular replacement prosthesis and 10 patients underwent ossiculoplasties using autologous incus. 5 of the patients in each group underwent canal wall up and 5 underwent canal wall down procedure. The average ABG closure was 9.30 dB in incus group and 15.22 dB in titanium group.</p><p><strong>Conclusions: </strong>Titanium ossicular prosthesis ossiculoplasties provide a significant hearing gain and are advantageous because of the easy insertion with pre-sculpted structure yet the cost is a concern. Better results were noted in canal wall up procedures more than canal wall down procedures.</p>

Acoustic Mechanisms

1998 ◽  
Vol 118 (6) ◽  
pp. 751-761 ◽  
Author(s):  
KENNETH R. WHITTEMORE ◽  
SAUMIL N. MERCHANT ◽  
JOHN J. ROSOWSKI
Keyword(s):  
Middle Ear ◽  
Sound Transmission ◽  
Canal Wall ◽  
Air Space ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Temporal Bones ◽  
Head Neck ◽  
Canal Wall Up ◽  
Space Volume

The contribution of the middle ear air spaces to sound transmission through the middle ear in canal wall-up and canal wall-down mastoidectomy was studied in human temporal bones by measurements of middle ear input impedance and sound pressure difference across the tympanic membrane for the frequency range 50 Hz to 5 kHz. These measurements indicate that, relative to canal wall-up procedures, canal wall-down mastoidectomy results in a 1 to 5 dB decrease in middle ear sound transmission below 1 kHz, a 0 to 10 dB increase between 1 and 3 kHz, and no change above 3 kHz. These results are consistent with those reported by Gyo et al. (Arch Otolaryngol Head Neck Surg 1986;112:1262-8), in which umbo displacement was used as a measure of sound transmission. A model analysis suggests that the reduction in sound transmission below 1 kHz can be explained by the smaller middle ear air space volume associated with the canal wall-down procedure. We conclude that as long as the middle ear air space is aerated and has a volume greater than 0.7 ml, canal wall-down mastoidectomy should generally cause less than 10 dB changes in middle ear sound transmission relative to the canal wall-up procedure. (Otolaryngol Head Neck Surg 1998;118:751-61.)

scholarly journals A comparative study of hearing outcomes in canal wall up versus canal wall down mastoidectomy in our experience

2019 ◽  
Vol 5 (2) ◽  
pp. 472
Author(s):  
Poornima S. Bhat ◽  
G. Gandhi ◽  
K. Pradheep
Keyword(s):  
Hearing Loss ◽  
Conductive Hearing Loss ◽  
Pure Tone Audiometry ◽  
Canal Wall ◽  
Hearing Gain ◽  
Hearing Outcome ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Conductive Hearing ◽  
Canal Wall Up

<p class="abstract"><strong>Background:</strong> COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Ossicular reconstruction is a surgical procedure which intends to improve the quality of hearing and life in such patients. Comparison of the outcomes will help to determine the merits or demerits of a particular procedure.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in the Department of ENT, VIMS, Bellary during the period from December 2010 to May 2012. All the patients with CSOM with ossicular erosion suggested by conductive hearing loss more than 40dB were included in the study. A detailed history taking, thorough clinical examination was done for these patients. Before and after the procedure pure tone audiometry was done to assess the hearing outcome. Post operatively PTA was done in 6<sup>th</sup> week, 3<sup>rd</sup> month, 6<sup>th</sup> month follow up. Hearing improvement was analysed according to the type of procedure. The data collected was tabulated and subjected to statistical analysis.  </p><p class="abstract"><strong>Results:</strong> This study compared the outcomes of hearing gain in canal wall up versus canal wall down mastoidectomy surgeries. Hearing gain was better in canal wall up mastoidectomy (18.36 dB) than canal wall down mastoidectomy surgeries.</p><p class="abstract"><strong>Conclusions:</strong> Hearing outcome was better in intact canal wall mastoidectomy than canal wall down mastoidectomy in our study.</p><p class="abstract"> </p>

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