Hearing Status After Ossiculoplasty in Open Cavity Mastoidectomy

To evaluate the hearing outcome in canal wall down mastoidectomy with middle ear reconstruction, prospective longitudinal study was done at National Institute of ENT, Dhaka from March 2015 to September 2016. Total 22 patients were included in the study undergoing canal wall down mastoidectomy with 6 months postoperative followup. Hearing outcomes were observed and compared with the preoperative hearing tests. Among the 22 patients 9 (39.1% of subjects) patients had hearing gain, 12 (52.2%) had hearing loss and 1 (4.3%) had no change in hearing postoperatively.Although disease clearance is the main objective in canal wall down mastoidectomy, hearing gain can be achieved if combined with ossiculoplasty and tympanoplasty. The hearing gain or loss depends upon the extension of disease and status of the ossicular chain. Most patients usually experience hearing loss more than the preoperative period due to removal of ossicle or ossicles for the sake of disease clearance. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 195-198

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190491 ◽

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

Background: 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.Methods: 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 6th week, 3rd month, 6th month follow up. Hearing improvement was analysed according to the type of procedure. The data collected was tabulated and subjected to statistical analysis. Results: 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.Conclusions: Hearing outcome was better in intact canal wall mastoidectomy than canal wall down mastoidectomy in our study.

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Management of Benign Middle Ear Tumors: A Series of 7 Cases

Ear Nose & Throat Journal ◽

10.1177/0145561317096010-1122 ◽

2017 ◽

Vol 96 (10-11) ◽

pp. 426-432

Author(s):

Z. Jason Qian ◽

Amy M. Coffey ◽

Kathleen M. O'Toole ◽

Anil K. Lalwani

Keyword(s):

Surgical Management ◽

Middle Ear ◽

Ossicular Chain ◽

Clinical Findings ◽

Mastoid Cavity ◽

Canal Wall ◽

Tumor Excision ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Rare Group

Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.

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

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2017.v25i1.101 ◽

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.

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Hearing Benefit in Allograft Tympanoplasty Using Tutoplast Processed Malleus

International Journal of Otolaryngology ◽

10.1155/2014/931308 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Anja Lieder ◽

Wolfgang Issing

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Conductive Hearing Loss ◽

Canal Wall ◽

Hearing Improvement ◽

Safe Alternative ◽

Hearing Thresholds ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Conductive Hearing

Objectives.Tutoplast processed human cadaveric ossicular allografts are a safe alternative for ossicular reconstruction where there is insufficient material suitable for autograft ossiculoplasty. We present a series of 7 consecutive cases showing excellent air-bone gap closure following canal-wall-down mastoidectomy for cholesteatoma and reconstruction of the middle ear using Tutoplast processed malleus.Patients and Methods.Tympanoplasty with Tutoplast processed malleus was performed in seven patients to reconstruct the middle ear following canal-wall-down mastoidectomy in a tertiary ENT centre.Main Outcome Measures.Hearing improvement and recurrence-free period were assessed. Pre-and postoperative audiograms were performed.Results.The average pre operative hearing loss was 50 ± 13 dB, with an air-bone gap of 33 ± 7 dB. Post operative audiograms at 25 months demonstrated hearing thresholds of 29 ± 10 dB, with an air-bone gap of 14 ± 6 dB. No prosthesis extrusion was observed, which compares favourably to other commercially available prostheses.Conclusions.Tutoplast processed allografts restore conductive hearing loss in patients undergoing mastoidectomy and provide an excellent alternative when there is insufficient material suitable for autograft ossiculoplasty.

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Intraoperative Findings during Canal Wall Down Mastoidectomy in Children

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v31i3.5357 ◽

1970 ◽

Vol 31 (3) ◽

pp. 184-187

Author(s):

S Shrestha ◽

P Kafle

Keyword(s):

Otitis Media ◽

Ossicular Chain ◽

Chain Condition ◽

Chronic Suppurative Otitis Media ◽

Canal Wall ◽

Suppurative Otitis Media ◽

Bony Landmarks ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Operative Findings

Objective: The main objective of this study is to assess the intraoperative finding during canal wall down mastoidectomy in paediatric patients undergoing surgery for unsafe type of chronic suppurative otitis media (CSOM) attending ENT OPD of Kathmandu Medical College. Materials and Methods: Fifty patients of age group 4 to 13 years who were suffering from unsafe type of CSOM with or without cholesteatoma were taken for the study. The study period was two years from April 2007 to March 2009. The operative findings like extent of cholesteatoma in different location of middle ear cleft, mastoid bony landmarks, and ossicular chain condition and otogenic complication were identified during canal wall down mastoidectomy. Result: Of the 50 patients 32 (64%) were boys and 18(36%) were girls. The age ranged from 4 years to 13 years. Majority of patients had cholesteatoma with granulation diseases (72%) followed by granulation diseases (16%). Involvement of disease in attic, aditus, antrum and mesotympanum were found to be high in majority of cases (82%) with high percentage of necrosis of incus (56%). Conclusion: The primary disease found in patients undergoing canal wall down mastoidectomy (CWDM) was cholesteatoma combined with granulation in72%, granulation in 16% and cholesteatoma in12%. Key words: Canal Wall Down; ENT; Mastoidectomy; Chronic Suppurative Otitis Media (CSOM) DOI: http://dx.doi.org/10.3126/jnps.v31i3.5357 J Nep Paedtr Soc 2011;31(3):184-187

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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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Cochlear implantation in the irradiated temporal bone

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002180 ◽

2006 ◽

Vol 121 (1) ◽

pp. 83-86 ◽

Cited By ~ 13

Author(s):

O F Adunka ◽

C A Buchman

Keyword(s):

Hearing Loss ◽

Facial Nerve ◽

Temporal Bone ◽

Cochlear Implantation ◽

Flap Reconstruction ◽

Canal Wall ◽

Free Flap Reconstruction ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Electrode Insertion

Objective: To demonstrate the feasibility and complexities of cochlear implantation in the setting of bilateral temporal bone osteoradionecrosis.Study design: Case report.Setting: Tertiary care referral centre.Case description: A 66-year-old woman with bilateral temporal bone osteoradionecrosis and profound hearing loss, following treatment for tonsillar cancer, underwent cochlear implantation. Prior canal wall down mastoidectomy and subsequent temporal bone resection with free flap reconstruction had been performed on the implanted ear. The contralateral ear received a canal wall down mastoidectomy. A completely dehiscent mastoid segment of the facial nerve and extensive fibrosis were evident in the implanted ear. Only minimal fibrous reaction was found within the cochlea, allowing for full electrode insertion. At three months, speech recognition testing documented a consonant-nucleus-consonant (CNC) word score of 54 per cent.Conclusions: This report demonstrates the feasibility of cochlear implantation after temporal bone surgery and free flap reconstruction in the setting of diffuse osteoradionecrosis. The patient's excellent open-set speech understanding using the cochlear implant implies that radiation did not severely damage the central auditory pathways. Thus, some patients with radiation-induced hearing loss may be appropriate cochlear implant candidates. Special attention should be paid to surgical planning, as complications related to wound healing, electrode insertion and facial nerve injury may be more likely.

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Post operative hearing status in canal wall down mastoidectomy with type III tympanoaplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v23i2.45145 ◽

2020 ◽

Vol 23 (2) ◽

pp. 146-152

Author(s):

Sheikh Mohammad Rafiqul Hossain ◽

Ahmmad Taous ◽

Md Mustafizur Rahman ◽

Ahmed Raquib ◽

Md Monwar Hossain

Keyword(s):

Tympanic Membrane ◽

Ossicular Chain ◽

Canal Wall ◽

Type Iii ◽

Hearing Status ◽

Number Of Patients ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy ◽

Type 3 ◽

Canal Wall Reconstruction

Background: Canal wall down procedure may be with or without reconstruction such as tympanic membrane, ossicular chain or posterior canal wall reconstruction. To preserve and improvement of hearing, prevent discharge and recurrence, now a days canal wall down mastoidectomy with reconstruction such as type III tympanoplasty under magnification is a modern advancement in otology. Objectives: To find out hearing status before mastoidectomy and hearing status after canal wall down mastoidectomy with and without reconstruction. Methods: Prospectove study done on 3 tertiaty hospitals in Dhaka. Number of patients were 40 who underwent for modified radical mstoidectomy, 20 were with reconstruction and 20 without reconstruction (Type 3 Tympanoplasty) Results: hearing was deteriorated in most of the cases (60%) of MRM without tympanoplasty. Air Bone (AB) Gap Increased 3.65dB after CWD without reconstruction. Closer of AB gap (9.77 dB) occurred after CWD with reconstruction. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 146-152

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Comparison of Pre and Post-operative Hearing Results in Canal Wall Down Mastoidectomy with Type III Tympanoplasty

Journal of Nepal Medical Association ◽

10.31729/jnma.163 ◽

2008 ◽

Vol 47 (172) ◽

Cited By ~ 3

Author(s):

Bikash Lal Shrestha ◽

CL Bhusal ◽

H Bhattarai

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Chronic Otitis Media ◽

Classical Type ◽

Canal Wall ◽

Hearing Results ◽

Type Iii ◽

Canal Wall Down ◽

Canal Wall Down Mastoidectomy

This study was done to compare the pre and post-operative hearing results in patients undergoingcanal wall down mastoidectomy with classical type III tympanoplasty using temporalis fasciaalone.Patients of ≥5 years age with the diagnosis of Chronic otitis media (squamous) with conductive ormixed hearing loss, needing canal wall down mastoidectomy and with intact and mobile stapessuprastructure at surgery who underwent classical type III tympanoplasty were included in thestudy. The pre and post-operative PTA was performed and evaluated. The post-operative hearingwas assessed in terms of average ABG and size of ABG closure.Mean pre and post-operative air bone gap in classical type III tympanoplasty were 37.8 dB and 29.8dB respectively and these differences were statistically significant. The postoperative PTA-ABGranged from 15-61.2 dB.Hearing results after type III tympanoplasty varied widely showing statistically significantimprovement in mean post-operative PTA-ABG but there was a great variation.Key words: air bone gap, chronic otitis media, mastoidectomy, tympanoplasty

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Study on esthetic appearance of reconstructed pinna in microtia

International Surgery Journal ◽

10.18203/2349-2902.isj20185023 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3940

Author(s):

G. Gopalan ◽

M. K. Rajendran ◽

R. Shankar

Keyword(s):

Hearing Loss ◽

Three Dimensional ◽

Dimensional Structure ◽

Ear Reconstruction ◽

Prospective Longitudinal Study ◽

Female Ratio ◽

Rib Cartilage ◽

Maxillary Surgery ◽

The Mean ◽

Prospective Longitudinal

Background: The normal external ear is a complex three-dimensional structure and, as such, reconstruction of the ear is a demanding undertaking. A new era in ear reconstruction began in 1959 when Tanzer introduced his multistage autologous rib cartilage technique and it gained wide acceptance from the surgeons. The aim of the present study was reconstruction of pinna in microtia cases using esthetic component and to study its surgical outcome.Methods: A prospective longitudinal study was conducted in the department of plastic, reconstructive and facio-maxillary surgery, Government Mohan Kumaramangalam Medical College, Salem, for a period of 2 years. A total of 26 patients with microtia were included in our study. The reconstruction of microtia was done by the following steps; a. first stage – removal of the rib cartilage and framework implantation; b. second stage - rotation of the ear lobule by Z plasty incision; c. third stage– creation of cephaloauricular sulcus; d. fourth stage - tragus construction and concha excavation. All the socio-demographic details and the clinical parameters related to the reconstructed ear were measured and tabulated.Results: The mean age of the study subjects was 14.3 years with a male: female ratio of 2:1. Based on the Tanzer classification all the patients were either in grade IIA or grade III of microtia with 35% of the patients had the hearing loss exceeding 40db. The mean length, breadth, degree of protrusion and degree of inclination of the reconstructed ear were 58.5mm, 34.6mm, 25o and 13o respectively. The most common complication reported in present study subjects was malposition of the reconstructed pinna (21.7%) followed by hematoma infection (8.6%) and hidden helix. Post-operatively the mean hearing loss was only 25db.Conclusions: The esthetic results of each of these techniques can be excellent when performed by an experienced surgeon in appropriately selected patients.

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