Comparative Analysis of Effects of Reconstruction and Radical Treatment of the Posterior Ear Canal Wall Using Periosteal Osteocomma and Mastoid Antrum Ventilation

Abstract

To analyze the results of repair defect of the ear canal with autologous bone containing periosteum and hearing reconstruction and postoperative inflation. Retrospective analysis of the 40 cases of surgeries conducted by senior surgeon. All cases received full open surgeries. Preoperative air conduction (AC) was 67.47 ± 14.32 dBHL, and GAP was 45.95 ± 12.63 dBHL. These cases were divided into two groups: the first 20 ears received repair surgery for radical mastoid cavity with bone slice containing periosteum combined with ear ossicle remodeling, namely the bone slice group. For another 20 ears, inflator was additionally used and the mastoid antrum cavity was inflated twice a day, namely the inflation group. Follow-up: 9-60 months (median follow-up of 26 months). Statistical analysis: U test was adopted. All ear canal showed a smooth appearance. Eight cases received CT scans and presenting re-gasification of attic and/or mastoid cavity. Hearing: AC of 47.32 ± 15.63 dBHL, and GAP of 18.28 ± 15.28 dBHL, both P values were \0.01 as compared with that before operation, and the difference was highly significant. 23 cases showed GAP \20 dB, and one case showed GAP [20 at follow-up, but narrowing was [30 dB, and these 24 cases were successful case, with a success rate = 60 %. 16 cases with GAP \10 dB, although 4 cases with GAP [10 dB, narrowing was [30 dB, thus the 20 cases were markedly effective, and with ratio = 50 %. The gap of 30 cases was narrowed more than 15 dB, although two cases showed gap narrowing less than 15 dB, postoperative GAP was less than 10 dB, both were valid, with an efficacy of 32/40 = 80 %, 18 cases (45 %) with AC \40 dBHL. Sub-group analysis: age: group P \ 0.05 when the two groups were compared, difference in ages of the two groups were significant, and the age of the inflation group was older. Both GAP and AC of the two groups showed no significant difference before and after the surgery. One case in the bone slice group showed poor postoperative hearing, adhesion was found between the mesotympanum and attic in reoperation, and best result of GAP Close to less than 10 dB was obtained using the decomposition method after inflation. Bone slice containing periosteum can be used for reconstruct the normal ear canal. Auxiliary inflation of middle ear can even promote the tympanic re-gasification and hearing recovery.

Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid—Anatomy, Physiology, Pathophysiology, and Pathogenesis)

“…Habib et al 193 found increased hearing gain with mastoidectomy, while others found that mastoidectomy and auxiliary inflation of the ME through an inflator for tympanum regasification resulted in hearing recovery. 194 Aeration of the ME and the mastoid also had a positive predictive value in long-term surgical outcome after tympanoplasty. 187 Mastoid obliteration with 1-stage eradication of the disease and a total reconstruction procedure provide long-term hearing improvement with a low incidence of persistent or recurrent disease in adults and children.…”

“…Yetişer and Karapinar 192 found that a significantly higher number of patients achieved normal ME ventilation in the first 3 months postmastoidectomy when compared with a group of patients without mastoidectomy. Habib et al 193 found increased hearing gain with mastoidectomy, while others found that mastoidectomy and auxiliary inflation of the ME through an inflator for tympanum regasification resulted in hearing recovery 194 . Aeration of the ME and the mastoid also had a positive predictive value in long‐term surgical outcome after tympanoplasty 187 …”