Type II tympanoplasty in chronic cholesteatoma and granulomatous otitis media – Distant results of otosurgery

Wiatr, Maciej; Składzień, Jacek; Tomik, Jerzy; Stręk, Paweł; Przeklasa-Muszyńska, Anna

doi:10.1016/j.advms.2013.07.004

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…The amount of hearing improvement decreases with the increasing extent of damage to the ossicular chain, which was also confirmed by the current analysis [13][14][15]. The least favourable effect was observed in patients with damage to the stapedial superstructure.…”

Section: Discussionsupporting

confidence: 85%

“…The least favourable effect was observed in patients with damage to the stapedial superstructure. As confirmed by other authors, preservation of intact stapes is of key importance in hearing improvement, as it offers a possibility to use modelled autologous incus and placing it on the stapes under the reconstructed tympanic membrane [14][15][16][17]. Partial ossicular replacement prosthesis (PORP) can be used in such cases.…”

Section: Discussionmentioning

confidence: 88%

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The effect of preserved stapedial superstructure on hearing improvement

et al. 2019

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Introduction: Ossiculoplasty can be carried out in a number of ways, depending on the anatomical and functional conditions encountered during otosurgery and the experience of a given centre. The extent of damage to the ossicular chain determines the reconstruction method. Aim: The objective of the study was to analyse treatment effects in terms of postoperative hearing improvement in patients with chronic otitis media, with a particular emphasis on stapedial superstructure preservation. Material and method: The records of 294 consecutive patients undergoing their first ENT surgery due to chronic otitis media at the Department of Otolaryngology of Collegium Medicum, Jagiellonian University of Kraków in 2009–2013 were analysed. In order to assess the role of preserved stapedial superstructure, 96 patients were eligible for further analysis. Results: The analysis points to a significant hearing improvement after ossiculoplasty with the preserved stapedial superstructure as compared with the patients after footplate mobilisation. On the other hand, the research results point to significantly smaller hearing improvement in those patients, in whom only stapes was preserved, as compared with those, in whom a more extensive reconstruction of the ossicular chain was possible. Conclusions: The air-bone gap measured before otosurgery often fails to reflect the extent of abnormalities and cannot, therefore, be considered as the only prognostic factor for postoperative hearing improvement. Stapes preservation is crucial for hearing improvement after middle ear surgery.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 88%

The effect of preserved stapedial superstructure on hearing improvement

et al. 2019

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“…According to information contained in reference literature, obtaining normal suprastructure of the stapes after abnormalities were removed, and the reconstruction of the ossicular chain by placing the patient’s own modelled ossicle on the head of the stapes, results in hearing improvement in nearly a half of cases [ 12 , 13 ]. The hearing improvement in the analyzed patients was significantly better in the group with cholesteatoma than in the cases of similar damage to the ossicular chain and the co-occurrence of other lesions on the mucous of the middle ear.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Change in Air-Bone Gap and Bone Conduction in Patients Operated on for Chronic Otitis Media

Wiatr

Składzień

et al. 2015

Med Sci Monit

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BackgroundMiddle ear surgery aims to eliminate pathology from the middle ear, improve drainage and ventilation of the postoperative cavity, and reconstruct the tympanic membrane and ossicles.The aim of this work is to define the factors that affect ABG (air-bone gap) and bone conduction in the patients operated on due to chronic otitis media.Material/MethodsA prospective analysis of patients operated on due to diseases of the middle ear during 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were analyzed.The analysis encompassed patients who had undergone middle ear surgery. The patients were divided into several groups taking into account the abnormalities of the middle ear mucous and damage of the ossicular chain observed during otosurgery.ResultsA significant hearing improvement was observed in patients with type 2 tympanoplasty in the course of chronic cholesteatoma otitis media and in patients with simple chronic inflammatory process in whom a PORP was used in the reconstruction. Granulation tissue was an unfavorable factor of hearing improvement following tympanoplasty.A significant improvement of bone conduction was observed in the patients with dry perforation without other lesions in the middle ear.The elimination of granulation lesions was a positive factor for the future improvement of the function of the inner ear.ConclusionsThe presence of granuloma-related lesions in the middle ear spaces is likely to impede hearing improvement.Damage to the ossicular chain rules out the possibility of bone conduction improvement after surgery.The prognosis on tube-related simple chronic otitis media after myringoplasty, with the preserved continuity of the ossicular chain, consists of closing the ABG and leads to significant improvement of bone conduction.

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“…On examining the full texts, 92 articles were assessed as unsuitable where COM was not the primary disease (7), tympanoplasty subtypes were not the primary intervention (11), the article was not published in English (5), the article did not contain long‐term hearing outcomes (68) or the presented data were too limited (1). Thirty‐nine studies 14‐52 reporting long‐term hearing outcomes and/or complications following middle ear interventions were included for synthesis.…”

Section: Resultsmentioning

confidence: 99%

“…10 of these studies 20,21,24,25,32,38,39,42,45,52 reported air‐bone gap (ABG) data in sufficient detail so that it could be categorized in to bins of ≤20 dB HL or ˃20 dB HL. Additionally, 14 publications 15,18,19,23,24,35,36,38,42,43,46‐48,52 reported mean pre‐ and post‐operative ABG for patients with and without cholesteatoma in sufficient detail to permit weighted averages for these subgroups to be calculated. Eight studies 18,21,24,32,34,42,45,52 also reported these data for patients that underwent ossicular reconstruction, permitting the calculation of weighted averages for this subgroup.…”

Section: Resultsmentioning

confidence: 99%

Success rates in restoring hearing loss in patients with chronic otitis media: A systematic review

Lewis¹,

Vanaelst²,

Hua³

et al. 2021

Laryngoscope Investig Oto

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Objective To assess the effectiveness of tympanoplasty in treating chronic otitis media‐related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow‐up period of 12‐months. Data Sources PubMed, Embase and the Cochrane Library. Methods Two independent reviewers performed literature searches. Publications reporting long‐term (≥12‐month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long‐term hearing outcomes, data on pure tone audiometry (air‐bone gap) and complications were extracted and synthesized. Results Thirty‐nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air‐bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air‐bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air‐bone gap ˂ 20 dB HL at long‐term follow‐up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively. Conclusion In patients with chronic otitis media, tympanoplasty successfully closed the air‐bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%. Level of Evidence 2a.

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Type II tympanoplasty in chronic cholesteatoma and granulomatous otitis media – Distant results of otosurgery

Cited by 5 publications

References 15 publications

The effect of preserved stapedial superstructure on hearing improvement

The effect of preserved stapedial superstructure on hearing improvement

Determinants of Change in Air-Bone Gap and Bone Conduction in Patients Operated on for Chronic Otitis Media

Success rates in restoring hearing loss in patients with chronic otitis media: A systematic review

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