Results of revision surgery for hearing failure in intact canal wall up tympanoplasty for chronic otitis media without cholesteatoma

Year 2010, Volume: 20 Issue: 4, 195 - 199, 20.08.2010

Hatice Çelik Sevim Aslan Felek Necmi Arslan Ahmet İslam M. Asım Şafak İlknur Haberal Can Yunus Kantekin

Abstract

Objectives: This study assessed the audiometric results of revision surgery in patients on whom previous canal wall up tympanoplasty had been performed for chronic otitis media without cholesteatoma, and investigated reasons for hearing improvement failure which required revision surgery. Patients and Methods: Seventy-two patients 49 females, 23 males; mean age 35.4±12.9 years; range 11 to 64 years suffering from chronic otitis media without cholesteatoma, who had intact canal wall up tympanoplasty and revision surgery due to bad hearing results between March 2004 and September 2009, were evaluated retrospectively. After evaluation of patients’ files, operative and audiological records, findings during the surgery, postoperative follow-up, audiometric results before revision surgery and the results in the last control after revision surgery were analysed. Results: Preoperative mean air-bone gap ABG decreased in all patients from 31.2 dB to 19.9 dB after followed up for mean 26.7 months. Air-bone gap values below 20 dB were 67%, below 30 dB were 83%, hearing gain above 10 dB was found to be 58%. Comparision of pre- and postoperative ABG values of the patients revealed statistically significant difference p<0.001 . In addition to hearing loss, the reasons for revision surgery were mucosal disease relapse in 10 patients, graft perforation in 43 patients, otorrhea control in 15 patients. Findings during revision surgery were relapse of mucosal diseases in 15 patients, insufficient mastoidectomy in six patients, problems related to prosthesis in 29 patients, ossicular limitations brid, hyalen and granulation in 30 patients, and ossicular necrosis in six patients. The decision for four patients was changed from canal wall up tympanoplasty to canal wall down tympanoplasty. Postoperative total hearing loss developed in one case. Conclusion: The most important problem in revision of tympanoplasty patients with hearing loss is related with stabilisation of columella. To get successful hearing results, it is important to control disease and provide a stable and safe continuity between the tympanic membrane and vestibule.

Keywords

Hearing loss, ossicular chain reconstruction, revision surgery, tympanoplasty

Kolesteatomsuz kronik otitis media için uygulanan intakt kanal duvar timpanoplasti sonrası başarısız işitme için uygulanan revizyon cerrahisi sonuçları

Abstract

Amaç: Bu çalışmada daha önce kanal duvar timpanoplasti uygulanan kolesteatomsuz kronik otitis medialı hastalarda revizyon cerrahisinin odyometrik sonuçları değerlendirildi ve revizyon cerrahisini gerektiren işitme düzeltmesindeki başarısızlık nedenleri araştırıldı.Hastalar ve Yöntemler: Mart 2004 - Eylül 2009 tarihleri arasında intakt kanal duvar timpanoplasti uygulanan ve kötü işitme sonucu nedeniyle revizyon timpanoplasti yapılan kolesteatomsuz kronik otitis medialı 72 hasta 49 kadın, 23 erkek; ort. yaş 35.4±12.9 yıl; dağılım 11-64 yıl geriye dönük olarak incelendi. Hastaların dosyaları, ameliyat ve odyolojik kayıtları incelendikten sonra, ameliyat sırasındaki bulgular, ameliyat sonrası takip bilgileri, revizyon ameliyatı öncesi ve sonrası son kontroldeki odyometrik sonuçları değerlendirildi.Bulgular: Tüm hastalarda ameliyat öncesi ortalama hava-kemik aralığı HKA ortalama 26.7 aylık takipte 31.2 dB’den 19.9 dB’e azaldı. Havakemik aralığı, 20 dB ve altında %67, 30 dB ve altında %83, 10 dB ve üzerinde işitmede elde edilen kazanç %58 olarak bulundu. Hastaların ameliyat öncesi ve sonrası HKA değerlerinin karşılaştırılması istatistiksel olarak anlamlı bulundu p

Keywords

İşitme kaybı, kemikcik zincir rekonstrüksiyonu, revizyon cerrahisi, timpanoplasti

References

• Uygur K, Kılıçkaya M, Tüz M, Döner F, Doğru H. Kronik otitis media cerrahisinde fonksiyonel sonuçlarımız. T Klin JENT 2001;1:148-53.
• Batman Ç, Tutkun A, Mamıkoğlu B, Korkmaz H, Üneri C, Şehitoğlu MA. Ossiküloplasti sonuçlarımız. Kulak Burun Boğaz ihtisas Dergisi 1994;2:41-4.
• Solmaz MA, Yücel EA, Ozdemir M, Güldiken Y, Değer K. Comparison of hearing levels and tympanic mem- brane healing obtained by cartilage palisade and tem- poral fascia tympanoplasty techniques: preliminary results. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2002;9:271-4.
• Kaylie DM, Gardner EK, Jackson CG. Revision chron- ic ear surgery. Otolaryngol Head Neck Surg 2006; 134:443-50.
• Özmen ÖA, Basut O. Total ossicular replacement pros- thesis (TORP). Türkiye Klinikleri JENT-Special Topics 2008;1:48-53.
• Dornhoffer JL, Gardner E. Prognostic factors in ossicu- loplasty: a statistical staging system. Otol Neurotol 2001;22:299-304.
• Albu S, Babighian G, Trabalzini F. Prognostic factors in tympanoplasty. Am J Otol 1998;19:136-40.
• Cho YS, Hong SD, Chung KW, Hong SH, Chung WH, Park SH. Revision surgery for chronic otitis media: characteristics and outcomes in comparison with pri- mary surgery. Auris Nasus Larynx 2010;37:18-22.
• Veldman JE, Braunius WW. Revision surgery for chronic otitis media: a learning experience. Report on 389 cases with a long-term follow-up. Ann Otol Rhinol Laryngol 1998;107:486-91.
• O’Leary S, Veldman JE. Revision surgery for chronic otitis media: recurrent-residual disease and hearing. J Laryngol Otol 2002;116:996-1000.
• House JW, Teufert KB. Extrusion rates and hearing results in ossicular reconstruction. Otolaryngol Head Neck Surg 2001;125:135-41.
• Charlett SD, Scott AR, Richardson H, Hawthorne MR, Banerjee A. Audiometric outcomes of tympanoplasty with hydroxylapatite prosthesis: consultant versus trainees. Otol Neurotol 2007;28:678-81.
• Bayazit Y, Göksu N, Beder L. Functional results of Plastipore prostheses for middle ear ossicular chain reconstruction. Laryngoscope 1999;109:709-11.
• Mills R, Zadrozniak M, Jie Z. The motion of conven- tional and novel total ossicular replacement prosthe- ses during changes in static pressure. Otolaryngol Head Neck Surg 2007;137:762-5.