Prognostic factors for graft success in tympanoplasty with mastoidectomy

Abstract

Objective: The aim of this study was to evaluate the different factors that may affect graft success in tympanoplasty with mastoidectomy. Methods: Patients who underwent tympanoplasty with mastoidectomy between September 2004 and July 2010 were included in this study. Patient data were collected retrospectively. The effects of the epitympanic patency, duration of the dry period of the ear, presence of preoperative otorrhea, location of the perforation, status of the middle ear mucosa, and status of the tympanic membrane on the rate of postoperative graft success in patients who underwent tympanoplasty with mastoidectomy were investigated. The chi-square test and Fisher’s exact test were used for statistical analysis. Results: A total of 130 patients, 74 male and 56 female, with an average age of 35.7 (range: 11 to 56) years were included. The overall success rate for full postoperative graft success was 75%. A >3-month dry period of the ear, absence of preoperative otorrhea, preoperative normal middle ear mucosa, and presence of epitympanic patency significantly increased the postoperative success rate of graft (p<0.001). The presence of preoperative otorrhea and granulation tissue in the middle ear mucosa, presence of preoperative myringosclerosis, and lack of epitympanic patency were significantly associated with graft failure after tympanoplasty with mastoidectomy (p<0.001). Conclusion: Epitympanic patency, middle ear infection, and the morphology of the tympanic membrane and middle ear mucosa should be considered prognostic factors in patients who undergo tympanoplasty with mastoidectomy. 

Keywords

• Tympanoplasty,mastoidectomy,prognostic factors,epitympanic patency

Mastoidektomili timpanoplastide greft başarısını etkileyen prognostik faktörler

Öz

Amaç: Çal›flman›n amac› mastoidektomili timpanoplastide greft baflar›s› üzerinde etkisi olabilecek faktörleri araflt›rmakt›r. Yöntem: Bu retrospektif çal›flma, Eylül 2004 ile Temmuz 2010 aras›nda mastoidektomili timpanoplasti amliyat› geçiren olgular›n verileri kullan›larak yürütüldü. Epitimpanik aç›kl›k, kula¤›n kuru kal›fl süresi, preoperatif otore olup olmamas›, perforasyonun yeri, orta kulak mukozas›n›n ve timpanik membran›n durumunun postoperatif greft baflar›s› üzerindeki etkisi araflt›r›ld›. ‹statistiksel analiz için ki-kare ve Fisher exact testleri kullan›ld›. Bulgular: Çal›flmada toplam 130 hasta (56 kad›n, 74 erkek; yafl ortalamas›: 35.7, yafl aral›¤›: 11–56) dahil edildi. Greft baflar› oran› %75 olarak belirlendi. Kula¤›n 3 aydan daha uzun süre kuru kalmas›, preoperatif olarak kulak ak›nt›s› olmamas›, preoperatif normal orta kulak mukozas› ve epitimpanik aç›kl›k oluflu postoperatif greft baflar›s›n› anlaml› flekilde art›rm›flt›r (p<0.001). Preoperatif otore ve orta kulakta granülasyon dokusu varl›¤›, preoperatif miringoskleroz oluflu ve epitimpanik aç›kl›¤›n olmamas› mastoidektomili timpanoplasti sonras› ise mastodiektomili timpanoplasti sonras› greft baflar›s› anlaml› olarak düflüren faktörler olarak izlendi (p<0.001). Sonuç: Çal›flmam›z›n sonuçlar›na göre epitimpanik aç›kl›k, orta kulak enfeksiyonu ve timpanik membran ve orta kulak mukozas›n›n yap›sal özellikleri mastoidektomili timpanoplasti yap›lacak hastalarda prognostik aç›dan önem tafl›maktad›r.

Anahtar Kelimeler

• Timpanoplasti, mastoidektomi, prognostik faktörler, epitimpanik açıklık

Kaynakça

1. Bluestone CD. Epidemiology and pathogensis of chronic suppu- rative otitis media: implications for prevention and treatment. In J Pediatr Otorhinolaryngol 1998;42:207–23.
2. Tos M. Indications for surgery and preoperative management. In: Tos M, editor. Manual of middle ear surgery. New York, NY: Thieme; 1993. p. 5.
3. Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multi- variate analysis of otological, surgical and patient-related factors in determining success in myringoplasty. Clin Otolaryngol 2005;30: 115–20.
4. Pignataro L, Grillo Della Berta L, Capaccio P, Zaghis A. Myringoplasty in children: anatomical and functional results. J Laryngol Otol 2001;115:369–73.
5. Caylan R, Titiz A, Falcioni M, et al. Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg 1998;118:709–13.
6. Adkins WY, White B. Type I tympanoplasty: influencing factors. Laryngoscope 1984;94:916–8.
7. Sadé J, Berco E, Brown M, Weinberg J, Avraham S. Myringoplasty: short and long-term results in a training program. J Laryngol Otol 1981;95:653–65.
8. Lee P, Kelly G, Mills RP. Myringoplasty: does the size of the per- foration matter? Clin Otolaryngol Allied Sci 2002;27:331–4.

9. Kotecha B, Fowler S, Topham J. Myringoplasty: a prospective audit study. Clin Otolaryngol Allied Sci 1999;24:126–9.
10. Koch WM, Friedman EM, McGill TJ, Healy GB. Tympanoplasty in children. The Boston Children’s Hospital experience. Arch Otolaryngol Head Neck Surg 1990;116:35–40.
11. Sheehy JL. Mastoidectomy: the intact canal wall procedure In: Brackmann DE, editor. Otologic surgery. Philadelphia, PA: WB Saunders; 1994. p. 211–24.
12. McGrew BM, Jackson CG, Glasscock ME 3rd. Impact of mas- toidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004;114:506–11.
13. Lau T, Tos M. Long-term results of surgery for chronic granulat- ing otitis. Am J Otolaryngol 1986;7:341–5.
14. Vartiainen E, Kansanen M. Tympanomastoidectomy for chronic otitis media without cholesteatoma. Otolaryngol Head Neck Surg 1992;106:230–4.
15. Mutoh T, Adachi O, Tsuji K, Okunaka M, Sakagami M. Efficacy of mastoidectomy on MRSA-infected chronic otitis media with tym- panic membrane perforation. Auris Nasus Larynx 2007;34:9– 13.
16. Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M. Mastoidectomy in noncholesteatomatous chronic suppurative oti- tis media: is it necessary? Otolaryngol Head Neck Surg 1997;117: 592–5.
17. Mishiro Y, Sakagami M, Takahashi Y, Kitahara T, Kajikawa H, Kubo T. Tympanoplasty with and without mastoidectomy for non- cholesteatomatous chronic otitis media. Eur Arch Otorhinolaryngol 2001;258:13–5.
18. Merenda D, Koike K, Shafiei M, Ramadan H. Tympanometric vol- ume: a predictor of success of tympanoplasty in children. Otolaryngol Head Neck Surg 2007;136:189–92.
19. Singh GB, Sidhu TS, Sharma A, Singh N. Tympanoplasty type I in children – an evaluative study. Int J Pediatr Otorhinolaryngol 2005;69:1071–6.
20. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognos- tic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg 2008;139:386–90.
21. Albu S, Babighian G, Trabalzini F. Prognostic factors in tym- panoplasty. Am J Otol 1998;19:136–40.
22. Hulka GF, McElveen JT Jr. A randomized, blinded study of canal wall up versus canal wall down mastoidectomy determining the differences in viewing middle ear anatomy and pathology. Am J Otol 1998;19:574–78.
23. Mishiro Y, Sakagami M, Kondoh K, Kitahara T, Kakutani C. Long-term outcomes after tympanoplasty with and without mas- toidectomy for perforated chronic otitis media. Eur Arch Otorhinolaryngol 2009;266:819–22.
24. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY
25. NC-ND3.0) Licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) which permits unrestricted noncommercial use, distribution, and reproduc
26. tion in any medium, provided the original work is properly cited.
27. Please cite this article as: Yurttaş V, Ural A, Kutluhan A, Bozdemir K. Prognostic factors for graft success in tympanoplasty with mastoidectomy. ENT
28. Updates 2015;5(2):72–75.