Middle ear surgery functional results in patients with tympanosclerosis

Abstract

Actuality: Tympanosclerotic changes (TSC) in the middle ear are common in patients with chronic otitis media. Tympanoplasty or functional middle ear surgery might be difficult in some cases due to the close contact of the TSC masses with the tympanic membrane and auditory ossicles and could lead to its injuries with sensorineural complications. The functional result of surgery depends on before and postoperative preventive treatment. Aim: to develop methods of preventive treatment of possible sensorineural complications in patients with chronic otitis media with tympanosclerosis and determine their effectiveness. Materials and methods: 30 patients were examined before and after surgery with preventive conservative treatment against possible sensorineural complications. Performance evaluation was carried out in nearest postop period (within 6 months) and in follow-up (12 and more months) after surgery. The patients were divided into 2 groups, depending on the localization of TSC in the middle ear and got a preventive treatment. Group 1 – patients with TSC in the stapes area got steroid therapy in the pre-and post-surgery period. Group 2 – patients with ossicles fixation that got anti-edema, detoxication and vasoactive therapy. Results and discussion: Functional middle ear surgeries (different types of tympanoplasty) for patients with chronic middle otitis and tympanosclerosis were successful. Positive changes from air conductive (AC) thresholds were registered in all patients. In follow up after preventive treatment in patients of group 1 with I stage of conductive hearing loss was improvement of tonal hearing with decreasing of AC thresholds (16,4±0,6) dB in comparison with before surgery data. At patients with II stage of hearing loss the bone conduction (BC) thresholds of tonal air signals reliable decreased on (25,1±1,4) dB. Patients of 2 group with I stage of hearing loss in followup got reliable increase of AC (17,3 ±0,9) dB. In patients with III stage of hearing loss thresholds of BC thresholds were decrease on (26,5±1,6) dB. In totally we got in all patients hearing improvement. However, our study found out that surgery treatment that is at the same time factor which may cause sensorineural complications at these patients. Proposed preventive treatment which carried out before, intra- and in post-surgery period could lead positive functional results. That may decrease number of possible sensorineural complications in follow-up. Conclusion: Proposed preventive treatment which carried out in pre-, intra- and post-surgery period could be predicted a possible sensorineural complication of middle ear surgeries in patients with tympanosclerosis and could lead the positive functional results. Preventive treatment must be prescribed to all patients with tympanosclerosis to prevent severe complications (sensorineural hearing loss, vertigo, dizziness)