Canal Wall-up Tympanoplasty Research Articles

3D-printed custom ossicular prosthesis - methodology of design and LDV measurements in a cadaver study.

In tympanoplasty, surgical reconstruction of the tympanic membrane and ossicular chain is well-established; however, its hearing results still require improvement. Custom 3D printing of individualized ossicular prostheses seems to be an attractive solution for optimal prosthesis adjustment and better hearing results. The aim was to design a custom ossicular prosthesis using a 3D printing method based on Cone-beam Computed Tomography (CBCT) scans and assess the acoustic conduction properties of such prosthesis. A cadaver fresh frozen temporal bone was used. Based on CBCT images, a new incus prosthesis was designed and 3D printed. Next, canal wall-up tympanoplasty was performed. The intact ossicular chain and reconstructed 3D-printed prosthesis chain movements/vibrations were measured with Laser Doppler Vibrometer (LDV) system and analyzed in detail. The CBCT scans provided enough information about the anatomical structures. For frequencies 500 and 1000 Hz and 80 dB SPL sound intensity, collected velocities were higher for the intact ossicular chain than the 3D-printed ossicular prosthesis. The intensity thresholds for movement at 500 and 1000 Hz were lower in the intact ossicular chain than in the 3D-printed ossicular prosthesis. At 2000 Hz, there was the same intensity threshold value in the two measured circumstances. It is possible to design a custom individually fitted ossicular prosthesis using a 3D printing method based on CBCT scans. The acoustic conduction properties of such 3D-printed prosthesis showed differences in movability pattern between the intact and reconstructed ossicular chain. More data are needed to analyze the acoustic properties of such designed prostheses in detail. The results of our experiment showed the 3D-printed prosthesis presents the potential to be an interesting option for conductive hearing loss treatment caused by chronic otitis media and the ossicular chain defects.

Hearing Evaluation Post Canal Wall-Up (CWU) Tympanoplasty on Patients with Safe Type Chronic Suppurative Otitis Media

Objective: Otitis media is a contagious inflammatory illness of the middle ear that might have a sudden onset and a complete resolution, or it can have a persistent presentation and long-term implications. Surgical treatment is available for all kinds of otitis media. Different types of operations include canal wall-up, canal wall-down, and their variations. The wall-up approach of the two canals with or without posterior tympanotomies, also known as tympanoplasty surgery, preserves the rear wall of the ear canal. Material and Methods: Hearing evaluation was conducted after canal wall-up tympanoplasty surgery at the outpatient clinic, Department of Otorhinolaryngology, Dr. Soetomo Hospital, Surabaya, Indonesia over a period of two years (2018-2019). Results: Two hundred and thirty-seven patients underwent from January 1, 2018 to December 31, 2019. However, only 74 (31.2%) of them had complete medical records after surgery. Fifty-nine ears (79.7%) experienced a better hearing threshold, six ears (8.1%) did not improve, and nine ears (12.2%) deteriorated. The hearing threshold improvement was of a magnitude of 10.9 dB; before surgery, it was 56.6 dB, and after surgery, it became 45.6 dB. Conclusion: A 10.9-dB improvement in hearing threshold mean was observed among patients undergoing canal wall-up tympanoplasty, whereas the bone gap improvement between pre- and post-tympanoplasty was 6.9 dB.

Change in chorda tympani nerve function after two-stage tympanoplasty for cholesteatoma.

Chorda tympani nerve (CTN) function may be damaged more by two-stage than by one-stage surgery for middle ear cholesteatoma. However, few studies have reported the relationship between two-stage cholesteatoma surgery and CTN function. This study aimed to investigate CTN function after two-stage surgery for cholesteatoma. In this prospective study, 35 patients underwent two-stage canal wall up tympanoplasty (CWUT). Perioperative CTN function was assessed using questionnaires and electrogustometry (EGM). Participants were categorized into minor, major, and section groups, based on the degree of CTN manipulation during surgery. In the first-stage surgery, posterior tympanotomy with an intact canal wall reduced the degree of CTN manipulation. The incidence of taste disorder after the first-stage surgery was 71.4%. Postoperative taste disorder and the EGM threshold improved early in the minor manipulation group. In the second-stage surgery, no new CTN damage occurred, even if this surgery involved removal of residual cholesteatoma. The incidence of taste disorder after second-stage surgery was less than that after first-stage surgery, independent of CTN preservation. However, the recovery rate of the EGM threshold after second-stage surgery was significantly lower in the section group than in those with CTN preservation. CTN function, including symptoms and EGM threshold, can be preserved during two-stage cholesteatoma surgery if care is taken to preserve the CTN in both the first- and second-stage surgeries. A two-stage CWUT, ensuring an intact bony annulus, may be effective to facilitate CTN preservation. 2b.

Quality of life after cholesteatoma surgery: comparison between surgical techniques.

SUMMARYObjectiveTo evaluate the long-term quality of life (QoL) in patients operated for cholesteatoma by canal wall-up tympanoplasty (CWUT) or canal wall-down tympanoplasty (CWDT) with mastoid obliteration.MethodsQoL was evaluated by the Chronic Otitis Media Questionnaire - 12 (COMQ-12). For each patient, the total score and three partial subscores, concerning disease activity, functional impairment and general impact on the patient’s life were calculated. These scores were correlated with the surgical technique, as well as anatomical and functional results.Results68 procedures were classified as CWUT and 78 as CWDT with obliteration. The mean follow-up was 65 months. Total and partial COMQ-12 scores did not show any significant difference between the two groups. Correlation analysis showed a significant direct association between the postoperative Air-Bone Gap (ABG) and both the COMQ-12 total score and functional subscore in the CWUT group.ConclusionsThis is the first study comparing CWUT and CWDT with obliteration with the COMQ-12, thus confirming the overlapping results in terms of QoL. These findings, together with the evidence of the significantly lower rates of recidivism, show that CWDT with obliteration should be considered as a good alternative to CWUT.

Analysis of surgical effect on middle ear cholesterol granuloma

Objective:To evaluate surgical effects on middle ear cholesterol granuloma（CG）. Method:The patients receiving surgery due to middle ear CG were retrospectively analyzed. The choice of operative methods was made according to medical history, endotoscope, pure-tone audiometry and temporal bone CT. Tympanostomy tube（TT） insertion was performed on 12 patients; canal wall up（CWU） tympanoplasty combined with tympanostomy tube was performed on 40 patients, and canal wall down（CWD） tympanoplasty combined with TT on 14 cases. The pre-and postoperative audiometric results（500, 1000, 2000 and 4000 Hz） were evaluated for each patient. Then the average air-bone gap（ABG） was analyzed. Result:One patient had postoperative tube obstruction. One patient who performed only TT insertion recurred. Secretory otitis media occurred in one case undergoing CWU tympanoplasty after removal of the ventilation tube. For TT insertion group, pre-and postoperative ABG levels were （21.25±5.96） dB and （8.85±6.49） dB, respectively（P<0.01）. For CWU+TT group, pre-and postoperative ABG levels were （34.19±10.43） dB and （23.55±12.48） dB, respectively（P<0.01）. For CWD+TT group, pre-and postoperative ABG levels were （36.43±12.11） dB and （25.71±13.50） dB, respectively（P<0.01）. Conclusion:The aim of surgical treatment for middle ear CG includes thorough removal of lesions, improvement of ventilation and drainage of middle ear. Individualized surgical strategy should be adopted according to the patients' conditions. And long-term follow-up should be done after operation.

Treatment of cholesteatoma with intact ossicular chain: anatomic and functional results

In case of cholesteatoma with intact ossicular chain, the primary aims of surgery are complete removal of the cholesteatoma matrix and reconstruction of a dry and safe middle ear; if possible, ossicular chain continuity and therefore the preoperative hearing must be preserved. The aim of this retrospective study is to present the experience of the U.O.C. Otorinolaringoiatria Universitaria of University of Bari "Aldo Moro" in treatment of intact ossicular chain cholesteatoma with Bondy modified radical mastoidectomy (BMRM) and canal wall up tympanoplasty (CWUT). The study group was composed of 65 subjects affected by cholesteatoma with intact ossicular chain. Mean age was 40.7 years (range 6-79), with 42 males and 23 females. 30 patients were treated by a BMRM and 35 by CWUT, in 22 cases without mastoidectomy and in 13 cases with mastoidectomy. Mean follow-up was 24.25 months. In the BMRM group, no cases of residual cholesteatoma located in the middle ear space were detected; at follow-up, 1 patient developed a retraction pocket (3.33%), 1 patient showed a small epidermal cysts of the tympanic membrane (3.33%) and 3 patients (10%) experienced otorrhoea. In CWUT, residual cholesteatoma was detected in 2 cases (5.7%); at follow-up, 3 patients presented recurrent cholesteatoma (8.57%; 2, 6 and 8 years after surgery), 3 cases a retraction pocket (8.57%) and one case otorrhoea (2.86%). Statistical analysis showed a significant higher number of residual cholesteatoma in CWUT (p 0.005) and differences in terms of long-term complications. No significant changes in hearing occurred post-operatively or at 1 year follow-up in either group. The current trend in our centre is to perform BMRM when indicated and CWUT preferably without mastoidectomy in case of mesotympanic cholesteatoma with normal OC.

Five-year postoperative outcomes of modified staged canal wall up tympanoplasty for primary acquired cholesteatoma.

For successful canal wall up tympanoplasty (CWUT) for the treatment of cholesteatoma, the restoration of stable middle ear aeration is also important; however, little is known about the dynamics of such aeration or the optimal surgical procedure. In this study, alternative additional surgical procedure was selected based on the grade of middle ear aeration during the second-stage operation. Patients included in this study underwent staged CWUT surgeries with mastoid cortex plasty (MCP) for well-aerated ears (grade 3) and bony mastoid obliteration (BMO) for poorly aerated ears (grade 2-0). Of the 115 ears included in this study, 62 were followed for more than 5years. Recurrence rates with deep retraction pocket formation were assessed using the Kaplan-Meier survival analysis. The aeration was graded as: 0, no aeration; 1, aeration of only the mesotympanum; 2, aeration of the entire tympanic cavity; and 3, aeration of both the tympanic and mastoid cavities. No recurrence was observed in ears associated with grade 3 aeration that underwent MCP or in ears with grade 2 aeration that underwent BMO during second-stage surgery. For grades 0 and 1 aeration ears, the recurrence rates were 8.1% after 5years and 12.5% after 10years (p < 0.05), and the aeration of recurrent ears deteriorated to grade 0. Aeration during second-stage surgery predicts the final outcome.

Functional outcomes of middle ear cholesteatoma surgery

Introduction. Chronic otitis media is defined as a persistent inflammation of the middle ear with signs of an infection lasting for three months or longer. Chronic otitis media may occur either with or without cholesteatoma. For both types of conditions, surgical treatment with closed canal wall-up or open canal wall-down techniques of tympanoplasty are considered. Our aim was to evaluate functional outcomes in two groups of patients (chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma) treated with various tympanoplasty techniques. Material and Methods. This retrospective study included 100 patients who underwent canal wall-down and canal wall-up tympanoplasty for the treatment of chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma from 2015 to 2016. All study patients underwent routine clinical and audiometric examinations. The study evaluated preoperative and postoperative functional results (evaluation of pure-tone audiogram screening). Results. A statistically significant lower incidence (p &lt; 0.05) of postoperative air-bone gap &lt; 20 decibels was established in patients with chronic otitis media with cholesteatoma, but there were no statistically significant differences between the two groups. There was a statistically lower incidence (p &lt; 0.05) of patients with postoperative pure tone audiometry &lt; 40 decibels in patients with chronic otitis media with cholesteatoma, but the difference between the two groups was not statistically significant. When analyzing the mean postoperative pure tone audiometry and air-bone gap in the study patients, canal wall-up tympanoplasty was found to be statistically more effective (p &lt; 0.05). Conclusion. Various pathomorphological and pathophysiological changes in the middle ear, presence of extensively different forms of cholesteatomas, the choice of surgical procedures and poor preoperative hearing are in direct correlation with postoperative hearing.

Acquired cholesteatoma in children: Clinical features and surgical results

Acquired cholesteatoma in children is an aggressive disease due to its rapid growth and high recurrence rate. ObjectiveTo assess clinical features of cholesteatoma in children and evaluate our experience in the surgical management of this disease. MethodsFourty children aged 5–16years operated on for acquired middle ear cholesteatoma (2002–2011), were included in our study. Surgery was bilateral for 3 patients, which makes a total number of 43 operated ears. Functional and anatomical results were evaluated after a minimum follow-up of 3years. ResultsMean age at the first operation was 11.7years. Canal wall-up tympanoplasty (CWUT) was performed as first-line procedure in 74% of cases. Canal wall-down tympanoplasty (CWDT) was performed in 26% of cases when cholesteatoma was hardly controllable with a CWUT. Cartilage graft was used in all cases for eardrum reinforcement. After a mean interval of 12.2months, second look procedure aimed to verify a residual cholesteatoma in 8 cases and perform an ossiculoplasty in one case. Total cholesteatoma recurrence rate was 18% with CWUT and 9% with CWDT (p=0.4). Predictive factors for recurrence were: children<10years (p=0.02) and ossicular chain resorption (p=0.04). Post-operative ABG⩽25dB was seen in 53% of CWUT against 18% of CWDT (p=0.04). ConclusionCWUT is the optimal management technique offering better hearing results, however, prevention of recurrences are considered to be better with CWDT.

A rare case of middle ear adenoma.

Middle ear adenoma is a rare disease that is thought to originate in the middle ear mucosa. It occurs over a wide age range, has no gender predilection, and is not characterized by specific symptoms or findings. The most frequent complaints are unilateral hearing loss and ear fullness. We report a 48-year-old woman with middle ear adenoma who had a history of unilateral ear fullness and hearing loss on the left side. Middle ear adenoma was suspected following a biopsy performed under local anesthesia. To remove the tumor, the patient underwent a left postauricular canal wall-up tympanoplasty type IIIc. Microscopic examination and immunohistochemistry confirmed a middle ear adenoma. In this case, we diagnosed the lesion as middle ear adenoma with neuroendocrine differentiation on the basis of the pathological findings. The patient has shown no recurrence for almost 5 years, but since this adenoma showed neuroendocrine differentiation, long-term observation is required.

Canal wall up tympanoplasty for cholesteatoma with intact stapes. Comparison of hearing results between cartilage and PORP on stapes and impact of malleus removal and total reinforcement of the tympanic membrane by cartilage

ObjectivesTo compare the results obtained with canal wall up (CWU) tympanoplasty for cholesteatoma using cartilage or an hydroxyapatite (HA) PORP positioned on the head of the stapes and to analyse the impact of malleus removal and total reinforcement of the tympanic membrane with cartilage. Materials and methodsRetrospective study of 128 cases (99 adults, 29 children) operated between 2003 and 2012 for cholesteatoma by CWU tympanoplasty with use of a cartilage graft (90 cases) or a PORP (38 cases) on the head of the stapes. Audiometric results were analysed according to the International Bureau for Audiophonology (BIAP) criteria and were submitted to statistical analysis. All ossiculoplasties were performed during the first operation and only 39% of patients required surgical revision. The malleus was preserved in 79 cases and sacrificed in 49 cases. ResultsWith a follow-up of 2 years, the residual mean air-bone gap was 16.8dB in the cartilage group (gain of 7.6dB; P=0.001) and 15.8dB in the PORP group (gain of 8.5dB; P=0.002). The air-bone gap was less than 20dB in 67.6% of cases in the cartilage group and 70.4% of cases in the PORP group. No significant difference was observed between the 2 techniques and no significant difference was observed according to whether or not the malleus was preserved in either the cartilage group or the PORP group. ConclusionThese results confirm the value of cartilage graft placed on the head of the stapes as ossiculoplasty technique in cholesteatoma operated by CWU tympanoplasty, giving comparable results to those obtained with a PORP. Malleus removal did not induce any reduction of the quality of hearing obtained. Total reinforcement of the tympanic membrane with cartilage appeared to decrease the cholesteatoma recurrence rate (8.5%).

Relationships between facial canal dehiscence and other intraoperative findings in chronic otitis media with cholesteatoma

ObjectiveWe investigated the relationship between facial canal dehiscence and intraoperative middle ear and mastoid findings in patients operated on for cholesteatoma. MethodsWe examined retrospectively 334 patients who had been operated on for cholesteatoma in Izmir Katip Celebi University, Ataturk Research and Training Hospital, ENT Clinic, between April 1997 and April 2010. The patients were examined for facial canal dehiscence according to age, gender, side of the ear, surgery type, first or revision surgery, localization of the facial canal dehiscence, spread of the cholesteatoma, with the presence of lateral semi-circular canal (LSCC) fistula and any defect in the ossicle chain, and destruction in the posterior wall of the external auditory canal(EAC). ResultsOf the patients, 23.6% had facial canal dehiscence and detected most commonly in the right ear 28.9% and tympanic segment, 83.5%. Facial canal dehiscence was found to be 24.2-fold more common in patients with LSCC fistula and 4.1-fold more common in patients with destruction in the posterior wall of the (EAC). In patients located cholesteatoma in tympanic cavity+antrum and the tympanic cavity+all mastoid cells and with incus and stapes defect, increased incidence of dehiscence. Age, first or revision operation and canal wall down tympanoplasty (CWDT) or canal wall up tympanoplasty (CWUT) did not affect the incidence of dehiscence. ConclusionsThat the likelihood of facial canal dehiscence occurrence is increased in patients with LSSC fistulas, destruction in the posterior wall of the EAC, or a stapes defect is important information for surgeons.

Middle Ear Reconstruction Using the Titanium Kurz Variac Partial Ossicular Replacement Prosthesis

Satisfactory functional results following ossicular chain reconstruction mainly depend on a stable connection between the tympanic membrane and the stapes, which is in turn dependent on the type of prosthesis used. Knowledge about the safety and functional outcome of the commercially available middle ear prostheses is therefore of great importance. To evaluate the efficacy and safety of the Kurz TTP-Variac System partial ossicular replacement prosthesis (PORP) in ossiculoplasty. Retrospective review of all ossiculoplasties performed by 1 surgeon at a secondary referral center from August 2006 through July 2012. Participants were patients with cholesteatoma, chronic otitis media, or ossicular chain disruption in the absence of inflammatory disease who underwent ossicular reconstruction. EXPOSURE Ossiculoplasty using a Kurz TTP-Variac System PORP. Mean preoperative and postoperative air-bone gaps (ABGs) and improvements in ABG were analyzed for each frequency by means of a 4-frequency pure-tone average. Successful postoperative hearing was defined as postoperative ABG smaller than 20 dB. Eighty-nine ears in 83 patients aged 7 to 85 years were included. Transmeatal tympanoplasty was performed in 17 ears (19%). Seven ears (8%) underwent tympanoplasty with canal wall-down mastoidectomy, and 65 ears (73%) underwent canal wall-up (combined approach) tympanoplasty with mastoidectomy. The study population comprised 61 primary tympanoplasties (69%) and 28 revision cases (31%). Mean follow-up was 13 months. Overall, the ABG significantly improved from a mean (SD; range) of 26.19 (11.53; 3.75-51.25) dB to 15.58 (9.80; 0-48.75) dB (P < .01 for all frequencies). Mean ABG improvement was 10.62 dB. Successful postoperative hearing was obtained in 65 ears (73%). Revision surgery, especially in ears with ossicular chain disruption without inflammatory disease, was associated with poorer functional outcome, whereas preservation of the malleus was associated with a better functional outcome (P < .05). There were few complications (1 prosthesis extrusion, 2 prosthesis dislocations, 2 reperforations, 3 cases of residual cholesteatoma, and 3 of light sensorineural hearing loss). The titanium Kurz TTP-Variac System PORP is an effective prosthesis to reconstruct the ossicular chain. Complications are rare, illustrating the safety of the prosthesis.

Intraoperative Monitoring of Hearing Improvement during Ossiculoplasty by LDV‐ABR‐ECochG Technique

Objectives: Assess utility of combined electrophysiological and laser-Doppler Vibrometry (LDV) technique for intraoperative monitoring (IM) of hearing threshold (HT) improvement during ossiculoplasty. Methods: Study Design: A prospective, feasibility study. Setting: Academic, tertiary referral center. Ten patients underwent two-stage canal wall-up tympanoplasty due to chronic otitis media with cholestaetoma. During the second look surgery performed 6 to 9 months later, ossiculoplasty was monitored intraoperatively by LDV to assess prosthesis movability and by electrocochleography from the round window (RW-ECochG), and by auditory brainstem responses (ABR) to evaluate HT improvement. The ear was stimulated acoustically by tone-bursts: 0.5kHz, 1.0kHz, 2.0kHz, and 4.0kHz. Intraoperative HT, defined as the last intensity for which RW-ECochG and ABR wave V was present, were tested for various configurations of prosthesis placement. Simultaneously for the same stimulation, LDV measured prosthesis moveability. In all subjects, pre- and postoperative pure tone audiometry was performed to evaluate postoperative air-bone gap closure (ABG-C). Results: Postoperative ABG-C ranged between 10 and 45 dB. HT improvement evaluated intraoperatively correlated with postoperative ABG-C. Various prosthesis configurations and placements resulted in measurable changes mostly in the RW-ECochG thresholds. LDV appeared sensitive mostly to prosthesis position changes manifesting by movability improvement at 0.5 and 1.0kHz. Conclusions: RW-ECochG was found to be better than ABR for IM of HT improvement, showing the best correlations with postoperative ABG-C. RW-ECochG and LDV showed their usefulness to control prosthesis position changes by confirming better acoustic energy transfer through the reconstructed ossicular chain.

The Role of Diffusion-Weighted Magnetic Resonance Imaging in Cholesteatoma Diagnosis and Follow-up: Study With the Diffusion PROPELLER Technique

Introduction and objectivesThe diagnosis of cholesteatoma is based on clinical evaluation and computed tomography. New non-echo-planar diffusion-weighted magnetic resonance imaging (MRI) techniques, without intravenous contrast, are capable of differentiating cholesteatoma from inflammatory tissue, cholesterol granuloma and granulation tissues. The technique is very helpful in differential diagnosis of cholesteatoma, mainly after canal wall-up tympanoplasty surgery, to avoid routine second-look surgery in these patients. Congenital cholesteatoma and difficult cases can be detected and correctly diagnosed as well. The aim of this study was to evaluate sensitivity, specificity, positive predictive value and negative predictive value of the diffusion-weighted PROPELLER MRI in cholesteatoma diagnosis. MethodsA prospective study was performed on 52 patients. Clinical and surgical findings were correlated with diffusion-weighted PROPELLER MRI results. ResultsSensitivity, specificity and positive and negative predictive values were 92.85%, 92.30%, 92.85% and 92.30%, respectively. ConclusionsDiffusion-weighted PROPELLER imaging is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2mm.

Papel de la resonancia magnética de difusión en el diagnóstico y seguimiento del colesteatoma. Estudio con la técnica PROPELLER difusión

Introduction and objectivesThe diagnosis of cholesteatoma is based on clinical evaluation and computed tomography. New non-echo-planar diffusion-weighted magnetic resonance imaging (MRI) techniques, without intravenous contrast, are capable of differentiating cholesteatoma from inflammatory tissue, cholesterol granuloma and granulation tissues. The technique is very helpful in differential diagnosis of cholesteatoma, mainly after canal wall-up tympanoplasty surgery, to avoid routine second-look surgery in these patients. Congenital cholesteatoma and difficult cases can be detected and correctly diagnosed as well. The aim of this study was to evaluate sensitivity, specificity, positive predictive value and negative predictive value of the diffusion-weighted PROPELLER MRI in cholesteatoma diagnosis. MethodsA prospective study was performed on 52 patients. Clinical and surgical findings were correlated with diffusion-weighted PROPELLER MRI results. ResultsSensitivity, specificity and positive and negative predictive values were 92.85%, 92.30, 92.85 and 92.30%, respectively. ConclusionsDiffusion-weighted PROPELLER imaging is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2mm.

Wczesne wyniki czynnościowe operacji tympanoplastycznych w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej CM UMK w Bydgoszczy w latach 2004–2009

ObjectiveThe aim of the study was to evaluate the results of the tympanoplasty in chronic otitis media in its functional aspect. MethodsWe analysed and categorized 489 tympanoplasties using Wullstein classification. The operations were performed in the Otolaryngology and Laryngological Oncology Department of the University School of Medicine in Bydgoszcz, Poland, from 2004 to 2009. The group consisted of 421 patients (221 women, 253 men, mean age 52.2 years). ResultsType I tympanoplasty was performed in 133 patients (31.59%), type II tympanoplasty was performed in 191 patients (45.36%), type III tympanoplasty was performed in 93 patients (22.09%) and type IV tympanoplasty was performed in 4 patients (0.95%). The audiometry was done one year after the operations. We observed good effect in 116 cases (86.9%) of type I tympanoplasty, good or satisfactory in 150 cases (78.6%) of type II tympanoplasty and satisfactory in 63 cases (67.7%) of type III tympanoplasty. There were no hearing improvement and its deterioration results in 61 cases (14.48%), including all treated by type IV tympanoplasty. Conclusions1. There were improvement of hearing in audiometry in majority of our patients. 2. The functional effect of hearing depends on the function of conductive mechanism of the ear before the treatment. 3. We prefer among all types canal wall-up tympanoplasty.

Canal wall up tympanoplasty for middle ear cholesteatoma in adults: Modeling cartilage

The authors report their experience with a variant cartilage tympanoplasty technique in a canal wall up (CWU) procedure for middle ear cholesteatoma, comparing reliability with other techniques. Functional results are analyzed according to ossicular chain status. A retrospective study was performed in adults operated on with CWU tympanoplasty for middle ear cholesteatoma. The surgical technique of "modeling" cartilage is described. One hundred and nine patients were included (113 procedures). There were four recurrences (3.5%). Mean follow-up was 48 months (range, 24-96 months). In case of normal ossicular chain, postoperative pure-tone average air-bone gap was always less than 20dB, and less than 20dB following myringostapedopexy in 60% of cases with incus destruction. Modeling cartilage is a reliable reconstruction technique to prevent recurrent cholesteatoma, and contributes to the quality of functional results in ossiculoplasty.

Residual cholesteatoma: Prevalence and location. Follow-up strategy in adults

To assess prevalence and location of residual cholesteatoma following closed "canal wall up" tympanoplasty (CWUT). The evolution of follow-up strategy is discussed. A retrospective study was run in adults operated on by CWUT for middle-ear cholesteatoma and who had undergone second look surgery and/or postoperative radiology (CT-scan, diffusion-weighted MRI). One hundred and nine patients (113 ears) underwent the procedure. Mean follow-up was 48 months (range, 24-96 months). Twenty-nine residual cholesteatomas were found (25%), including 11 located in the anterior attic (38%). Follow-up included 77 second look operations (70%), and 71 radiological examinations (62 CT-scans and nine diffusion-weighted MRIs). Second look surgery was without benefit for the patient (no residual, no ossiculoplasty) in one third of cases. Residual cholesteatoma in the anterior attic is a problem in CWUT. When postoperative auditory results are good, second look surgery should not be systematic but guided by high quality imaging.

Intraoperative Monitoring of Hearing During Ossiculoplasty

Krzysztof Morawski Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland Email: morawski@neurotology.pl Phone: +48 502 043 162 Website: www.otolaryngology.pl www.wum.edu.pl Objective: To evaluate the utility of electrocochleography recorded from the round window (RW-ECochG) and auditory brainstem responses (ABR) for assessment of hearing improvement during ossicular reconstruction performed during second look operation. Study Design: A prospective study of 20 patients undergoing two-stage canal wall-up tympanoplasty with intraoperative RW-ECochG and ABR recording during the second look operation to improve hearing results. Setting: This study was performed in a tertiary referral center. Subjects and Methods: Twenty patients 18 to 50 years of age underwent two stage canal wall-up tympanoplasty and followed for at least 6 months. During the second look operation RW-ECochG and ABR were measured intraoperatively. Needle electrode for RW-ECochG was placed at RW niche via posterior tympanotomy. Various options of ossiculoplasty were evaluated. Auditory thresholds defined by N1-peak in RW-ECochG and ABR wave V were evaluated for various prostheses types and orientations. Results: Intraoperatively measured thresholds demonstrated a good improvement for click and tonebursts. RW-ECochG appeared more sensitive than ABR during ossicular prostheses manipulations. The largest changes in measurements occurred during TORP placement procedures. In two cases intraoperative bleeding from tympanic mucosa made impossible effective testing. For all the others a good correspondence between intraoperative recordings and postoperative hearing results were achieved. Conclusions: Intraoperative evoked potentials using RW-ECochG and, to some extent, ABR were found to be good predictors of postoperative hearing after second stage ossicular reconstruction and good tool for intraoperative evaluation of ossicular reconstruction efficacy. Bleeding from mucosa limited intraoperative application of both RW-ECochG and ABR. Support: NCBiR Poland, Grant N R13 0040 06/2009 Intraoperative Monitoring of Hearing During Ossiculoplasty Krzysztof Morawski, MD, PhD1; Kazimierz Niemczyk, MD, PhD1; Fred Telischi, MEE, MD, FACS2 1Department of Otolaryngology, Medical University of Warsaw, Poland; 2Department of Otolaryngology, University of Miami Miller School of Medicine, FL, USA