Intact Canal Wall Tympanoplasty Research Articles

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma

Correlation between the perforation size and patency of eustachian tube and graft uptake in intact canal wall tympanoplasty surgery: a study of 32 benign-type chronic suppurative otitis media patients

Background: Factors that contribute to the success of Intact canal wall Tympanoplasty have yet to be certainly known. Several studies show varied success rates and success criteria. Objective: To investigate the correlation between the perforation size and patency of Eustachian Tube and the results of graft uptake on benign-type chronic suppurative otitis media patients that undergo intact canal wall tympanoplasty surgery. Methods: This research used observational descriptive analysis. The participants were patients diagnosed with benign-type chronic suppurative otitis media who were treated with intact canal wall tympanoplasty surgery in 2018. Data such as demographic data, smoking history, clinical findings including perforation size of tympanic membrane, Eustachian Tube patency, results of pure-tone audiometry examination, results of graft uptake, and type of Tympanoplasty were collected from each participant. The statistic tests in use included contingency coefficient correlation test and Fisher exact test. Result: Most of the participants were male (53.13%), the average age was 28.03 ± 12.32 years old, and most participants do not smoke (71.87%). The overall graft uptake success rate is 71.87% (n = 23), while the failure rate is 28.12% (n = 9). Pure Tone Average (PTA) was 37.19 dB at pre-op and 25.79 dB at post-op, which is a significant improvement (p=0.000) with average hearing improvement (PTA-Gain) of 15.75 dB. The patent Eustachian Tube functions give the best graft uptake results of 88.90%, followed by partial patency at 75% and non-patent at 40% (p=0.020). The highest average of PTA in non-patent function of the tube is 20.94 dB. Hearing threshold improvement (PTA-Gain) on patent, partial, and non-patent ETF groups differs significantly (p=0.046). Results of graft uptake on small and medium perforation size show the highest rate of (81.80%), followed by large perforation (50%). The highest PTA in total perforation size is (18.90 dB), then medium (15.14 dB), and small (6.22 dB). The perforation size of TM before surgery does not correlate with the success of graft uptake (p=0.297). The size of perforation correlates with improvement of hearing threshold (p=0.011). Conclusion: Eustachian Tube’s function has correlation with the success of graft uptake and hearing threshold improvement (PTA-Gain), while the perforation size of TM before surgery correlates with hearing threshold improvement (PTA-Gain).

Success Rate of Intact Canal Wall Tympanoplasty in Safe Type of Chronic Suppurative Otitis Media’ Patients

Background: Surgical therapy for chronic suppurative otitis media (CSOM) is by tympanoplasty with orwithout mastoidectomy. The purpose of surgery is to eradicate the source of infection. Success indicatorsof tympanoplasty are achieving dry ears without recurrent otorrhea, myringoplasty, and an increase in thehearing threshold.Objectives: is to know the success rate of intact canal wall tympanoplasty in safe type CSOM patients.Methods: Retrospective descriptive was used in this study. All safe-type of CSOM patients undergoing intactcanal wall tympanoplasty surgery from January to December 2018 at Dr. Soetomo General Hospital were usedas the participant data.Results : There were 32 participants, divided into a higher proportion of males than females (ratio 1.1:1). The characteristics of the participants included; the most age group were 21-30 years (37.50%), originoutside Surabaya (59.37%), and high school education level (62.50%). Most perforations were subtotal(40.63%) and hearing loss was conduction (62.50%). Apparently, 56.25% were patent Eustachian tubes,90.63% were sclerotic mastoid Schuller photographs, and 62.50% were granulation tympanic cavity findings.Additionally, 78.13% were performed tympanoplasty type 1. The results of postoperative eradication showeddry ears (84.38%) and successful of myringoplasty (71.88%). The mean increase in the hearing threshold forAC, BC, and ABG after surgery was 15.98 dB, 4.57 dB, and 11.40 dB.Conclusion: The results of eradication after intact canal wall tympanoplasty were mostly dry ears, successfulmyringoplasty, and an increase in the mean hearing threshold of AC, BC, and ABG.

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma

ObjectiveThe aeration status of the middle ear is presumed to be one of the factors affecting the outcome in acquired cholesteatoma. The present study investigated the impact of postoperative middle ear aeration on hearing and recurrence after intact canal wall tympanoplasty. MethodsWe conducted a retrospective chart review of 127 pars flaccida cholesteatoma patients who underwent primary intact canal wall tympanoplasty at a tertiary academic medical center. We collected data on clinical characteristics, including extent of cholesteatoma, surgical procedure, pre- and postoperative middle ear aeration, hearing level, and recurrence. The aeration was measured before and at one year after operation on two axial computed tomography (CT) planes: at the lateral semicircular canal (mastoid cavity) and at the oval window (tympanic cavity). Based on the postoperative air-bone gap (ABG), patients were categorized into two groups: the successful hearing (ABG ≤15 dB) group and the unsuccessful hearing (ABG >15 dB) group. We used aeration ratio to assess the relationship between postoperative aeration improvement and hearing outcome or recurrence. Multivariate logistic regression analysis was used to identify the factors associated with hearing outcome. ResultsAt one year after operation, aeration ratio in both mastoid and tympanic cavities was significantly improved than the preoperative status (p < 0.001, p < 0.001, respectively, Wilcoxon signed-rank test). The positive correlation was found between postoperative aeration ratios of mastoid cavity and tympanic cavity (r = 0.348, p < 0.001, Spearman's rank-correlation coefficient). In mastoid and tympanic cavities, the postoperative aeration ratio in successful hearing group (n = 57) was significantly higher than that in the unsuccessful hearing group (n = 45) at one year after operation (p < 0.001, p = 0.028, respectively, Mann-Whitney U test). Multivariate logistic regression analysis demonstrated that postoperative aeration ratio in mastoid cavity and preoperative ABG were significant independent prognostic factors for successful hearing (odds ratio [95% confidence interval]: 2.630 [0.985 - 7.024], p = 0.045; 0.891[0.840 - 0.944], p < 0.001, respectively). However, postoperative aeration ratios did not significantly differ between with (n = 14) and without recurrence (n = 113) groups in both cavities. ConclusionOur results suggest that better postoperative aeration in mastoid cavity is independently associated with satisfactory hearing outcome after intact canal wall tympanoplasty in pars flaccida cholesteatoma. However, no significant differences were observed between middle ear aeration at one year after operation and recurrence.

Hearing Improvement in Interposition Ossiculoplasty and Myringostapediopexy.

Chronic otitis media (COM) may lead to partial or complete loss of tympanic membrane and erosion of the ossicles. Ossicular chain reconstruction may be done by interposition ossiculoplasty or myringostapediopexy.The aim of our study was to determine the hearing outcome in interposition ossiculoplasty and myringostapediopexy using autologous incus or cortical bone graft in intact canal wall tympanoplasty. 64 patients with COM, who underwent interposition ossiculoplasty or myringostapediopexy were included in the study. Audiometric evaluation was done after 3months after surgery and all patients were followed up for a period of 1year. The hearing results were compared in terms of mean pre-op and post-op Air conduction thresholds, Air-Bone gap (ABG) and hearing gain or ABG closure. In this study the mean ABG closure for interposition ossiculoplasty and myringostapediopexy was 15.4dB and 21.8dB, respectively. Hearing gain with cortical bone graft was higher than hearing gains with incus in both the groups, but not statistically significant. Myringostapediopexy provides marginally better hearing gain compared to interposition ossiculoplasty. Aulogous incus, and cortical bone graft are suitable autologous materials for ossicular reconstruction and provide similar hearing outcome.

Cartilage Ossiculoplasty from Stapes to Tympanic Membrane in One-Stage Intact Canal Wall Tympanoplasty for Cholesteatoma.

To report hearing results of cartilage interposition ossiculoplasty in one-stage intact canal wall (ICW) tympanoplasty for cholesteatoma with intact stapes. A retrospective study of pre and postoperative hearing status was conducted at a tertiary referral otologic center in a series of 61 patients having undergone one-stage ICW tympanoplasty for cholesteatoma with intact stapes and cartilage ossiculoplasty during the same procedure. In the preoperative period, the mean air conduction thresholds (AC), air-bone gap (ABG), and speech reception thresholds (SRT) were 35.3, 20.14, and 35.6 dB, respectively. Postoperatively, with a mean follow-up of 29 months, AC, ABG, and SRT were 27.8, 13.34, and 28.8 dB, respectively. Mean hearing gain was 6.8 dB and mean SRT improvement was 6.8 dB. Mean bone conduction thresholds for 1, 2, and 4 kHz remained stable after surgery (17.6 dB preoperatively vs. 18 dB postoperatively). Cartilage ossiculoplasty from stapes to tympanic membrane in one-stage ICW tympanoplasty for cholesteatoma is a safe, reliable, easy, and effective procedure, with no additional cost.

Attik kolesteatom fonksiyonel cerrahisinin uzun dönem sonuçları

Objective: To evaluate the long-term findings obtained using microscopic approaches to attic cholesteatoma and with respect to the reconstruction materials used in ossiculoplasty. Methods: The results of these procedures were evaluated in 30 of the patients who subsequently returned for follow-up. One of the surgical techniques among atticotomy + tympanoplasty, intact canal wall tympanoplasty (ICWT) and canal wall-down tympanomastoidectomy (CWDT) was performed. The responses to procedures based on postoperative complaints, otoscopy and audiometry results were evaluated and compared with those pre-treatment. Results: A comparison of the preoperative and postoperative air-bone differences in 26 (85%) patients showed a hearing gain of 5–35 dB. The largest gain was achieved with ICWT type II surgery. Evaluation of the tympanic membrane by microscopic otoscopy showed various degrees of retraction in 30% of the patients in the open group and approximately 20% of those in the closed group. After a six-year long-term followup, 55% of the patients in the open group and 45% of those in the closed group had normal findings. Conclusion: An adequate exposure allowing full removal of an attic cholesteatoma may require an open technique. Compared to closed techniques, this also allows hearing preservation and ossicular reconstruction. Good results in the reconstruction of the ossicles can be achieved using recently developed biomaterials, assuming that the stapes and manubrium mallei are in good condition.

Autologous total ossicular replacement prosthesis.

To develop an autologous total ossicular replacement prosthesis with sustainable hearing results. The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air-bone gap measured at 0.5, 1, 2 and 3kHz. Successful rehabilitation of pure tone average to 30dB or less was achieved in 75 per cent of patients, and air-bone gap to 20dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air-bone gap was 23.9±8.5dB (p<0.001). Mean improvements in air-bone gap were significantly greater (p<0.05) in the tympanoplasty only group (27.3±6.6dB) and the intact canal wall tympanoplasty group (25.9±6.3dB) than in the canal wall down tympanoplasty group (16.3±8.9dB). This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

Quality of Life After Cholesteatoma Surgery

The aim of this study was to evaluate, by means of the Chronic Ear Survey (CES), the quality of life of patients who had undergone either intact-canal wall tympanoplasty (ICWT) or canal wall-down tympanoplasty (CWDT) with mastoid obliteration. This was a retrospective case review study performed at a tertiary referral center. Among 379 patients affected by middle ear and mastoid cholesteatoma operated on between November 2000 and December 2009, 50 patients who underwent ICWT and 50 who underwent CWDT with mastoid obliteration were randomly selected. The CES scores were analyzed for both groups. The mean scores on the CES were 6.5 ± 2.1 in patients who underwent CWDT and 6.9 ± 2.2 in patients treated with ICWT (t = -0.93; p > 0.05). No significant differences between the two groups were found on the activity restriction, symptom, or medical resource subscales (p > 0.05). The results of this study demonstrate that CWDT with mastoid obliteration resulted in a quality of life comparable with that after ICWT. Postoperative hearing loss is the most frequently reported problem for both techniques.

Correlation Between MRI Findings and Second-Look Operation in Cholesteatoma Surgery

Two-staged intact canal wall tympanoplasty is a common operation for treatment of middle ear cholesteatoma. MRI provides better tissue differentiation of the middle ear and/or mastoid, which often become occupied with soft density tissue after the first operation. If MRI was able to detect the presence of a recurrent or residual cholesteatoma with sufficient sensitivity and specificity, this may facilitate a decrease in the number of second-look procedures. This study compared MRI findings to surgical findings at second-look surgery and calculated the correlation rates between the two sets of findings. Thirty ears having undergone intact canal wall tympanoplasty for cholesteatoma at the initial operation were examined by MRI prior to the second look. Otoscopic findings of the tympanic membrane were nonsuspect in all cases. The true positive rate was 11/30 (37%) and the true negative rate was 10/30 (33%), leading to a radiosurgical correlation of 70%, whereas the false positive rate was 6/30 (20%) and the false negative rate was 3/30 (10%). This indicates that 30% of the MRI findings were incorrect. Therefore, at the present time, MRI does not appear as a likely replacement for second-look surgery in cases of intact canal wall tympanoplasty.

Hearing results using titanium ossicular replacement prosthesis in intact canal wall tympanoplasty for cholesteatoma

Conclusions: Titanium proved to be a valuable alternative to ossicles in ossiculoplasty procedures. Complication rates are comparable to those obtained by other authors with titanium and nontitanium prostheses. Hearing results were worse compared with other reports; however, no conclusion can be drawn on the basis of the literature because of the heterogeneity of the populations studied. Objectives: To evaluate the results and complications of total (TORP) and partial (PORP) titanium ossicular replacement prostheses in middle ear cholesteatoma. Methods: Fifty-seven patients affected by acquired cholesteatoma of the middle ear undergoing titanium ossiculoplasty during second stage intact canal wall tympanoplasty were evaluated. Postoperative hearing gain, complication rate, and revision rate were analyzed. Results: Average postoperative gain was 13.6 dB HL for PORP and 17.9 dB HL for TORP. After ossicular reconstruction the mean postoperative ABG was 24.1 dB HL in PORPs and 27.2 dB HL in TORPs. The difference in air-bone gap (ABG) between the two groups after ossiculoplasty was not significant. The number of patients with an ABG > 30 dB was higher in the TORP group compared with the PORP group (p = 0.024) after ossicular reconstruction. The total extrusion rate was 5.2% and the total revision rate was 10.5%.

Learning curve for Piezosurgery in well-trained otological surgeons

Objective Piezosurgery is an ultrasound instrument (24.7-29.5 kHz) capable of cutting bone without necrosis and nonmineralized tissue damage. The aim of this work has been to determine the time required for a well-trained surgeon to perform otological surgery with the piezoelectric device. Study Design Case series with planned data collection. Sixty-three patients affected by otosclerosis and 63 by chronic otitis media were enrolled. For each disease, patients were divided into three numerically equal groups, with each group assigned to a well-trained otological surgeon. Patients underwent stapedotomy (n = 63) and intact canal wall tympanoplasty (n = 63) with the piezoelectric device. Setting ENT Department, University of Genoa (Italy). Subjects and Methods We recorded “skin-to-skin” operation time, surgical success, surgical complication, and hospital stay duration. Before and one year after surgery, all patients underwent pure-tone audiometry, tympanometry, recording of transient-evoked otoacoustic emission, recording of distortion product otoacoustic emission, auditory brainstem response, and electronystamographic recording. Results In each surgical technique, the piezoelectric device provided excellent control without side effects on the adjacent structures of the middle and inner ear. Conclusion The piezoelectric device is a new bony scalpel that uses microvibrations at ultrasonic frequency so that soft tissue (nerve, vessel, dura mater, etc) will not be damaged even on accidental contact with the cutting tip. A feature of the piezoelectric device is its good manageability, which makes it easy for a well-trained otological surgeon to create a straight osteotomy line without any learning period: this renders the piezoelectric device suitable for bone surgery.

The Investigation of the Recurrence Rate of Cholesteatoma Using Kaplan-Meier Survival Analysis

To investigate the recurrence rate of cholesteatoma using Kaplan-Meier survival analysis. Retrospective study. Tertiary referral center. Three hundred forty-five patients with middle ear cholesteatoma operated on by the same surgeon between 1987 and 2002. The cumulative recurrence rate of cholesteatoma during a 5-year follow-up period was calculated using Kaplan-Meier survival analysis. The overall 5-year recurrence rate was 11.8%. The recurrence rate increased with the follow-up time. The 5-year recurrence rate was 3.9% in patients treated with canal wall down tympanoplasty (CWDT) and 16.7% in patients treated with intact canal wall tympanoplasty (ICWT) or canal wall reconstruction (CWR) after CWDT with a significant difference (p < 0.01). The 5-year recurrence rate was 26.0% in patients operated on between 1987 and 1996 and 0.7% in patients operated on between 1997 and 2002, again with a significant difference (p < 0.001). Kaplan-Meier survival analysis should be used for calculating the recurrence rate of cholesteatoma. Although this analytic method further demonstrates that CWDT is a more reliable surgical method than ICWT/CWR in reducing cholesteatoma recurrence, clinical judgment should be exercised, and we continue to recommend that a flexible approach should be adopted in deciding whether to perform CWDT or ICWT/CWR for individual cases.

Tympanosclerosis involving the ossicular chain: mobility of the stapes in association with hearing results

Conclusion. The preoperative bone conduction level provides not only prognostic information but also information on the mobility of the stapes in tympanosclerosis. The surgical results depend upon the stapes mobility.Objectives. We aimed to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, in order to understand the pathophysiology and to establish better surgical treatment of tympanosclerosis.Patients and methods. Between January 1998 and March 2004, 29 patients (29 ears) with tympanosclerosis involving the ossicular chain underwent tympanoplasty at our hospital. Patients with myringosclerosis only, or with an associated cholesteatoma, were excluded from this study. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed retrospectively.Results. Intact canal wall tympanoplasty was applied to all 29 patients. A non-staged operation was performed on 21 patients, and a staged operation was performed on the remaining 8 patients. In 25 patients (86.2%), the sclerotic lesion of the ossicles was located in the epitympanum. In the remaining four, the sclerotic lamella coated only the ossicular chain. On average, the preoperative air conduction hearing level of 57.9 dB was significantly improved to 46.3 dB after tympanoplasty. The success rate of middle ear surgery was 65.5% (19 of 29 patients), according to the criteria of the Otological Society of Japan. In 16 patients (55.2%), the mobility of the stapes was preserved (group A), while in the remaining 13 patients (44.8%), the stapes was fixed (group B). The mean preoperative bone conduction of 25.5 dB in group A was significantly better than that of 37.2 dB in group B. The hearing result significantly improved in group A but not in group B. The success rates were 75% (12 of 16 patients) in group A and 53.8% (7 of 13 patients) in group B.

骨パテによる乳突皮質形成術と中耳含気

Otologists have generally paid little attention to the bony defect of the mastoid cortex following a mastoidectomy. To prevent ingrowth of retroauricular soft tissue into the mastoid cavity and to restore the aerated mastoid cavity, we attempted to reconstruct the mastoid cortex with bone paste hardened with fibrin glue in intact canal wall tympanoplasty. In 55 patients with middle ear cholesteatoma, the outcome of mastoid cortex plasty was observed during second stage operation. In 40 patients (72.7%), the mastoid cortex was completely reconstructed and soft tissue ingrowth into the mastoid cavity was perfectly blocked. In the remaining 15 patients (27.3%) defects of varying sizes were found at the site of the drainage tube insertion. However, the defect was small enough not to allow soft tissue ingrowth into the mastoid cavity. To determine the effect of the mastoid cortex plasty, thirty-five patients with cholesteatoma treated by staged surgery were randomly divided into two groups. Seventeen patients received mastoid cortex plasty with scutum plasty and the remaining 18 control patients received only scutum plasty. Restoration of the middle ear aeration was assessed using High Resolution CT scans before both the first stage operation and the second stage operation. Mastoid cortex plasty was significantly effective for the amelioration of the epitympanum, and also provided mastoid cavity aeration. Mastoid cortex plasty using bone paste is a valuable adjunct to mastoidectomy not only for prevention of retroauricular dimple but for restoration of better aeration of the middle ear cavity.

Correlation between MRI Findings and Second-Look Operation in Cholesteatoma Surgery

Two-staged intact canal wall tympanoplasty is a common operation for treatment of middle ear cholesteatoma. MRI provides better tissue differentiation of the middle ear and/or mastoid, which often become occupied with soft density tissue after the first operation. If MRI was able to detect the presence of a recurrent or residual cholesteatoma with sufficient sensitivity and specificity, this may facilitate a decrease in the number of second-look procedures. This study compared MRI findings to surgical findings at second-look surgery and calculated the correlation rates between the two sets of findings. Thirty ears having undergone intact canal wall tympanoplasty for cholesteatoma at the initial operation were examined by MRI prior to the second look. Otoscopic findings of the tympanic membrane were nonsuspect in all cases. The true positive rate was 11/30 (37%) and the true negative rate was 10/30 (33%), leading to a radiosurgical correlation of 70%, whereas the false positive rate was 6/30 (20%) and the false negative rate was 3/30 (10%). This indicates that 30% of the MRI findings were incorrect. Therefore, at the present time, MRI does not appear as a likely replacement for second-look surgery in cases of intact canal wall tympanoplasty.

中耳真珠腫再発に関する前鼓室開放術の有用性

It is well known that dysfunction of the eustachian tube can cause retraction of the ear drum, and resultant cholesteatoma. In this study, we investigated retrospectively the relationship between reccurence of middle ear cholesteatoma and eustachian tube function.From 1993 to 1996,81 cholesteotoma patients (83 ears) received intact canal wall tympanoplasty in the Department of Otolaryngology at Aichi Medical University. Before surgery, we evaluated their eustachian tube function by sonotubometry and tubotympano aerodynamic graphy (TTAG).They were divided into four groups based upon the presence of a normal or dysfunctional eustachian tube and whether or not they received anterior tympanotomy. The rate of recurrence was lowest in the group who had normal function of the eustachian tube and previous anterior tympanotomy. In contrast, recurrence was most in the group who had a dysfunctional eustachian tube and did not receive anterior tympanotomy.These results indicate that aeration of the middle ear is a significant factor in preventing recurrence of cholesteatoma.

Problems of pediatric cholesteatoma and countermeasures

We report a retrospective study of 35 children, aged 3 to 15 years, with 37 affected ears who underwent surgery for cholesteatoma between 1985 and 1998 in our clinic. The patients were followed for an average of 56 months (range 7 to 147 months). Patient data was collected from clinical records, audiology files, and radiological records in order to reexamine problems of pediatric cholesteatoma and consider the countermeasures. Twenty nine (85%) of ears with acquired cholesteatoma had a history of otitis media. Purulent otorrhea was observed in 71% of the affected ears at the first medical examination, 4 cases were complicated by acute mastoiditis. Sonotubometry showed eustachian tube dysfunction in 10 (91%) of affected 11 ears. Among patients who underwent open & reconstructive tympanoplasty combined with mastoid obliteration during the early study period (1985-1992), the total recurrence rate was 39%, including residual cholesteatoma in 8% (n=1) of 13 ears, and recurrent cholesteatoma in 31% (n=4). The recurrence rate decreased to 22% (residual cholesteatoma in 0 %, and recurrent cholesteatoma in 22%, n=2), in 9 patients who underwent intact canal wall tympanoplasty during the latter period (1993-1998). Postoperative hearing tests showed that modified type III and N tympanoplasties using artificial ossicular chain prostheses appeared to be superior to tympanoplasties using the residual ossicle. Mastoidectomy did not influence development the temporal bone in terms of length. We conclude that infection and eustachian tube malfunction might be involved in rapid and wide spread of pediatric cholesteatoma and contribute to the high recurrence rate. Therefore, appropriate antibiotics should be given and sufficient cleaning of the ear should be carried out, especially before and during the surgery. Although the surgical approach should be tailored to the particular features of each case, the one-stage operation using the canal-up technique seems to be advantageous.

真珠腫性中耳炎の術後成績

Surgical treatment of middle ear cholesteatoma was evaluated from the point of postoperative hearing and recurrence of cholesteatoma. Of the 36 ears operated on in the previous 5 years and 5 months, intact canal wall tympanoplasty was performed in 27 ears, and tympanoplasty with posterior canal wall removal in 9 ears. The patients were evaluated for a follow-up period of more than 6 months after tympanoplasty. The rate of success in hearing improvement was 82.4% according to the criteria of the Japan Otological Society. Recurrence of the cholesteatoma was found in 2 ears (5.6%), which had been treated by intact canal wall tympanoplasty. A retraction pocket in the attic was found in 5 ears (17.9%), following intact canal wall tympanoplasty. Reconstruction of the attic defect with cartilage and obliteration of the mastoid cavity were useful in the prevention of postoperative retraction pocket.

Surgical Technigues And Results İn Cholesteatoma Surgery

§/ A review of 349 patients with cholesteatoma operated between 1980 and 1995 was done. Of 349 patients, 272 cases had documented follow-up for 1 year or longer and were included in the study which consists of the incidence of residual and recurrent cholesteatoma. The most appropriate surgical technique was performed for each individual case. The surgical techniques were placed in two groups. Open cavity technique: 120 radical mastoidectomy, 26 modified radical mastoidectomy; closed technique: 113 intact canal wall tympanoplasty with mastoidectomy, 13 planned two stage procedure. Recurrence rates were 7.5% with open technique and 11.1% with closed technique. Residive rates were 9.6% with open technique and 5.5% with closed technique. Total failure rate was 17% with open technique and 16.6% with closed technique. The mean follow-up period was 30 months. In our series, there was no significant difference in the incidence and total failure rate of recurrent and residual cholesteatoma between open cavity and closed cavity techniques (p> 0.05). Cerrahi Teknikler ve Sonuclarimiz 1980-1995 yillari arasinda kolesteatoma tanisiyla opere edilen 349 hasta incelendi. 349 hastadan 272'si bir yildan fazla takip edilmisti. Bu hastalar calismaya alinarak rezidiv ve rekurrens yonunden degerlendirildi. Her hasta icin en uygun cerrahi yontem secildi. Cerrahi teknikler iki gruba ayrildi. Acik teknik: 120 radikal mastoidektomi, 20 modifiye radikal mastoidektomi; kapali teknik, 113 in takt kanal wall timpanoplasti ve mastoidektomi, 13 iki asamali timpanoplasti idi. Rekurrens oranlan acik teknik icin %7.5 ve kapali teknik icin % 11.1 olarak bulundu. Rezidiv oranlari acik teknik icin %9.6 ve kapali teknik icin %5.5 bulundu. Toplam basarisizlik orani acik teknik icin %17, kapali teknik icin %16.6 bulundu. Ortalama takip suresi 30 ay idi. Bu seride iki grup arasinda rekurrens ve rezidiv yonunden anlamli fark bulunamamistir.