Mean Postoperative Air-bone Gap Research Articles

Endoscopic Transcanal Myringoplasty for Anterior Perforations of the Tympanic Membrane

Repairing anterior perforations of the tympanic membrane has been challenging for otolaryngologists. Therefore, devising a simple and effective technique for performing the repair is crucial. To assess the results of endoscopic transcanal myringoplasty for repairing anterior perforations of the tympanic membrane. This medical record review included 59 patients who underwent endoscopic transcanal myringoplasty from January 1, 2013, to June 1, 2015, at PoJen General Hospital, Taipei, Taiwan. Patients with ossicular chain disease and cholesteatoma or inadequate follow-up were excluded. Patients were followed up for 6 months, and final follow-up was completed on January 1, 2016. The main outcome was the rate of overall graft success after endoscopic transcanal myringoplasty. Secondary outcomes included hearing results and prognostic factors. The study sample included the medical records of 59 patients (30 men [51%]; 29 women [49%]; mean [SD] age, 49.5 [13.1] years) who underwent endoscopic transcanal myringoplasty. Overall, 55 patients (93%) had a successful graft at 6 postoperative months. The mean (SD) preoperative and postoperative air-bone gaps were 15.9 (9.4) and 5.4 (7.0) dB, respectively, revealing a significant mean (SD) improvement of 10.3 (7.6) dB (Cohen d, 1.27; 95% CI, 0.90-1.63; P < .001, paired t test) in the gap. The postoperative air-bone gap in 46 patients (78%) was less than 10 dB; in 12 patients (20%), 10 to 20 dB; and in 1 patient (2%), more than 20 dB. Postoperative otorrhea significantly affected the graft success rate (odds ratio, 52.00; 95% CI, 4.08-662.55; P < .01, χ2 test). The visualization of the perforation margin (complete or partial) was not significantly associated with the graft success rate. However, partial visualization of the perforation margin significantly prolonged the mean (SD) operative time (complete vs partial, 59.2 [13.7] vs 68.1 [14.1] minutes; Cohen d, 0.64; 95% CI, 0.12-1.18; P = .02, t test). The rate of graft success and hearing outcomes for endoscopic transcanal myringoplasty are comparable with those of microscopic myringoplasty for repairing anterior perforations of the tympanic membrane. However, the present technique is simpler because postauricular incision, canalplasty, and general anesthesia are not required. Thus, endoscopic transcanal myringoplasty should be considered for repairing anterior perforations of the tympanic membrane.

Endoscopic transcanal stapes surgery: our technique and outcomes.

This study aims to evaluate the outcomes of endoscopic stapes surgery in terms of hearing gain and complications. The medical records of 31 patients (13 males, 18 females; mean age 41.5±8.6 years; range 23 to 60 years) who underwent endoscopic stapes surgery in our clinic between April 2013 and June 2015 were retrospectively analyzed. The mean preoperative and postoperative pure tone bone conduction, air-bone gap, postoperative air-bone gap gain, duration of surgery and complications were evaluated. The right ear was operated on 15 patients and the left ear on 16 patients. The mean postoperative air-bone gap was statistically significantly improved, compared to preoperative values (p<0.001). The mean air-bone gap gain was 25.5±7.0 dB. Our study results suggest that endoscopy is a safe method which can be used in stapes surgery.

Tympanoplasty in adhesive otitis media: A descriptive study

There is no consensus among clinicians regarding the best treatment strategy for adhesive otitis media (AdOM). It is common practice to only intervene in the presence of recurrent infections or significant conductive hearing loss. In an attempt to provide evidence regarding the efficacy and safety of surgical intervention, we have analyzed the long-term outcome of tympanoplasty for AdOM . Prospective study. From January 2013 to April 2014, 57 patients with AdOM (60 ears) who fit our criteria for tympanoplasty were recruited and underwent tympanoplasty using tragal cartilage combined with transtympanic ventilation tube and cortical mastoidectomy. Otorrhea control, graft uptake, hearing level changes, and complications were evaluated within a 3-year period of follow-up. Otorrhea was controlled in 94% of the ears. Tympanic membrane healing was achieved in all ears except one ear, which had myringitis. Overall there was significant improvement in hearing. Whereas the mean preoperative air-bone gap (ABG) was 30.4 ± 4.0 dB, postoperative mean ABG was 8.6 ± 6.9 dB at 1 year. Closure of ABG to within 20 dB was achieved in 46 ears (83.6%). One ear showed a drop in bone conduction level by 25 dB. No iatrogenic cholesteatoma was detected in any of the cases. This study demonstrated that tympanoplasty has favorable outcomes in AdOM . Risks of iatrogenic sensorineural hearing loss or cholesteatoma formation are negligible. 4. Laryngoscope, 126:2804-2810, 2016.

The effect of inlay butterfly cartilage tympanoplasty technique on compliance

Conclusion: IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results. Objective: The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters. Methods: Overall, 25 patients that underwent an operation between August 2010–May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4 kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared. Results: The graft survival rate in patients was found to be 92%. Mean pre-operative air–bone gap (ABG) was 16.4 ± 5.4 in patients, while mean post-operative ABG was 10.9 ± 5.8, with a statistically significant difference (p = 0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r = −0.025 and p = 0.936).

Long-term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media.

The primary objective is to report long-term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media. Case series with chart review. Tertiary care hospital. In total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long-term postoperative ABG. The stability of hearing over time was determined by comparing short-term and long-term postoperative air-bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air-conduction pure-tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined. At short-term follow-up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long-term follow-up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short- and long-term follow-up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short- or long-term follow-ups. In patients with both short- and long-term follow-up (n = 50), deterioration in hearing was noted (3.4 dB, P = .04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P = .02), while TORPs did not (2.5 dB, P = .50). The long-term extrusion rate was 3.2%. With a minimum follow-up of 2 years, titanium ossiculoplasty provides good long-term hearing results. Modest deterioration in hearing is noted over time.

A Different Cartilage Graft Technique: Perichondrium-Preserved Palisade Island Graft in Tympanoplasty.

Various graft materials have been used since tympanoplasty technique was first described. In this study, the authors aimed to share our modified island cartilage graft technique.A total of 47 ears of 46 patients on whom tympanoplasty or tympanomastoidectomy operation was performed in our clinic because of chronic otitis media were included in the study.Mean preoperative air-bone gap of the patients was 32.25 ± 11.85 dB and mean postoperative air-bone gap was 19.25 ± 10.46 dB. The difference was statistically significant (P < 0.001). When all the patients were evaluated, preoperative and postoperative air conduction pure tone audiometry values were 43.38 ± 14.74 dB and 32.61 ± 15.62 dB, respectively. The difference was statistically significant (P < 0.001). Graft success rate in terms of perforation closure was found to be 44/47 (93.61%).Our modified island cartilage graft technique is easy to apply and its graft success rate and hearing results are good.

Revision stapes surgery for lysis of the long process of the incus: comparing hydroxyapatite bone cement versus malleovestibulopexy and total ossicular replacement prosthesis.

The objective of the study was to report audiological results in revision stapes surgery, comparing hydroxyapatite (HAP) bone cement, malleovestibular (MV) prosthesis, and total ossicular replacement prosthesis (TORP). The study is a retrospective case review conducted in a tertiary referral center. Patients treated for revision stapes surgery from 2010 to 2014, where a lysis of the long process of the incus (LPI) was observed with the use of HAP bone cement, MV prosthesis, or a TORP were included in the study. The main outcomes measured were pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3kHz), including high frequencies BC (HFBC) (1, 2, 3, 4kHz) and air-bone gap (ABG). 107 revision stapes surgery were performed in 96 ears. Main cause of failure was LPI lysis in 38 cases (39.6%). 31 patients were analyzed: HAP bone cement was used in 11 patients (Group I), MV prosthesis in ten patients (Group II), and TORP in ten patients (Group III). The mean post-operative ABG was 10.7dB (±7.4) (p=0.003), 10.7dB (±8.8) (p=0.001), and 16.9dB (±9.8) (p=0.001), respectively. There were no significant differences between groups. In Group I, the mean change in HFBC revealed an improvement of 5.6dB (±7.9) (p=0.03), while in Group III there was a significant deterioration of the thresholds of 5.8dB (±7.6) (p=0.04). There were no cases of post-operative anacusis. In revision stapes surgery when LPI is eroded, we recommend to perform a cement ossiculoplasty for stabilizing a standard Teflon piston when LPI is still usable, the LPI lengthening with cement being not recommended. When LPI is too eroded, we prefer performing a malleovestibulopexy, and reserve TORP for cases with a bad anatomical presentation.

Malleus to Stapes Bone Cement Rebridging Ossiculoplasty: Why Don't We Perform Frequently?

To evaluate the effectiveness of malleus to stapes bone cement rebridging (MS-BCR) for Austin Kartush group A ossicular defects and compare the audiological results with incus interposition (IP) and incus to stapes bone cement rebridging (IS-BCR). Patients for whom type 2 tympanoplasty had been performed in a tertiary referral center were examined. Revision cases and those with graft failure were excluded. Three treatment groups were IS-BCR, IP, and MS-BCR. Preoperative and postoperative audiological results were compared. A total of 92 patients were enrolled. The IS-BCR was performed in 42 (45.65%), IP in 18 (19.56%), and MS-BCR in 32 (34.78%) patients. Postoperative mean air bone gap was 20.1 ± 9.8 dB HL and did not differ significantly between the groups (P = .271). Postoperative mean air bone gap less than 20 dB HL was achieved in 23 (54.7%) patients in IS-BCR, 10 (55.5%) patients in IP group, and 24 (75%) patients in MS-BCR group (P = .06). Mean closure in air bone gap was 14.0 ± 11.6 dB HL. The changes in mean and frequency-specific air bone gap were not significantly different between treatment groups (P > .05). Malleus to stapes bone cement rebridging may provide hearing results comparable to IS-BCR and IP.

The "One Shot" Diode Laser Stapedotomy.

The purpose of this study was to evaluate the effectiveness and the safety of diode laser stapedotomy, through the functional results analysis. A total of 179 primary cases of otosclerosis that had been operated on with a diode laser technique from 2004 to 2012 were retrospectively reviewed. Preoperative, 1 month postoperative, and late annual follow-up audiograms (up to 8 years) were obtained in all the cases. Mean preoperative and 1 month postoperative pure-tone average (500-1000-2000-4000 Hz) bone conduction thresholds (PTA-BCs), air conduction (AC) hearing outcomes for 8 kHz and mean postoperative air-bone gap (PTA-ABG) closure were analyzed. The mean preoperative (pre) PTA-BC was 24.22 dB (±8.7 SD) whereas the mean postoperative (post) PTA-BC was 21.11 dB (±9.1 SD). The mean preoperative 8 kHz AC was 56.41 dB (±22.86 SD) and the postoperative 8 kHz AC was 52.56 dB (±24.35 SD). A statistically significant improvement of the PTA-BC post and of the postoperative 8 kHz AC was observed. The 1 month ABG closure within 10 dB in 89.02% of the patients and within 20 dB in 97.69% of the patients was obtained with statistically significant stability over long-term follow-up. No major complications occurred in the series. The use of diode laser with high power and short time exposure as setup can be considered a safe, precise, and useful tool in stapes surgery.

A systematic review of the effect of different crimping techniques in stapes surgery for otosclerosis.

To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry. PubMed, EMBASE, and the Cochrane Library. A systematic search was conducted. Studies comparing the effect of different crimping methods on pure-tone audiometric results in patients undergoing stapes surgery for otosclerosis were included. Relevance and risk of bias were assessed. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted or calculated for the primary and secondary outcomes, which were air-bone gap closure to 10 dB or less, mean postoperative air-bone gap, and postoperative sensorineural hearing loss. Twenty-two studies with moderate or high risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in 17 studies and mean postoperative air-bone gap in 20 studies. The hearing outcomes did not consistently favor one crimping method. However, the differences that were statistically significant were consistently in favor of heat crimping over manual and no crimping (difference in air-bone gap closure to 10 dB or less ranged between 22% and 42% in these studies and difference in mean postoperative air-bone gap between 2.8 dB and 7.4 dB) and in favor of manual crimping over no crimping (30% difference in air-bone gap closure to 10 dB or less and difference in mean postoperative air-bone gap between 2.6 dB and 6.0 dB). Moderate to high risk of bias and inconsistent results characterize the current evidence. Laryngoscope, 126:1207-1217, 2016.

Stapes malformations: the contribute of the endoscopy for diagnosis and surgery.

The aim of this study is to investigate the contribute of the endoscopic exclusive transcanalar approach for the management of stapes malformations. A retrospective chart review was made at our tertiary referral centers. 17 patients with stapes malformations underwent surgery with endoscopic exclusive transcanal approach. A complete audiological and radiological assessment before and after surgery was performed. 12/17 (70%) underwent a surgical endoscopic correction, In case of fixed platina underwent five endoscopic stapedotomy and one endoscopic stapedectomy were performed. In case of mobile platina five endoscopic ossiculoplasties with partial ossiculoplasty replacement prosthesis were performed, 3 with autologous remodeling incus and 2 with malleus head remodeling. In 1 case, only an endoscopic stapes mobilization was made. In 5/17 (30%), due to difficult anatomical findings an endoscopic explorative tympanotomy was finally performed. The mean preoperative air conduction (AC), bone conduction (BC) and air-bone gap (ABG) were, respectively, 60.7, 26.3 and 34.4dB. The mean postoperative AC, BC and ABG were, respectively, 33.8, 26.5 and 7.3dB, with a mean improvement of the ABG of 27.1dB. Discharge from hospital was on the first post-surgery day. No relevant postoperative complications were noted. The median follow-up was 3.6years (range 1-6). The endoscopic approach results very adequate for the diagnosis and treatment of stapes malformations, checking variations of the ossicles conformation and functioning and performing safe surgery, under direct control of middle ear structures.

Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Prostheses.

(1) To describe the use of total ossicular prostheses (TOPs) in the setting of stapedectomy requiring an incus bypass procedure. (2) To analyze the short- and long-term audiometric results of TOP utilization in the setting of stapedectomy for an incus bypass procedure. Case series with chart review. Tertiary neurotologic referral center. Seventeen cases of TOP reconstruction after stapedectomy were performed due to advanced incus erosion. The cases were assessed for pre- and postoperative bone conduction and air conduction pure-tone averages (PTAs; 0.5, 1, 2, 3 kHz), including high-tone bone conduction (1, 2, 4 kHz), air-bone gap, and speech discrimination scores. Hearing outcomes were measured: short-term (3 weeks) and long-term (average, 22 months). Among 17 ears undergoing revision stapedectomy managed with TOP reconstruction, the average number of previous revision attempts was 1.0 (SD, 1; range, 1-5). The preoperative bone conduction PTA was 30.7 dB preoperatively, while the preoperative air conduction PTA was 64.3 dB. The mean postoperative air-bone gap significantly decreased to 18.9 dB (SD, 12.7; range, 5-46.25; P < .003) with a mean follow-up of 22.2 months (SD, 25.0; range, 0.75-78). No significant decrement in high-tone bone conduction PTA was observed (mean, 0 dB; SD, 12.8; range, -36.7 to 20; P = .427); however, 1 ear revealed a severe decrease in PTA and speech discrimination score postoperatively. No further revisions were noted in follow-up. TOP reconstruction in the setting of previous revision stapedectomy with limited incudovestibular reconstructive options may lead to favorable hearing outcomes, but it carries an increased risk of sensorineural hearing loss.

A systematic review of the effect of piston diameter in stapes surgery for otosclerosis on hearing results.

To evaluate the effect of piston diameter in primary stapedotomy for otosclerosis patients measured by hearing outcome. PubMed, Embase, and the Cochrane Library. A systematic search was conducted. Studies reporting original data on the effect of piston diameter on pure-tone audiometric results in patients undergoing primary stapedotomy for otosclerosis were included. Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted. Twelve studies with moderate to high relevance and moderate risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in six studies, the majority of which did not show a statistically significant or clinically relevant difference between two pistons with a different diameter. More importantly, the differences that were found were not consistently in favor of smaller-diameter pistons or larger-diameter pistons. Mean postoperative air-bone gap ranged from 3 dB in favor of a smaller-diameter piston to 3 dB in favor of a larger-diameter piston across four studies. Permanent sensorineural hearing loss was assessed in eight studies and occurred in only one study. In this study, no difference was found between a 0.4-mm-diameter piston and a 0.6-mm-diameter piston. There is not sufficient evidence to support the superiority of the use of a larger-diameter piston compared to a smaller-diameter piston for primary stapedotomy in otosclerosis patients.

Tympanoplasty outcomes in elderly patients.

To investigate the outcomes of tympanoplasty in elderly (≥60 years) compared with young patients (18-59 years). Patients who had been performed type I tympanoplasty between 2009 and 2012 were retrospectively analyzed. Preoperative and postoperative audiological results and the graft success of 42 older patients were compared with those of 72 younger ones. The mean preoperative air conduction levels were statistically significantly higher in older group (57.4±16.8dB) than younger group (37.3±10.3dB) (p<0.001). Preoperative bone conduction levels were statistically significantly higher in older group (28.5±13.4dB) than in the younger group (12.4±4.8dB) (p<0.001). The mean preoperative and postoperative air-bone gaps were statistically significantly larger in the older group (28.5±11.0dB, 16.4±9.0dB) than in the younger group (24.9±7.7dB, 12.4±8.0dB respectively) (p<0.001). The intragroup comparisons of preoperative and postoperative mean air-bone gaps revealed statistically significant improvements in both groups (p<0.001 for both). Graft success rates and the mean hearing gains were not statistically significantly different between the groups (p=0.225, p=0.786 respectively). Although preoperative and postoperative air and bone conduction levels were worse in the older group, graft take rates and postoperative hearing gain did not differ between the groups. If the physical status is stable tympanoplasty procedure can be recommended for elderly patients.

Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis.

This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis. A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air-bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air-bone gap were the main outcome measures. Mean post-operative air-bone gap was 5.25 dB. Four patients had an air-bone gap of less than 10 dB; the remaining patient had an air-bone of 12.50 dB. Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.

Surgical success of boomerang-shaped chondroperichondrial graft in pediatric chronic otitis media cases

ObjectivesTo reveal the success of boomerang-shaped chondroperichondrial graft (BSCPG) in pediatric chronic otitis media cases. MethodsA total of 43 pediatric patients (age 7–16 years) who had undergone type 1 tympanoplasty with the diagnosis of chronic otitis media between March 2010 and March 2013 were included in this retrospective study. The main outcome measures were the graft success rate and level of hearing improvement. ResultsGraft intake success rate was 90.7%. Mean preoperative and postoperative air-bone gap values were 20.51±4.34dB SPL and 9.32±5.64dB SPL, respectively (p<0.001). Mean preoperative and postoperative pure tone average values were 28.6±3.52 and 12.24±5.22 respectively (p<0.001). Air-bone gap was improved to ≤10dB in 38 (88.37%) patients during the postoperative period. ConclusionsBoomerang-shaped chondroperichondrial grafting technique seems to be a successful alternative in the management of pediatric chronic otitis media cases. It has relatively higher grade graft success rate.

Transcanal endoscopic tympanoplasty in the treatment of chronic otitis media

This study aims to report early postoperative complications and hearing results in patients with chronic otitis media undergoing endoscopic transcanal tympanoplasty. Twenty-four patients (6 males, 18 females; mean age 25.9 years; range 9 to 46 years) who were operated with endoscopic transcanal tympanoplasty in the Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University between December 2012 and January 2014 were included. Postoperative complication rates, graft success, and hearing outcomes (mean air-bone gap) were evaluated. The mean preoperative air bone gap was found 25.1 dB and the mean postoperative air bone gap was found 20.3 dB. Postoperative duration of hospital was 24 hours. Reperforation was seen in one patient and medialization of the anterior quadrant of the graft was seen in one patient. The mean follow-up time was 7.3 months. Endoscopic transcanal tympanoplasty can be easily applied, cheap and safe method and can be given successful results in challenging cases.

Recurrence rate of cholesteatoma with autoclaved incus autograft.

To study the long-term recurrence rate of cholesteatoma with autoclaved incus autograft. Prospective observational study between 1994 and 2009. The incus remnants were autoclaved at 134°C for 24 minutes at 205 kPa. The mean follow-up duration was 65.5 months, with a minimum follow-up duration of 31 months and a maximum follow-up duration of 186 months. Secondary referral center in a district general hospital. Thirty-seven cases of cholesteatoma treated with canal wall down mastoidectomy with primary ossicular reconstruction with autoclaved incus autograft were included. The age range of the patients was from 11 years to 67 years. The mean age was 38 years. Fifty-four percent was male, and 46% was female. Therapeutic and rehabilitative--to treat and improve the patients' hearing loss secondary to cholesteatoma by using autoclaved autologous incus. Primary end point is the recurrence rate of cholesteatoma with a mean follow-up period of more than 5 years. Secondary end point is the audiometric outcome with air-bone gap (ABG) and air conduction improvement. No recurrence of cholesteatoma was observed. No graft extrusion was seen. Preoperative mean ABG was 29.8 dB. Postoperative mean ABG was 25.6 dB at the final review, with the air conduction improvement at final review at 4.2 dB. Autoclaving the incus remnant harvested from cholesteatomatous middle ear cleft is a safe and effective method to prepare an incus autograft for primary ossicular reconstruction.

Sklerotik mastoid kemiğe sahip kronik otitis medialı hastalarda tip 1 timpanoplasti: Anatomik ve fonksiyonel sonuçlar

Objective: To evaluate success of tympanoplasty type 1 in the treatment of patients with sclerotic mastoid bone. Methods: A retrospective study where 92 patients with non-cholesteatomatous chronic suppurative otitis media were recruited during the period of 2010 to 2012. Patients were managed medically and after dryness of their perforations they were operated upon. Ninety-two patients underwent type 1 tympanoplasty alone without cortical mastoidectomy. Underlay technique with chondroperichondrial graft was performed for all patients. Results: Mean air-bone gap values were estimated and compared. In pre- and postoperative audiograms, air-bone gap values at 500, 1000, 2000 and 4000 Hz frequencies were determined. Pre- and postoperative mean air-bone gap values of the patients were 23.47±4.95 and 11.58±4.77 dB, respectively. Conclusion: Our study emphasizes the fact that overall satisfactory hearing outcome with adequate air-bone closure can be achieved irrespective of cortical mastoidectomy in the surgical treatment of noncomplicated chronic ear diseases.

Long-term outcome of ossiculoplasty using autogenous mastoid cortical bone.

To observe the long-term outcome of ossiculoplasty using autogenous mastoid cortical bone in chronic otitis media in-patients. Sixty-one ears of 57 in-patients with chronic otitis media, with or without cholesteatoma, underwent type III tympanoplasty using autogenous mastoid cortical bone as the prosthetic material. Twenty-one ears were treated by canal wall down mastoidectomy and 40 ears by canal wall up mastoidectomy. The follow-up period was 3 to 6 years (average 4.2 years). Pure tone averages for thresholds at 0.5, 1, 2 and 3 kHz were calculated using standard conventional audiometry. The pre-operative mean air-bone gap of 31.6 dB, for all ears, was reduced to 20.3 dB post-operatively. For the 40 canal wall up ears, this value decreased from 30.8 dB to 19.9 dB, and for the 21 canal wall down ears it decreased from 33.0 dB to 21.0 dB. The differences between the pre- and post-operative mean air-bone gap values were significant. No cases of extrusion, necrosis or resorption were exhibited for the autogenous mastoid cortical bone prosthesis. A significant hearing improvement was obtained in the majority of cases and this remained stable over time.