Non-cholesteatomatous Chronic Otitis Media Research Articles

Radiological and Audiological Prediction for Ossicular Fixation in Chronic Otitis Media and Tympanic Membrane Perforation.

Recurrent middle-ear infection can lead to ossicular fixation, adversely affecting post-tympanoplasty hearing outcomes. Preoperative prediction of ossicular fixation remains challenging. We aimed to investigate potential predictors of ossicular fixation in patients with chronic otitis media. Retrospective. Tertiary academic medical center. Patients with noncholesteatomatous chronic otitis media and tympanic membrane perforation, without ossicular discontinuities. Diagnostic. The fixation of each ossicle was assessed during tympanoplasty. The impact of preoperative otoscopic findings, computed tomography (CT) features, and hearing levels on the prediction of ossicular fixation was evaluated using uni- and multivariable logistic regression analyses. One hundred thirty-five patients were included. Soft-tissue density between the malleus head and the anterior wall (odds ratio, 3.789 [95% confidence interval, 1.177-12.196]; p = 0.0255) and poor development of mastoid cells (16.826 [2.015-134.520]; p = 0.0078) were independent predictors of malleus fixation. In addition, ≥50% tympanic membrane perforation (5.412 [1.908-15.353]; p = 0.0015), poor development of mastoid cells (3.386 [1.039-11.034]; p = 0.0431), and a ≥40-dB preoperative air-bone gap (ABG) at 500 Hz (4.970 [1.732-14.261]; p = 0.0029) were independent predictors of incus fixation. Soft-tissue density surrounding the stapes (18.833 [1.856-191.104]; p = 0.0119) and a ≥40-dB preoperative ABG at 500 Hz (13.452 [1.640-∞]; p = 0.0138) were correlated with stapes fixation. The accurate prediction of ossicular fixation in patients with chronic otitis media based on CT features and the ABG may facilitate decision-making regarding the need for ossiculoplasty, possibly avoiding unnecessary manipulation or overlooking of fixation.

Aural polyps: What's behind them?

Introduction: Polyps in the external auditory canal (EAC) may be present due to inflammation induced by chronic otitis media. In many cases, the type of underlying otitis media is a cholesteatoma. Aim: The aim of this article is to determine the etiology of EAC polyps in patients referred to the Otology Division of a tertiary hospital in south Brazil. Materials and Methods: Cross-sectional study was conducted with a cohort of patients with otologic diseases who were evaluated from July 2001 to December 2020. Patients with unilateral or bilateral aural polyps underwent anamnesis and recorded video-otoscopy and had their online medical chart reviewed. Results: Of the 2432 patients evaluated, 133 (5.4%) had a polyp in the external auditory canal. Of those, 53 were excluded, leaving a final sample of 81 patients (3.3%). Discussion: Middle ear cholesteatoma (MEC) and non-cholesteatomatous chronic otitis media (NCCOM) were responsible for 86.3% of all polyps evaluated and the majority of diagnoses were established through surgery (76.5%). Conclusion: Symptoms associated with polyps and their aspect do not reveal the most probable etiologies making imaging exams, biopsy and surgery necessary steps in aural polyp investigation.

Surgical Outcomes of Revision Operation for Non-Cholesteatomatous Chronic Otitis Media

Background and Objectives The aim of this study was to investigate the surgical outcomes of revision operation due to recurrence of non-cholesteatomatous chronic otitis media (COM) surgery cases.Subjects and Method From 1989 to 2018, 5197 cases of COM surgery were performed at Kangdong and Hallym University Sacred Heart Hospital. Among them, clinical data of 297 subjects who had undergone revision tympanoplasty and/or mastoidectomy for recurrent noncholesteatomatous COM were retrospectively collected from computerized database of middle ear surgery (Korean Otological Society program 2005). Each case was categorized by surgical approaches into canal wall down mastoidectomy (CWDM), canal wall up mastoidectomy (CWUM), or tympanoplasty only groups.Results Tympanoplasty only was performed in 170 cases, CWDM in 74 cases, and CMUM in 53 cases. Postoperative perforation occurred in 9.4% of total cases, and less frequently in CMDM compared with tympanoplasty only (<i>p</i>=0.023), and CMUM (<i>p</i>=0.049), respectively, whereas no differences between tympanoplasty only and CMUM (<i>p</i>=0.930) were found. Postoperative infection rate was 1.0% and did not show any differences among the groups. Postoperative successful hearing was obtained in 66.7% of total cases, and the success rate of tympanoplasty only was better than that of CMDM (<i>p</i>=0.001), and CMUM (<i>p</i>=0.011). And, that of CMUM was better than that of CMDM (<i>p</i>=0.011).Conclusion The results showed that postoperative perforation occurred less frequently in CMDM than in tympanoplasty only and in CWUM; successful hearing was achieved more frequently in tympanoplasty alone than in the other surgical approaches in recurrent non-cholesteatomatous COM.

Serum sclerostın levels ın chronıc otıtıs medıa wıth and wıthout cholesteatoma.

OBJECTIVE Sclerostin is a glycoprotein that plays a catabolic role in bone and is involved in the regulation of bone metabolism by increasing the osteoclastic bone resorption. In this study, serum sclerostin levels were measured in chronic otitis media (COM) with and without cholesteatoma, assuming that it might have a role in the aetiopathogenesis of bone resorption. METHODS A total of 44 patients with cholesteatomatous COM (cCOM) (n = 22) and non-cholesteatomatous COM (ncCOM) (n = 22) were included in this study, and 26 healthy volunteers without any chronic ear disease problem(s) constituted the control group (n = 26). RESULTS No significant difference was not found in terms of serum iPTH, ALP, and vitamin D levels between ncCOM, cCOM, and the control groups. A significant difference was found in terms of serum sclerostin, Ca, and P levels between ncCOM, cCOM, and the control groups (p<0.05). Serum sclerostin levels in the study groups were significantly higher but their serum Ca and P levels were significantly lower compared to the control group. CONCLUSION We think that serum sclerostin concentrations, which were significantly higher in patients with cCOM and ncCOM compared to healthy controls are associated with bone erosion. There is a need for further studies with larger samples in order to determine the relationship between sclerostin and bone erosion in cholesteatoma to help in establishing preventive measures against cholesteatoma and set new targets for the development of non-surgical treatments.

A comprehensive study of oxidative stress in patients with chronic otitis media

Objective: The purpose of this research study was to evaluate dynamic thiol/disulphide homeostasis (TDH) as a novel oxidative stress marker in participants with noncholesteatomatous chronic otitis media (ncCOM) and cholesteatomatous chronic otitis media (cCOM), as well as to investigate lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) markers and compare the results with a healthy control group. Methods: This research was carried out at Harran University Medical Faculty Ear-Nose-Throat Department, between April 2017 and April 2019. This was a prospective controlled trial study including 121 participants, 40 ncCOM, 39 cCOM and 42 healthy controls. Total thiol, native thiol, disulphide levels and LOOH, TAS, TOS levels were measured in plasma of all patients and healthy volunteers. Results: In our study, we found that total thiol, native thiol levels, native thiol/total thiol ratios and TAS levels were significantly lower in cCOM patients compared with the control group (p<0.01). Disulphide/native thiol, disulphide/total thiol ratios, LOOH, TOS and OSI levels were significantly increased in the cCOM group compared with the control group (p<0.01). Conclusion: Oxidative stress (OS) is believed to be one of the underlying reasons for COM pathogenesis. In this research, we analyzed dynamic TDH as a novel OS marker using a novel improved fully automatic colorimetric technique, along with other parameters. This study may shed light on understanding the underlying reasons for the pathogenesis of COM and identify potential targets for antioxidant drug treatment.

Long-Term Outcomes after Performing Tympanoplasty without Mastoidectomy for Active and Inactive Noncholesteatomatous Chronic Otitis Media

Objective: This study aimed to assess long-term outcomes after performing tympanoplasty without mastoidectomy (TWOM) for active and inactive noncholesteatomatous chronic otitis media (COM) and to estimate the optimal time for surgery. Methods: The patients were placed into an active ear group (group A) and an inactive ear group (group B). All patients were followed up for 5 years after TWOM. Results: Ninety-two cases among 113 achieved dry ears in half a month to 1 month. The tympanic pressure gradually improved 3–6 months after the operation. A total of 69/72 ears achieved dry ears in the active ear group, and 37 ears had effective hearing improvement. In all, 40/41 ears achieved dry ears in the inactive ear group, and 20 ears had effective hearing improvement. There was no difference in the recurrence rate or hearing improvement in the two groups. Conclusion: With good quality control of the surgical treatment of TWOM, there are no differences in long-term outcomes in noncholesteatomatous COM in different chronic infection conditions.

Correlation between cognitive functions and central auditory processing in adolescents with non-cholesteatomatous chronic otitis media.

Auditory deprivation associated with early otitis media with effusion has been considered a risk factor for central auditory processing (CAP), as well as for the development of a number of cognitive functions.Objective:To study the neuropsychological functions of attention, working memory and executive function in adolescents with and without non-cholesteatomatous chronic otitis media (NCCOM) and analyze their interrelationships with the behavioral evaluation of CAP.Methods:Sixty-eight adolescents were recruited, 34 were diagnosed with NCCOM (study group - SG), and 34 had no otological history (control group - CG). The Neupsilin Brief Neuropsychological Assessment Instrument was used. CAP was assessed by: Masking Level Difference, Synthetic Sentence Identification, Random Gap Detection Test, Duration Pattern Sequence Test and Dichotic Digits Test.Results:The results of Neupsilin showed lower scores in the study group when compared to the control group on the following tests: digit sequence repetition, ascending digit ordering, auditory sentence span, and phonemic verbal fluency. An association was found between central auditory processing tests and Neupsilin subtests.Conclusion:The effects of NCCOM on attention, memory and executive function related to central auditory processing disorder in adolescents seem to be enhanced by the severity of the disease.

Bioactive glass obliteration of the mastoid significantly improves surgical outcome in non-cholesteatomatous chronic otitis media patients.

This retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Merchant's scale. Hearing results as measured by air-bone gap and the incidence of adverse events were assessed as secondary outcomes. Thirty-two ears (44%) in the control group (n=73) achieved complete control of infection at the most recent postoperative clinic visit vs 17 (74%) in the S53P4 obliteration group (n=23). Comparing these outcomes yielded an odds ratio (OR) of 3.6 (p=0.012, 95% CI 1.3-10.3). Complete failure to manage infection significantly differed (p=0.048) between the control group (11 ears; 15%) and the S53P4 obliteration group (0 ears). No adverse events were observed in either group. Pre- and postoperative ABG results did not differ significantly between groups. Obliteration of the mastoid cavity using BAG S53P4 along with mastoidectomy in patients with chronically discharging NC-COM significantly improves the achievement of a dry and safe ear as compared to mastoidectomy alone. Importantly, no adverse events were observed with S53P4 BAG obliteration.

Presence of osteoclasts in middle ear cholesteatoma: a study of undecalcified bone sections

Conclusions: Osteoclasts are unlikely to be involved in bone resorption in middle ear cholesteatoma.Objective: The authors searched for osteoclasts in undecalcified bone sections in patients with middle ear cholesteatoma to determine whether and to what extent these cells are involved in this disease.Methods: Twelve patients, eight men and four women, aged 30–87 years, who underwent tympanomastoidectomy were enrolled. Six patients had primary acquired middle ear cholesteatoma (cholesteatoma group) and the other six patients had other otologic diseases including otosclerosis, non-cholesteatomatous chronic otitis media, adhesive otitis media, perilymphatic fistula and ossicular malformation (control group). The scutum bone was collected during surgery, fixed with ethanol, stained with Villanueva bone stain, and embedded in methyl methacrylate. Five-micrometer-thick sections were prepared and examined under a polarizing microscope. Images were analyzed using a semiautomatic graphics system.Results: No osteoclasts were seen in any of the samples in either group. To avoid the risk of under-estimating the presence of osteoclasts, the number of osteoclasts was considered to be <1 in each sample, and the osteoclast density was calculated. The osteoclast densities in both the cholesteatoma and control groups were significantly lower than the sex- and age-matched standard value of the normal iliac cortical bone (p = .028).

Is Cholesteatoma a Risk Factor for Graft Success Rate in Chronic Otitis Media Surgery?

In developing countries, chronic otitis media (COM) and cholesteatoma are relatively prevalent. Within the field of otology, COM surgery remains one of the most common surgical treatments. Most recent studies evaluating the potential prognostic factors in COM surgery have addressed graft success rate and types of middle ear and mastoid pathology. There has been much controversy about this issue until the present time. This study evaluated the effect of cholesteatoma on the GSR in COM surgery. The present retrospective, case-controlled study investigated 422 ears undergoing COM surgery. The minimum and maximum postoperative follow-up periods were 6 and 48 months, respectively. The study group consisted of patients with cholesteatomatous COM, while the control group included patients with non-cholesteatomatous COM, who had undergone ear surgery. Postoperative graft success rate and audiological test results were recorded and the effect of cholesteatoma on graft success rate was investigated. The overall GSR was 92.4%. In the study group (COM with cholesteatoma),the postoperative GSR, mean speech reception threshold improvement, and mean air-bone gap gain were 95.3%, 2.1 dB, and 3.2 dB, respectively. In the control group (COM without cholesteatoma), however, these measurements were 90.9%, 9.4 dB, and 9.1 dB, respectively. The difference between the two groups was not statistically significant. The study results suggest that cholesteatoma is not a significant prognostic factor in graft success rate.

Relationship between CT findings and sensorineural hearing loss in chronic otitis media

To investigate the relationships between the temporal bone CT findings and sensorineural hearing loss in ears with non-cholesteatomatous chronic otitis media (COM). Preoperative bone conduction (BC) hearing thresholds of 266 patients (304 ears) with COM were compared with those of 342 normal individuals (440 ears) by audiometry. The incidence of abnormal BC threshold at lower frequencies (250-1000 Hz) and at higher frequencies (2000-4000 Hz) were examined and the differences between control and COM groups were compared by using χ2 test. In the COM group, the cross-sectional area of the mastoid air cells based on the axial CT image (n=255) were correlated with the results of BC threshold. The percentage in the COM group exceeds 15% in their 50s at lower frequencies while in their 40s at higher frequencies. The BC thresholds were significantly better in the group with normal mastoid area than in those with smaller mastoid area at each decadal age group. The BC impairment from COM becomes worse as the course of the disease progresses and deteriorated from 40s rapidly, especially at higher frequencies and in the group with smaller mastoid area. These results recommend that early treatment, including surgery, should be considered as early as possible before BC impairment occurs, especially for COM cases with smaller mastoid area, which may indicate the existence of more severe otitis media since earlier childhood.

Chronic Otitis Media in Children

To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the management of chronic otitis media (COM) in children. Literature review and critical analysis of the available evidence in Medline and other scientific database sources. Otorrhea and hearing loss are the cardinal symptoms of COM, while oto-microscopy and imaging techniques can confirm the diagnosis. Conservative treatment is acceptable to some extent (i.e. mild cases of COM without cholesteatoma). It involves topical drops (quinolones as first choice drugs- strength of recommendation B), as well as performing aural toilet (strength of recommendation B), and avoiding water ingress. Tympanoplasty without mastoidectomy is expected to improve hearing in cases of non-cholesteatomatous COM (strength of recommendation C), and positively affect the children's quality of life (strength of recommendation B). Less experienced surgeons and inflamed, wet middle ear mucosa represent the two most important factors, which could lead to reperforations (strength of recommendation C). The surgical management of COM with cholesteatoma tends to employ the least invasive surgical technique, in order to obtain a small self-cleaning mastoid cavity, as well as good hearing results (strength of recommendation C). The treatment of choice in most cases of pediatric COM is surgery. Figure 1 proposes a detailed and easy-to-follow evidence-based algorithm with regard to the diagnosis and management of COM in children.

Expression of Keratinocyte Growth Factor and Its Receptor in Noncholesteatomatous and Cholesteatomatous Chronic Otitis Media

The purpose of the study was to test a hypothesis that the keratinocyte growth factor (KGF) is a key factor in the pathologic difference between cholesteatomatous (C-COM) and noncholesteatomatous chronic otitis media (NC-COM). We compared the expression levels of KGF and its receptor (KGFR) and the proliferation activity of epithelial cells between NC-COM and C-COM. The epithelial lesion was surgically excised with subepithelial tissue from 18 patients with NC-COM and 70 patients with C-COM, and was processed for immunohistochemistry for KGF and KGFR. We also examined the proportion of proliferating epithelial cells using Ki-67 and the extent of infiltrating B and T cells. Keratinocyte growth factor was positive in 5 of 18 (28%) NC-COM specimens and in 61 of 69 (88%) C-COM specimens (p < 0.0001). Furthermore, 37 (60%) C-COM specimens were positive for KGFR, but none of NC-COM were positive (0%; p < 0.01). The Ki-67 labeling index (LI) was significantly smaller in NC-COM than in C-COM (p < 0.001). B-Cell LI was almost similar in the 2 groups. T-Cell LI was significantly higher in C-COM than in NC-COM (p < 0.0001). Interestingly, T-cell LI in NC-COM was higher in KGF-positive tissues than in KGF-negative tissues (p < 0.05). The results indicated that coexpression of KGF and KGFR seems to explain the pathologic difference between C-COM and NC-COM, and that KGF may play an important role in the development of cholesteatoma.

Pre-operative Evaluation of Eustachian Tube Function Using a Modified Pressure Equilibration Test is Predictive of Good Postoperative Hearing and Middle Ear Aeration in Type 1 Tympanoplasty Patients

ObjectivesThe Eustachian tube (ET) plays an important role in maintaining a normally aerated middle ear. Inflammation in middle ear disease is related to ET dysfunction, and postoperative restoration of middle ear integrity and hearing are closely related to ET function in chronic ear disease patients. After successful tympanoplasty, restoration of a well-aerated middle ear with good ET function can permit better compliance of the tympanic membrane. In this study, we evaluated the predictive validity of preoperative ET function measurements.MethodsWe reviewed 137 patients who underwent type 1 tympanoplasty. All patients had non-cholesteatomatous chronic otitis media and received canal wall-up-type tympanomastoidectomies. Patients were categorized into four groups according to preoperative ET function measurements using a modified pressure inflation-deflation equilibration test. Group I patients had residual pressures less than 10 daPa, and Group IV patients showed no pressure change (poor results). Groups II and III were intermediate. Hearing levels were determined using pure tone averages at four frequencies. Postoperative tympanography was performed to determine middle ear aeration.ResultsThe preoperative air bone (AB) gap was 29.6±7.0 dB, and the postoperative gap was 16.5±5.7 dB; thus, there was significant overall improvement. In all groups, hearing was significantly better after surgery, but the worst postoperative hearing level was seen in Group IV patients. Type B tympanograms were more frequently recorded in Group IV patients than they were in Group I or II patients. Postoperative AB gaps were 9.2±3.8 dB in patients with type A tympanograms, 13.4±2.1 dB in those with type As, 24.1±2.5 dB in those with type C, and 18.5±2.8 dB in those with type B.ConclusionET function measured with a modified pressure equilibration test using an inflation-deflation manometric method is a good indicator of an aerated middle ear and is predictive of improved postoperative hearing.

S213 – Gustatory Alterations in Patients with Chronic Otitis Media

Objectives 1) To identify gustatory alterations due to chorda tympani nerve involvement in patients with chronic otitis media (COM) without prior surgery, and 2) To see if the presence of cholesteatoma worsened gustatory sensitivity in these patients. Methods Study Design: prospective study. The test was performed in patients with unilateral cholesteatomatous or suppurated COM not previously submitted to otological surgery. The test was based on “taste strips” with different concentrations of salt, sweet, bitter, and sour, using the otological disease-free side as the control. The score could be between 0 (worst) and 16 (best). All the other data were collected by interview and physical exam and analysed by Poisson Regression. Results A total of 45 patients with COM were evaluated, including 25 with cholesteatoma and 20 with non-cholesteatomatous COM, with a mean age of 38 years. 8 cases of unilateral ageusia were found on the affected side. The mean score was 6.65 for the affected side and 9.91 for the half of the tongue on the side of the healthy ear (p&lt;0,05). No patients had complained of gustatory alterations before the examination. There was an association between presence of cholesteatoma and worse gustatory sensitivity (p&lt;0.05). Conclusions Patients with cholesteatomatous or suppurated COM can present gustatory alterations, even in the absence of complaints. The presence of cholesteatoma worsened gustatory sensitivity.

Bilateral promontory fistula due to noncholesteatomatous chronic otitis media

The authors describe a case of bilateral promontory fistula due to noncholesteatomatous chronic otitis media in a 46-year-old male. We performed both open cavity mastoidectomy and left staged ossiculoplasty. One year postoperatively, the audiogram showed an improved left air conduction threshold and maintenance of bone conduction. We suggest that noncholesteatomatous chronic otitis media can induce various destructive changes via the chronic inflammatory reaction.

Mastoid obliteration combined with soft-wall reconstruction of posterior ear canal

To clarify the usefulness of modified soft-wall reconstruction method by combing with mastoid obliteration, 96 patients (98 ears) with their age ranging from 5 to 82 (average 51.3), including 62 ears with chronic otitis media (COM) with cholesteatoma, 18 ears with non-cholesteatomatous COM, 14 ears with postoperative cavity problem, and 4 ears with adhesive-type COM, who had soft-wall reconstruction of the posterior ear canal and mastoid obliteration using mainly bone powder following mastoidectomy, were evaluated their postoperative conditions more than a year after surgery. Overall success rate was 76.5% (75/98), and fresh cases showed better success rate (84.8%) than those with a history of multiple surgeries (69.2%). Among unsuccessful cases, crust and/or debris accumulation was observed most (nine ears), followed by persistent wet condition (seven ears), and exposure of the obliterated material (five ears), while only two ears showed a retraction pocket formation. The success rates remained almost the same among those who were followed for more than 2 and 3 years (46/61, 75% and 21/28, 75%, respectively). In 60 ears on which postoperative hearing was assessed, 41.7% showed less than 15 dB of air-bone gap (ABG), and 61.7% showed less than 20 dB of ABG. Mastoid obliteration with bone powder in combination with soft-wall reconstruction of the posterior ear canal appeared a useful method for obliterating mastoidectomized cavity especially for prevention of postoperative pocket formation.

Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty

Objectives To examine the correlation between the middle-ear pressure-regulation functions including active eustachian tube (ET) functions and transmucosal gas exchange function, and outcome of tympanoplasty. Patients and methods Seventy five patients (78 ears) with non-cholesteatomatous chronic otitis media with eardrum perforation but without ossicular damage or middle-ear anomaly participated in this study. Before surgery, patency of the ET was examined by applying positive pressure to the middle ear through the eardrum perforation, and then the ET pressure-regulation functions were examined using the inflation–deflation test. Also their transmucosal gas exchange function was evaluated by examining the presence or absence of aeration in the mastoid on the CT before surgery or through the microscope during the surgery. All of them underwent type-I tympanoplasty, and their postoperative conditions including the hearing were followed for more than 6 months. The outcome of the surgery was judged as poor outcome when they had any of the following conditions; more than 20 dB of mean air-bone gap, spontaneous perforation within 6 months, or persistent wet condition including recurrent otorrhea. Results First, the outcome of all the four ears of which ETs were considered mechanically obstructed was poor. Next, among the remaining 74 ears, none of the three individual parameters, including positive and negative middle-ear pressure-equalizing functions and mastoid aeration, showed significantly positive correlation with the outcome of the surgery, but significantly higher incidence of poor outcome was seen only when all the three parameters were poor. Conclusions These results indicated that impairment of all the middle-ear pressure-regulation functions was likely to cause poor outcome of tympanoplasty, and also allowed us reconfirm that ears with mechanically obstructed ETs were contraindicated for tympanoplasty. Therefore, assessment of mastoid condition is important as well as the ET function before tympanoplasty.

Success of cartilage grafting in revision tympanoplasty without mastoidectomy.

Candidates for revision tympanoplasty have experienced at least one failed attempt at repair of the tympanic membrane and are, therefore, at higher risk for subsequent repair failure. The adjunctive use of mastoidectomy with tympanoplasty in those patients with noncholesteatomatous chronic otitis media is often used to decrease the risk for subsequent failure. However, at this institution, where we use cartilage tympanoplasty, mastoidectomy is rarely performed in the absence of cholesteatoma. Our objective was to assess outcomes in patients undergoing revision tympanoplasty without mastoidectomy using cartilage grafting. We conducted a retrospective case review. Tertiary referral center. A total of 95 patients (42 female, 53 male; 5-81 yr of age) with a recurrent perforation who were treated surgically with cartilage tympanoplasty without mastoidectomy were included in the chart review. Patients must have undergone at least one previous tympanoplasty without mastoidectomy and had to have complete audiologic and chart follow up. An underlay tympanoplasty technique using either a tragal cartilage-perichondrium island graft or palisaded concha cymba cartilage was used. Ossiculoplasty was performed as needed. Main outcome measures were incidence of reperforation of the grafted tympanic membrane, hearing result, and prevalence of other complications. Successful closure without reperforation was obtained in 90 of 95 patients (94.7%). Average postoperative pure-tone average air-bone gap was 12.2 +/-7.3 dB compared with 24.6+/-13.8 dB preoperatively (p <0.001). Revision tympanoplasty with cartilage provided equivalent results to tympanoplasty with mastoidectomy. Thus, mastoidectomy may not be necessary in revision tympanoplasty in the absence of cholesteatoma if the repair is made with cartilage.

Results of tympanoplasty in children after 15 to 27 years.

Results of tympanoplasty in children with noncholesteatomatous chronic otitis media are presented in a 16- to 27-year follow-up. During the 13-year period from 1968 to 1980, 116 children (124 ears) were operated on, and they were submitted to several follow-ups with audiometry and otomicroscopy. The attendance at the last follow-up was 70%, and the minimum time since surgery for these patients was 15 years. All dry ears were operated on transcanally with a fixed ear speculum, without any lateral incision of the ear canal skin. Cumulatively, in total, 14 ears (11%) had reperforation: 7 ears early and 7 ears late. At 6 months, there were 6% early reperforations; some were surgically closed and some reappeared later, even after several years, as late perforations. At 2 to 15 years of follow-up, there were 4% reperforations, and at 16 to 27 years, 6%. Hearing was good and stable. The results were the same in ears operated on at the ages of 2.5 to 7 years and 8 to 14 years, as well as with preoperatively positive and negative Valsalva maneuvers. In total, 14% of ears were revised during the entire observation period. It is concluded that transcanal tympanoplasty, even in young children, has good long-term stability and can definitively and permanently solve the problem of noncholesteatomatous chronic otitis in children.