Retraction Pocket Formation Research Articles

Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results

Introduction and objectivesThe aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets. Materials and methodsPatients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic–endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up. ResultsCholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases. ConclusionsWith only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice.

Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results

Introduction and objectivesThe aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets. Materials and methodsPatients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic–endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up. ResultsCholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases. ConclusionsWith only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice.

Asymptomatic Middle Ear Dysfunction in Children with Upper Respiratory Infection – Analytical Cross Sectional Study

Introduction Otitis Media with Effusion (OME) is the commonest cause of hearing difficulty and one of the most frequent reasons for elective admission to the hospital for surgery during childhood. The condition starts with dysfunction of middle ear due to poor ventilation through Eustachian tube or extension of the inflammatory process from nasopharynx. In the natural history of the disease, there may be a period of the pre-clinical stage without symptoms or signs of OME. If the disease is identified in this stage, the further sequel of it (like persistent hearing difficulty or retraction pocket formation) may be prevented. Materials and Methods A hospital based analytical cross-sectional study was conducted among the children below 12 years of age to assess the middle ear function (by tympanometry) in children having upper respiratory tract infection (but no ear related complaints) and comparing them with the middle ear function in children not having such infection or any recent history of the same. Age and sex matched control group having no such symptoms was constructed. There were 25 children in both study and control group selected from Otorhinolaryngology and Pediatrics outpatient department (OPD). So total numbers of children were 50. Results There was no statistically significant difference in background characteristics (age, sex) of the of study and control groups. There was no statistically significant difference when the tympanic membrane retraction or middle ear pressure is taken into account. But significant difference found in the parameters like middle ear compliance (68% children have low compliance in the study group vs 20% in control, with df= 1, ϰ2 = 11.688 and p value was 0.001) and tympanogram curve type (48% in study group have B or C type and 8% have such in control group). Conclusion Early diagnosis of the middle ear dysfunction among the children with upper respiratory infection, by clinical examination and suitable audiological investigation in the pre-clinical stage with appropriate intervention can prevent further progression of the disease, causing hearing loss as well as retraction pocket formation.

Mongolian Gerbils as a Model for the Study of Cholesteatoma: Otoendoscopic as a Diagnostic Tool.

Introduction Cholesteatoma is a disease with significant clinical impact but is incompletely understood. The challenge of performing studies with long-term follow-up in humans is a factor that has restricted the advance of knowledge in this field. Thus, the use of animal models is highly pertinent, and the Mongolian gerbil model has emerged as one of the most useful. Objective The present study aims to evaluate, through serial otoendoscopies, the development and characteristics of pars flaccida retraction pocket and cholesteatoma in Mongolian gerbils after obliteration of the eustachian tube and compare it with the control group. Methods Forty Mongolian gerbils were divided into two groups of 20 animals each. In the intervention group, the animals were followed with serial otoendoscopies after eustachian tube obliteration. In the control group, the animals were only followed through serial otoendoscopies. Results At the end of the 16-week follow-up, cholesteatoma was present in 13 of 38 (34.2%) ears in the intervention group, and in 7 of 34 (20.6%) in the control group ( p = 0.197). When we considered cholesteatoma and its potential precursor, pars flaccida retraction pocket, in a combined way, we verified it in 23 of 38 (60.8%) in the intervention group and in 11 of 34 (32.3%) in the control group ( p = 0.016). Conclusions Over the 16 weeks of follow-up, serial otoendoscopies enabled us to evaluate the formation and development of pars flaccida retraction pockets and cholesteatomas in Mongolian gerbils and proved to be an excellent diagnostic tool.

Unmitigated negative nasopharyngeal pressure is associated with attic retraction pocket formation: LaPlace's law in action.

Decades of clinical observation have led our subspecialty team to suspect that negative nasopharyngeal pressure is associated with attic retraction pocket formation. Furthermore, LaPlace's law, which states that the pressure within a sphere varies with the inverse of the radius, provides the dynamic explanation for why the attic area of the tympanic membrane tends to retract more frequently than the pars tensa. The attic retraction pockets of 154 patients were classified into grades of severity (grades I-V). Impedance audiometry of middle-ear pressure was measured in the resting state, and after sniffing, swallowing and the Valsalva manoeuvre. Negative nasopharyngeal pressure (sniffing) caused a diminution of middle-ear pressure of -5 daPa on average in normal ears, and of -24 daPa to -45 daPa for tympanic membranes with attic retraction pockets of grade I to grade V. Attic retraction pockets are associated with greater collapse of middle-ear volume when negative pressure is created in the nasopharynx. LaPlace's law, and the composition of the pars flaccida, suggests an explanation for why the attic region retracts more than the pars tensa.

Clinical analysis of 21 cases of cholesteatoma recidivism after canal-wall-up mastoidectomy with tympanoplasty

Objective:To discuss the possible reasons for cholesteatoma recidivism after canal-wall-up mastoidectomy with tympanoplasty by analyzing clinical characteristics of patients. Methods:Data of 21 cases who suffered from cholesteatoma recidivism after canal-wall-up surgery were retrospectively reviewed, including preoperative examination, high resolution temporal bone CT, and intraoperative findings. Results:90.5%（19/21） cases had recurrent cholesteatoma with retraction pockets. Among 12 cases with previous operative notes, 66.7%（8/12） had extensive cholesteatoma which was not limited to attic in the original surgery. The intraoperative features of revision surgery in 21 patients including the destruction of reconstructive lateral attic wall and scutumwere found in 19.0%（4/21） cases, the head of malleus left in 19.0%（4/21） cases, the cholesteatoma found in hidden part in 14.3%（3/21） cases, the hadeustachian tube dysfunction in 38.1%（8/21）cases. the sclerotic mastoid in 42.9%（9/21） cases. hadanatomic variations of the temporal bone in 14.3%（3/21） cases and atresia of external auditory canal in 4.8%（1/21） cases. Conclusion:In this group of recidivism cases, most patients had extensive cholesteatoma, which may lead to excessive mucosa loss during lesion clearance, poor ventilation of tympanic isthmus after surgery, and promote the formation of retraction pocket. In addition, some cases had eustachian tube dysfunction, unstable reconstruction of attic lateral wall, and improper selection of the indications, which may also increase the risk of recurrence. Therefore, in order to reduce cholesteatoma recidivism after canal-wall-up surgery, attention should be paid to the striction of surgical indications, comprehensive preoperative evaluation, thorough clearance of lesions and firm reconstruction.

Retraction pockets of the tympanic membrane – introduction to the development of cholesteatoma

The tympanic membrane retraction pocket is a phenomenon that is described as a deformation of the tympanic membrane (most often hollow) caused by long persistent negative pressure inside the tympanic cavity. There are many theories about the pathomechanism of the formation of retraction pockets, but the most probable seems to be the one that which talks about pockets as a natural attempt by the body to heal inflammation in the tympanic cavity. Most untreated retraction pockets can lead to the development of cholesteatoma, which is so important knowing the classification of pockets. Due to it, it is possible to properly assess pathology and apply an appropriate treatment. There is no standardized scheme to the treatment of retraction pockets. Everything depends on the severity of the disease as well as on the co-occurrence of the upper respiratory tract infections or ear effusion.

Comparision of Allogenic Cartilage and Autologous Cortical Bone in Ossicular Reconstruction: A Comparative Study.

Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves the result in hearing. This study was conducted to compare and analyze the outcome of ossicular reconstruction using allogenic septal spur cartilage and autologous cortical bone in terms of hearing results and graft uptake rates. Study design: randomized clinical trial. Study included 112 patients visiting our ENT department. Patients between 16 and 50years of age with history of chronic ear discharge and air-bone-gap (ABG) of > 35dB and ossicular involvement were included in the study. The patients underwent detailed ENT examination, audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with allogenic septal spur cartilage (group I) and autologous cortical bone (group II) randomly. The patients were followed up to 6months to analyze functional and anatomical results. 50 patients out of 56 patients (90%) from group I who underwent allogenic septal cartilage ossicular reconstruction showed significant improvement in hearing as assessed by pure tone audiogram after 3months and 6months. Remaining 10% of patients who did not show hearing improvement on PTA were reopened after 6months. It was observed that the stapes head got necrosed in them. 40 patients (72%) out of 56 patients (50%) from group II who underwent autologous cortical bone reconstruction showed hearing improvement. Remaining 16 patients (28%) showed no hearing improvement. They were reopened and ankylosis, dislocation of ossicle and extrusion were noted. In our study, graft uptake rates, formation of retraction pockets, and hearing improvements were analyzed. Complications like ankylosis formation, dislocation of ossicle and extrusion rates were more in the group II compared to group I. Hearing results of group I are better compared to group II and the allogenic septal cartilage being readily available is a good option for ossicular reconstruction.

Comparison of graft uptake in patients undergoing myringoplasty/ tympanoplasty by overlay and underlay procedure.

Objectives: To determine which method underlay or overlay has higher results in graft uptake in Tympanoplasty. Study Design: It was experimental study. Setting: it was carried out at ENT Department of Benazir Bhutto Hospital, Rawalpindi. Period: One year from March 2017 to February 2018. Material and Methods: It consisted of a total of 27 patients presenting with chronic otitis media with dry perforation. Two groups of patients were made. Group A had 14 members who undergone underlay technique while the 13 patients in group B undergone overlay technique. Comparison was made on basis of successful graft uptake the main criteria of which was absence of lateralization, atelectasis, blunting or formation of retraction pockets by the end of 6 weeks of follow up. Result: Out of the 27 surgeries, 70.37% of the Myringoplasties were successful. The percent graft uptake came out to be 61.5% with overlay and 78.5% with underlay myringoplasty. In 15 out of the 27 surgeries temporalis fascia was used with a graft uptake rate of 80%, the 12 grafts taken from tragus had a graft uptake rate of 58.33%. Conclusion: Underlay myringoplasty technique has higher results than overlay myringoplasty technique.

Endoscopic Management of Tympanic Membrane Retraction Pockets: A Two Handed Technique with Endoscope Holder.

The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction pocket are pars flaccida and postero-superior parts. Decision about the procedure and the timing of the treatment of retraction pockets is debatable and depends on the functional and anatomic condition of the ear. To evaluate the results of the technique of two handed endoscopic management of retraction pockets with sliced tragal cartilage. Prospective Non Randomized Clinical Study. The study included 41 ears operated with the technique of two handed endoscopic cartilage tympanoplasty for retraction pockets with endoscope holders from November 2013 to May 2016 with a follow up period ranging from 22 to 53months. Cases of cholesteatoma and tympanic membrane perforation were excluded from the study. Pre and postoperative symptoms and air-bone gaps were recorded. The average preoperative air-bone gap in the study group was 24.53 ± 4.326dB. 28 ears were of pars tensa retractions (stage II-4, stage III-15, and stage IV-9) and 13 were pars flaccida retractions (stage III-8 and stage IV-5). 24 ears had ossicular erosion. The follow up revealed that, the results of two handed endoscopic sliced cartilage tympanoplasty for retraction pockets were stable and there was no recurrence of the retraction and the post-operative air-bone-gap closure was achieved to 13.62 ± 4.78, 14.13 ± 5.91dB, 14.32 ± 3.46 and 14.57 ± 3.88dB at 6months, 1 year, 2 years, 3 years respectively. Though, indications for surgery are based mostly on anatomic status and observation of behaviour of retraction pocket over time, we recommend early management of retraction pockets by the technique of endoscopic sliced tragal cartilage tympanoplasty with tragal cartilage of 0.5mm thickness using endoscope holder. Level of Evidence: Level 4.

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

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

Effects of the fibers distribution in the human eardrum: A biomechanical study

The eardrum separates the external ear from the middle ear and it is responsible to convert the acoustical energy into mechanical energy. It is divided by pars tensa and pars flaccida. The aim of this work is to analyze the susceptibility of the four quadrants of the pars tensa under negative pressure, to different lamina propria fibers distribution. The development of associated ear pathology, in particular the formation of retraction pockets, is also evaluated. To analyze these effects, a computational biomechanical model of the tympano-ossicular chain was constructed using computerized tomography images and based on the finite element method. Three fibers distributions in the eardrum middle layer were compared: case 1 (eardrum with a circular band of fibers surrounding all quadrants equally), case 2 (eardrum with a circular band of fibers that decreases in thickness in posterior quadrants), case 3 (eardrum without circular fibers in the posterior/superior quadrant).A static analysis was performed by applying approximately 3000Pa in the eardrum. The pars tensa of the eardrum was divided in four quadrants and the displacement of a central point of each quadrant analyzed. The largest displacements of the eardrum were obtained for the eardrum without circular fibers in the posterior/superior quadrant.

Evaluation of Hearing Results of Anterior Atticoantrostomy in Childhood Cholesteatoma

Objectives: We aimed to evaluate hearing results and complications of anterior atticoantrostomy in pediatric patients who had cholesteatoma. Methods: This is a clinical retrospective study. Fifty children who underwent anterior atticoantrostomy for cholesteatoma were included. Patients’ preoperative and postoperative pure tone audiometry results were compared. In addition, postoperative complications including formation of retraction pockets, perforation, recurrence of cholesteatoma, and absorption of cartilage were analyzed. Results: The mean age of the patients was 12.7 years, with 27 female and 23 male patients. Patients’ preoperative and postoperative air-bone gaps were narrowed significantly. Number of retraction pockets, recurrence of cholesteatoma, and perforations seen were 3, 7, and 4, respectively. Conclusion: Anterior atticoantrostomy is a safe method with low complication rate and can be applied in pediatric cholesteatoma cases with good hearing results.

Long-Term Results of Canal Wall Reconstruction Tympanomastoidectomy

Objectives This study was designed to evaluate the long-term results using the technique of canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma. Study Design Institutional review board–approved retrospective case review. Setting Tertiary referral center. Patients Retrospective review was performed on consecutive patients undergoing CWR tympanomastoidectomy with mastoid obliteration at a single institution from 1997 to 2011. Main Outcome Measures Status of tympanic membrane and ear canal anatomy, preoperative and postoperative audiometry, residual cholesteatoma at second look surgery, postoperative complications, recurrence rate, and location. Results Two hundred eighty-five ears in 273 patients underwent CWR tympanomastoidectomy with a mean age of 35 years with average follow-up of 4.29 years (median, 3.16 yr). A second-look ossiculoplasty was performed in 253 (89%). Recurrent retraction pocket formation occurred in 34 ears (13%). A secondary endaural atticotomy only was required to improve access for debridement in 16 of these 34 ears (5.8% of total ears). Only 7 ears (2.6%) required a revision open cavity mastoidectomy (n = 5) or subtotal petrosectomy (n = 2) for recurrent cholesteatoma. Those undergoing second-look ossiculoplasty demonstrated a small improvement in preoperative versus postoperative air-bone gap (ABG), 28 dB versus 23 dB, respectively. Postoperative infection occurred in 16 patients (5.6%) with 1 patient requiring conversion to open cavity mastoidectomy. Conclusion A CWR tympanomastoidectomy provides excellent intraoperative exposure of the middle ear and mastoid without the long-term disadvantages of a canal wall down mastoidectomy. Long-term follow-up demonstrates that there were only 2.6% failures requiring conversion to an open cavity or subtotal petrosectomy. Level of Evidence 4

Ocena wyników zastosowania nowego wspornika systemu Baha® i nowej techniki chirurgicznej bez redukcji tkanki podskórnej

The aim of this study is the evaluation of results of using new Baha abutment covered by hydroxyapatite (Baha® BA400, Cochlear Ltd.) which enables new surgical technique without soft tissue reduction. Material and methodsThe results of treatment of 9 adult patients were compared with results of 126 patients implanted earlier by standard technique with soft tissue reduction. ResultsIn analyzed group we find: slight shortening of time of surgery, similar results of implant stability (RFA) before sound processor connection, very good cosmetic results in 6 patients, some soft tissue overhanging in 2 and retraction pocket formation and inflammation (Holgers 2) in 1, no numbness and pain in operated area in all operated. ConclusionsNew Baha abutment covered by hydroxyapatite (Baha® BA400) enables to safely use new surgical technique without soft tissue reduction. In authors’ opinion the most important benefit from this technique is limited bleeding during operation, reduction of using of coagulation and less risk of lesion of nerves and numbness or pain after operation. This technique required less time, but the need of measuring of soft tissue and choosing of proper abutment cause longer preoperative time, so the time of all procedure is only slightly shorter. The esthetic results and healing process confirm the advantage of technique without soft tissue reduction over standard technique. However in patients with a thick soft tissue there is a risk of soft tissue overhanging, so in such cases it is better to make a partial soft tissue reduction.

Epitympanoplasty with cartilage obliteration in the preservation of posterior canal wall: a technique for surgical treatment of attic cholesteatoma

To report and evaluate the surgical outcomes of the treatment of attic cholesteatoma using epitympanoplasty with cartilage obliteration in the preservation of the posterior canal wall. Our study group consists of 138 subjects with attic cholesteatoma who underwent surgery of the mastoidectomy of the intact posterior canal wall and epitympanoplasty with cartilage obliteration, from November 2008 to November 2010. The major techniques employed included the following: (1) mastoidectomy with the preservation of the posterior canal; (2) removal of the scutum; (3) epitympanum obliteration with cartilage, and (4) mastoid obliteration with bone dust. The post-operative observation period was between 2 and 4years. All patients were examined via microscopy and oto-endoscopy. Of these 138 subjects, 91 subjects have a follow up period of more than 3years. There was no retraction pocket formation in the epitympanum in all cases. However, in two subjects, there was a recurrence of cholesteatoma within the mesotympanum. Other observable post-surgery complications were also recorded. For hearing results, 64 of the 138 subjects underwent post-operative audiometric testing for 2 to 3years and 3 to 4years consecutively. The average pre- and post-operative air-bone gap closure was found to be 11.97±11.02dB for the 2 to 3year period, and 10.08±10.34dB for the 3 to 4year period. Based on the results of our study group, epitympanoplasty with cartilage obliteration in the preservation of the posterior canal wall is a better alternative treatment technique for attic cholesteatoma.

Attic Reconstruction in Pediatric Canal Wall‐up Mastoidectomy

Objective: 1) To evaluate 3 methods: conchal cartilage, tragal cartilage, and bone pate, for primary attic reconstruction (scutumplasty) in pediatric canal wall-up mastoidectomies in terms of recurrence rates and formation of retraction pockets. Method: All patients undergoing attic reconstruction following a canal wall up mastoidectomy were evaluated from a single surgeon prospective pediatric otological database maintained over a 10-year period. The reconstruction of the scutum defects was done using bone pate, conchal and tragal cartilage. The outcome measures were postoperative retraction pocket formation and recurrence of cholesteatoma. Results: A total of 120 patients underwent primary attic reconstruction following canal wall-up mastoidectomy over a 10-year period. The overall recurrence rate was 9.83% (n = 12). Fifty-one patients underwent attic reconstruction with tragal cartilage, while 33 were reconstructed using conchal cartilage and 36 with bone pate. The recurrence rate with various reconstruction methods was 5.8% (n = 2), 15.1% (n = 5), and 13.8% (n = 5) for tragal, conchal, and bone pate, respectively. Cholesteatoma recurrence rates with the use of tragal cartilage for reconstruction of the scutum were significantly lower as compared to that of conchal cartilage ( P = .034, chi square = 3.308) and bone pate ( P = .046, chi square = 2.834). Conclusion: The use of the tragal cartilage for scutum reconstruction is associated with the least recurrence rate for pediatric cholesteatoma. The easy accessibility, stability, and good long-term results with the use of the tragal cartilage makes it an ideal material for outer attic wall reconstruction in pediatric canal wall up mastoidectomies.

Middle Ear Mechanics of Cartilage Tympanoplasty Evaluated by Laser Holography and Vibrometry

To assess the effects of thickness and position of cartilage used to reconstruct the tympanic membrane (TM) using a novel technique, time-averaged laser holography. Cartilage is commonly used in TM reconstruction to prevent formation of retraction pockets. The thickness, position, and shape of the cartilage graft may adversely affect TM motion and hearing. We sought to systematically investigate these parameters in an experimental setting. Computer-assisted optoelectronic laser holography was used in 4 human cadaveric temporal bones to study sound-induced TM motion for 500 Hz to 8 kHz. Stapes velocity was measured with a laser Doppler vibrometer. Baseline (control) measurements were made with the TM intact. Measurements were repeated after a 0.5- or 1.0-mm-thick oval piece of conchal cartilage was placed on the medial TM surface in the posterior-superior quadrant. The cartilage was rotated so that it was either in contact with the bony tympanic rim and manubrium or not. At frequencies less than 4 kHz, the cartilage graft had only minor effects on the overall TM fringe patterns. The different conditions had no effects on stapes velocity. Greater than 4 kHz, TM motion was reduced over the grafted TM, both with 0.5- and 1.0-mm-thick grafts. No significant differences in stapes velocity were seen with the 2 different thicknesses of cartilage compared with control. Computer-assisted optoelectronic laser holography is a promising technique to investigate middle ear mechanics after tympanoplasty. Such positioning may prevent postoperative TM retraction. These findings and conclusions apply to cartilage placed in the posterior-superior TM quadrant.

Epitympanoplasty with mastoid obliteration technique: A long-term study of results

Objective To report the long-term results of epitympanoplasty with mastoid obliteration technique. Subjects and Methods Two hundred adult cases had undergone epitympanoplasty with mastoid obliteration from December 1994 to May 2003. The mean postoperative observation period was 91 months, with a minimum of five years. Epitympanoplasty with mastoid obliteration technique has four major procedures: the widening of the external auditory canal and removal of the scutum; preservation of the posterior canal wall; epitympanoplasty; and mastoid obliteration. We examined postoperative complications and hearing outcomes. Results There was no retraction pocket formation and recurrence of cholesteatoma. Residual cholesteatoma in the tympanic cavity was seen in 10 cases (5%) and three cases were seen in the mastoid cavity (1.5%). Other complications were otorrhea (15 cases), perforation (8 cases), material extrusion (6 cases), and posterior auricular infection (4 cases). The average preoperative pure tone air-bone gap, postoperative pure tone air-bone gap, and air-bone gap closure were 31.5 ± 12.4 dB, 25.3 ± 12.2 dB, and 6.2 ± 12.6 dB, respectively. There were significant differences between the preoperative and postoperative values ( P < 0.01). Conclusions The authors believe that epitympanoplasty with mastoid obliteration technique can combine the advantages of canal wall down and canal wall up techniques while improving their shortcomings.

A New Role of Staged Tympanoplasty for Cholesteatoma

Objective 1) Investigate a correlation between pathological findings at the 2nd stage operation and long-term outcomes in a staged canal wall-up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study. Methods SCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow-up with endoscopic observation and CT was performed for all patients. Results At the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long-term follow up study revealed that the statistically higher incidence of RP re-formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively. Conclusions The present study showed that the long-term outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long-term prognosis in addition to exploration of RC.