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Gutierrez JA, Cabrera CI, Stout A, Mowry SE. Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:1453-1466. [PMID: 36951041 DOI: 10.1177/00034894231159000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. METHODS A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. RESULTS Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. CONCLUSION Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. LEVEL OF EVIDENCE 3B.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amber Stout
- Medical Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Song I, Oh KH, Kim HJ, Lee YH, Lim KH, Yoon HS, Rah YC, Choi J. Audiologic results of total ossicular replacement prosthesis bypassing the stapes suprastructure in canal wall down mastoidectomy. Am J Otolaryngol 2023; 44:103969. [PMID: 37437334 DOI: 10.1016/j.amjoto.2023.103969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Sometimes performing PORP adequately is challenging when the stapes is tilted or the suprastructure is partially damaged owing to inflammation or infection. In such cases, the implementation of a TORP bypassing the stapes can be a useful alternative. This study aimed to investigate whether bypassing the stapes suprastructure during total ossicular replacement prosthesis (TORP) affects postoperative complications or audiological outcomes. MATERIAL AND METHODS Among 104 patients who underwent open cavity mastoidectomy and ossiculoplasty using a titanium prosthesis at Korea University Ansan Hospital between January 2012 and December 2019, we compared the preoperative and postoperative audiological results and surgical complications of 52, 21, and 31 patients who underwent partial ossicular replacement prosthesis (PORP), TORP bypassing the remaining stapes suprastructure, and TORP on the stapes footplate or oval window, respectively. RESULTS The air-bone gap before surgery was significantly different in the TORP on the stapes footplate group (34.2 ± 12.0 dB) than that in the PORP (22.9 ± 13.8 dB) and TORP bypassing the stapes groups (20.7 ± 11.5 dB, p < 0.001). After surgery, there were no significant differences among the groups (p = 0.818). The air-bone gap difference before surgery was associated with the presence of stapes before surgery (p < 0.001). There was no difference in the proportion of postoperative tympanic perforation, whether it was a revision surgery, malleus status, or the size of perforation of the tympanic membrane among the three groups. CONCLUSION When performing ossiculoplasty using TORP, bypassing the stapes did not affect surgical and audiologic outcomes.
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Affiliation(s)
- Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Kyoung Ho Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hong Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ye Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Kang Hyeon Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hee Soo Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
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Castro A, Sousa F, Azevedo S, Lino J, Abrunhosa J, Meireles L. Labyrinthine Fistula in Chronic Otitis Media Surgery: Management and Outcomes. Indian J Otolaryngol Head Neck Surg 2023; 75:60-65. [PMID: 37206777 PMCID: PMC10188663 DOI: 10.1007/s12070-022-03208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
The objective of this retrospective study was to present the experience on the management of labyrinthine fistula secondary to chronic otitis media in a tertiary center. 263 patients, who underwent tympanomastoidecomy, in Centro Hospitalar Universitário do Porto, between 2015 and 2020 were reviewed, to select only those with labyrinthine fistulas. 26 patients (9.89%) had cholesteatoma complicated by fistula of the lateral semicircular canal. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. Preoperative high-resolution computed tomography predicted fistula in 54%. Using the Dornhoffer and Milewski classification, 10 cases (38.46%) were identified as stage I, 15 (57.69%) at stage II, and 1 (3.85%) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In one patient matrix was left over the fistula. After surgery, hearing (bone conduction) was preserved or improved in 73% of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula, type of material used in fistula repair and the hearing outcome. Also, we didn't find a statistically significant relationship between extent of the labyrinthine fistula and the presence of facial nerve canal dehiscence, tegmen timpani erosion, sigmoid sinus exposure or ossicular bone erosions. In conclusion, a complete and nontraumatic removal of cholesteatoma matrix over the fistula in a single-staged procedure, is a safe and effective procedure, which achieves a hearing preservation or improvement in most cases.
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Affiliation(s)
- Afonso Castro
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Sara Azevedo
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Lino
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Abrunhosa
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Meireles
- Centro Hospitalar Universitário do Porto, Porto, Portugal
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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鲁 兆, 潘 滔, 王 宇. [Postoperative hearing in tympanoplasty preserving the manubrium of malleus and tensor tympani muscle tendon]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:981-987. [PMID: 34886600 PMCID: PMC10128360 DOI: 10.13201/j.issn.2096-7993.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Indexed: 06/13/2023]
Abstract
Objective:To study the effect of retaining the manubrium of malleus and tensor tympani muscle tendon (TT) on postoperative hearing reconstruction in tympanoplasty. Methods:Ninety-seven patients underwent tympanoplasty and ossiculoplasty in Peking University Third Hospital from January 2012 to December 2017, their postoperative results of audiometry were analyzed and compared with the preoperative results. The patients were divided into two groups according to retaining the manubrium of malleus and TT or not during the operation. Retention group include the cases with the manubrium of malleus and TT retained, resection group include the cases with TT resected with the manubrium retained or resected. T test was used to analyze and compare the differences of air conduction threshold air-bone gap (ABG) and the postoperative improvement between the two groups. Results:One year after operation, the air conduction thresholds and ABG were lower in retention group (n= 44) than those in resection group (n= 53) at each frequency, and there were differences with statistically significant at 0.25, 0.5 and 1.0 kHz (P<0.05); the postoperative improvement of hearing thresholds and ABG at above frequencies in retention group was better than that in resection group. In cases with canal-wall-up operations or partial ossicular prostheses implanted, the above differences still existed between the two groups with statistical significance (P<0.05); while in cases with canal-wall-down operations or total ossicular prostheses implanted, there were no significant differences between the two groups (P>0.05). Conclusion:The preservation of the manubrium of malleus and TT is significant for postoperative hearing improvement in tympanoplasty, especially in the canal-wall-up operation with partial ossicular prostheses.
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Affiliation(s)
- 兆毅 鲁
- 北京大学第三医院耳鼻咽喉科(北京,100191)Department of Otolaryngology, Peking University Third Hospital, Beijing, 100191, China
| | - 滔 潘
- 北京大学第三医院耳鼻咽喉科(北京,100191)Department of Otolaryngology, Peking University Third Hospital, Beijing, 100191, China
| | - 宇 王
- 北京大学第三医院耳鼻咽喉科(北京,100191)Department of Otolaryngology, Peking University Third Hospital, Beijing, 100191, China
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Zhang M, Chen X, Huang Y, Yang Z, Zhang Y, Wu X. The effect of using a PORP to reconstruct the ossicular chain under otoendoscopy with and without a malleus handle. Acta Otolaryngol 2021; 141:19-22. [PMID: 33063573 DOI: 10.1080/00016489.2020.1815835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There are many reports on the role of the malleus handle in ossicular chain reconstruction (OCR). However, the effect of the presence of the malleus handle is not clear. AIM/OBJECTIVES To compare the hearing outcomes of using a partial ossicular replacement prosthesis (PORP) to reconstruct the ossicular chain under otoendoscopy with and without a malleus handle. METHODS Records of 57 patients requiring OCR were retrospectively analyzed. They were divided into the malleus handle-present group (group 1) and the malleus handle-absent group (group 2). The audiometric results were analyzed pre- and postoperatively. A postoperative air-bone gap (ABG)≤20 dB was considered successful. RESULTS The mean improvement in air conduction hearing thresholds was 19.80 dB in group 1 and 16.70 dB in group 2. The mean ABG improvement was 18.09 ± 12.79 dB for group 1 and 17.20 ± 16.44 dB for group 2. The malleus handle-present group achieved higher success (65.63%) than the malleus handle-absent group (52%; p> .05). CONCLUSIONS AND SIGNIFICANCE Improvements in hearing outcomes were similar for the two groups. However, the malleus handle-present group showed a better reconstruction success rate. Our results suggest that if there is no lesion in the malleus handle, it is recommended to be retained.
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Affiliation(s)
- Min Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyun Chen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yideng Huang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zifei Yang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yue Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianmin Wu
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Neo WL, Yuen HW. TORP ossiculoplasty in the presence of an intact stapes superstructure. Am J Otolaryngol 2021; 42:102831. [PMID: 33221637 DOI: 10.1016/j.amjoto.2020.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In this series, we describe ossicular reconstruction using routine TORP in the presence of the stapes superstructure using a tympanic-membrane-to-footplate configuration. MATERIALS AND METHODS This is a case series of 12 patients who underwent TORP ossiculoplasties from 1st January 2010 to 31st October 2017. Data collected included demographics, indication for surgery, status of the middle ear and pre-operative and post-operative audiometric data (including pure tone average (PTA) and air-bone gap (ABG)). RESULTS The mean pre-operative PTA was 56.5 dB and ABG was 39.8 dB. Surgical success (ABG ≤ 20 dB) was achieved in 83.3%, with an average improvement in PTA of 24.3 dB and closure of ABG of 27.1 dB. The mean post-operative ABG was 12.7 dB. CONCLUSION TORP ossiculoplasty with tympanic-membrane-to-footplate configuration is a feasible means of ossicular reconstruction, independent of the status or spatial arrangement of the remnant ossicles. Using this technique, it is possible to achieve a consistently good outcome for improvement in hearing and closure of ABG.
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Affiliation(s)
- Wei Li Neo
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - Heng Wai Yuen
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
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Job K, Składzień J. The suitability of scanning electron microscopy in the evaluation of bone structure surfaces and selection of alloplastic materials for facial skeletal reconstruction. Otolaryngol Pol 2020; 75:14-19. [PMID: 34344840 DOI: 10.5604/01.3001.0014.6174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Functional and aesthetic problems can arise even from small losses created in the facial skeleton. Injuries and oncological surgeries are the most frequent causes of these losses within the facial skeleton. Advances in surgical interventions have allowed for ever-increasing degrees of resections, increasing oncological radicality as well as treatment effectiveness, providing the patient with the chance for a longer life. However, this subsequently requires the use of even more advanced reconstruction techniques in order to restore quality of life and comfort to the patient, as well as enable their return to professional and social activities. The necessity of reconstructive surgery applies not only to patients with cancer, but also to patients with impaired or failing sensory and organ function as a result of inflammatory conditions, injuries, or non-oncological surgeries. There are many available reconstruction procedures, which depend on the location of the loss, the type of tissue lost, the degree of loss and patient-dependent factors. Materials used in reconstruction surgeries may include the patients' tissues when available, and artificial reconstruction materials otherwise. MATERIAL AND METHODS The analysis involved fragments of bone tissue removed during surgery. Due to the nature of the medical procedure and the inability to replant the tissue, it was regarded as medical waste. The preparations used were observed under an optical microscope and an electron scanning microscope, and a chemical analysis was performed. The chemical composition of samples was analysed using a low vacuum detector (LVD) at an accelerating voltage of 15 kV and 10 kV and at a spot size of 4 and 3.5. The observations were performed in a secondary electron (SE) detection system. RESULTS Observation of parameters under an optical microscope and of images obtained using an electron scanning microscope showed the presence of typical, compact bone tissue with varied surface shapes in each case (various degrees of unevenness and porosity). Chemical composition analysis confirmed the presence of compounds from the CaO-P2O5-H20 system. The Ca/P (calcium/phosphorus) ratio obtained from the chemical analysis varied from 1.33 to 2.1, and indicated a varied morphology of calcium phosphates forming the bone structures of the facial skeleton. CONCLUSIONS 1. Calcium phosphates are characterised by excellent biocompatibility because of their chemical affinity to bone, and are ideal for the reconstruction of bone losses within the facial skeleton. 2. Biodegradable polymers have the highest functional potential among several groups of biomaterials used in tissue engineering because of their ability to be tailored individually, in addition to their high biocompatibility.
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Affiliation(s)
- Katarzyna Job
- Department of Otolaryngology, Jagiellonian University Medical College in Krakow, Poland
| | - Jacek Składzień
- Department of Otolaryngology, Jagiellonian University Medical College in Krakow, Poland
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Volokhov LL, Pankova VB. [Modern ideas about the professional suitability of employees of regulated professions with middle ear pathology and the possibility of their return to work (analytical review of the literature)]. Vestn Otorinolaringol 2020; 85:58-64. [PMID: 32885639 DOI: 10.17116/otorino20208504158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fitness for work in persons with middle ear disease who are exposed to harmful work environment and their possible return to work was analyzed. Fitness for work expertise procedure in the Russian Federation is disclosed in detail. A list of medical contraindications to work in harmful and/or dangerous work environment according to hearing condition is given. Clinical aspects of middle ear diseases in the industry workers are presented and modern ideas about middle ear surgical treatment, it's functional results, documenting technique and outcome calculation are described in detail. Possibility of returning the employee to work is discussed based on all the analyzed materials.
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Affiliation(s)
- L L Volokhov
- National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, Moscow, Russia
| | - V B Pankova
- National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, Moscow, Russia.,All-Russian Research Institute of Railway Hygiene, Moscow, Russia
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