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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 24  |  Issue : 4  |  Page : 227-230

The results of tympanoplasty for chronic suppurative medial otitis: Our experience for 10 years


Department of Otolaryngology-Head and Neck Surgery, Pyongyang Medical College Hospital, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea

Date of Web Publication15-Mar-2019

Correspondence Address:
Dr. Chol-Ung Sin
Department of Otolaryngology-Head and Neck Surgery, Pyongyang Medical College Hospital, Kim Il Sung University, Ryonhwa-dong, Central District, Pyongyang
Democratic People's Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_48_18

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  Abstract 


Object: The aim is to analyze the results of the tympanoplasty (TP) for the chronic suppurative medial otitis and some factors which influence to the results of the TP. Materials and Methods: A total of 133 patients (148 ears) with chronic suppurative medial otitis (CSMO) undergone TP at our hospital for 10 years, were reviewed and the rates of the tympanic membrane perforation closure and the improvement of hearing loss by type of CSMO and operation, were retrospectively evaluated. Results: The success rates of the perforation and hearing loss were 29 ears (85.2%) and 22 ears (75.9%) in myringoplasty, 77 ears (82.8%) and 54 ears (70.1%) in TP, and 17 ears (80.9%) and 11 ears (64.7%) in TP with mastoidectomy. Conclusion: The rates of the tympanic membrane perforation closure and improvement of the hearing loss were 123 ears (83.1%) and 87 ears (70.7%). Some factors influence on the success of TP for CSMO, such as choosing the operation, eradication of focus, processing fascia, and management the effusion, should be considered.

Keywords: Chronic suppurative medial otitis, ossiculoplasty, tympanoplasty


How to cite this article:
Sin CU, Kim TM, Cheo HS. The results of tympanoplasty for chronic suppurative medial otitis: Our experience for 10 years. Indian J Otol 2018;24:227-30

How to cite this URL:
Sin CU, Kim TM, Cheo HS. The results of tympanoplasty for chronic suppurative medial otitis: Our experience for 10 years. Indian J Otol [serial online] 2018 [cited 2019 Apr 23];24:227-30. Available from: http://www.indianjotol.org/text.asp?2018/24/4/227/254232




  Introduction Top


The chronic suppurative medial otitis is the incurable disease using the only drug so that many operations are being developed and introduced at the ear, nose, and throat field.

The operation for chronic supprative medial otitis (CSMO) is mainly divided by two, removing the inflammatory focus and repairing of destructed conductive structures, the results of these operations are being reviewed and announced. For example, simple and radical mastoidectomy were used to remove the inflammatory focus before, but as a prior stage for tympanoplasty (TP), atticotomy, intact canal wall mastoidectomy, modified radical mastoidectomy is taking place now.[1],[2],[3],[4],[5],[6],[7] At plastic operation field, many operation, such as myringoplasty (MP) using temporal fascia, perichondrial graft, and so on, and ossiculoplasty by autoossicle, auto cartilage, and artificial ossicle (plasti-pore), were introduced.[8],[9],[10],[11] Besides researches to find factors influence to TP are also being reported.[11],[12],[13],[14]

The aim of this investigation is to analyze the clinical and audiological results of TP for the patients with CSMO at our hospital for 10 years and to discuss some factors for TP.


  Materials and Methods Top


Materials

The 133 patients (148 ears) with CSMO undergone TP at our hospital from May 2006 to December 2017 were reviewed.

Methods

We analyzed the clinical and audiological results retrospectively by the type of CSMO and operation.

The CSMO was classified into simple medial otitis (SMO), granulomatous type (GMO), and cholesteatomatous medial otitis (CMO) by of the preoperative findings of the middle ear cavity; inactive (dry ear for >3 months) and active (discharged ear) type in SMO by otorrhea; tympanic and mastoid type in GMO and CMO by site of focus.

As the surgical operation, MP, TP, and TP with mastoidectomy (TPWM) were applied. The dry ears with the perforation <3 mm in diameter were treated by scratching the margin of the perforation and its results were included in MP results. If the destruction of incudostapedial joint was identified, ossiculoplasty was carried out using the autoossicle and tragus cartilage.

After following 3 months to 6 months, the results of treatment were evaluated.

The patients with 10 dB-50 dB of A-B gap before operation were selected to analyze the audiological data.

Before and at 3 months after the operation, the hearing test was done and then audiological results by pure tone audiometry A-B gap were analyzed.

The ears that had the reducing more than 10 dB than preoperative data were estimated of the ears with hearing improvements.


  Results Top


In 133 patients with CSMO, 84 patients (63.1%) were male and 49 patients (36.9%) were female. With age, there were 18 patients (13.5%) at teenage, 22 patients (24.1%) at 20s, 58 patients (43.6%) at 30s, 21 patients (15.8%) at 40s, three patients (2.2%) at 50s, and one patient (0.8%) at 60s.

The success rates for tympanic membrane perforation were 60 ears (84.5%) in SMO, 32 ears (82.1%) in GMO, 31 ears (81.6%) in CMO, and 123 ears (83.1%) [Table 1].
Table 1: Success rates for tympanic membrane perforation (%) n=148 ears

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In 15 ears with perforation <3 mm in diameter, the success rate was 14 ears (93.3%).

There were 12 ears with inflammation (48.0%) and 10 ears with massive effusion (40.0%) on the external ear canal in 25 ears with postoperative perforation [Figure 1].
Figure 1: Reperforation rates

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Among them, most of the perforations were the central perforation in the ears with effusion and the marginal perforation in the ears with inflammation [Figure 2].
Figure 2: Rates by type of perforation

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The mean duration for epithelialization on the external ear canal were 22 ± 5.2D in MP, 28 ± 4.7D in TP, and 45 ± 5.1D in TPWM.

There were 21 ears (53.8%) with retract and adhesive tympanic membrane after operation in 39ears with poor ventilation of the  Eustachian tube More Details.

The hearing improvement rates were 22 ears (75.9%) in MP, 54 ears (70.1%) in TP, 11 ears (64.7%) in TPWM, and 87 ears (70.7%) in total [Table 2].
Table 2: Hearing improvements by type of chronic suppurative medial otitis and operation (%) n=123 ears

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Postoperative A-B gap were 13.8 ± 5.0 dB in MP, 25.7 ± 6.1 dB in TP, and 30.1 ± 5.6 dB in TPWM. In every operation, postoperative results had significant differences than preoperative results [Table 3].
Table 3: A-B gap by type of operation (x̄±standard error, dB) n=123 ears

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In 41 ears with bony hearing loss before the operation, there were 10 ears (24.3%) with improvements more than 5 dB.


  Discussion Top


In this study, we analyzed the rates of the tympanic membrane perforation closure according to the type of the CSMO and operation, and the total success rate was 123 ears/148 ears (83.1%), which was in the range of literature (70%–90%).[14],[15],[16],[17],[18],[19],[20],[21]

The success rates of SMO were 29 ears (85.2%) in dry ears and 31 ears (83.7%) discharged ears, so that had no significant difference between both types.

Some researchers[14],[15] recommended MP after 3–6 months of dry in tympanic cavity, because success rate was higher in dry ear than in discharged ear, but in the present study, there was no significant difference between the dry ears and discharged ears, so it may be more preferable rather to select the operation by the type of CSMO than to consider the time for operation.

Furthermore, the success rate of the scratching method was 93.3% in the perforation with 3 mm in diameter, so that we think that the scratching method may be better than graft implantation in some cases.

In 25 ears with postoperative reperforation, the perforations with massive effusion were 10 ears (40%) and perforations with inflammation on the external ear canal were 12 ears (48.9%).

Many literatures[11],[12],[13],[16] reported that the inflammation and poor ventilation of Eustachian tube were included in failure factors for TP; in our study, the rates of reperation were high in ears with inflammation and effusion on the external canal; the ears with inflammation had many marginal perforation and the ears with effusion many central perforation. Therefore, we suppose that reoperation with massive effusion may be prevented by these drugs and these results may support the literature[22],[23] in which local desensitizer and decongestant are recommended to conservative therapy for CSMO. In addition, the central perforation may be related to process the graft thinly.

In our cases, retract or adhesive tympanic membranes at 2 months after operation were 21 ears (53.8%), that was similar with some literature.[11],[12]

According to some documents, the results of ossiculoplasty using the autossicle and cartilage range 46%–85%.[8],[14],[17],[20]

The ears with A-B gap reduced more than 10 dB, were 22 ears (75.9%) in MP, 54 ears (70.1%), and 11 ears (64.7%) in TMWM; the rates of hearing improvements using autossicle and cartilage was 25 ears/27 ears (67.6%).

Besides, we founds that some cases had the improvements of the bony threshold; this result may be related with the change in the solid angle of the oval window and the round window.


  Conclusion Top


The rates of the tympanic membrane perforation closure and improvement of the hearing loss were 123 ears (83.1%) and 87 ears (70.7%).

Some factors influenced on the success of TP for CSMO, such as choosing the operation, eradication of the focus, processing the fascia, and management the effusion, should be considered.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M, et al. Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: Is it necessary? Otolaryngol Head Neck Surg 1997;117:592-5.  Back to cited text no. 1
    
2.
Nikolopoulos TP, Gerbesiotis P. Surgical management of cholesteatoma: The two main options and the third way – Atticotomy/limited mastoidectomy. Int J Pediatr Otorhinolaryngol 2009;73:1222-7.  Back to cited text no. 2
    
3.
Uyar Y, Oztürk K, Keles B, Arbaǧ H, Ulkü CH. Anterior atticoantrostomy for cholesteatoma surgery. Ann Otol Rhinol Laryngol 2006;115:150-5.  Back to cited text no. 3
    
4.
Grewal DS, Hathiram BT, Saraiya SV. Canal wall down tympanomastoidectomy: The 'on-disease' approach for retraction pockets and cholesteatoma. J Laryngol Otol 2007;121:832-9.  Back to cited text no. 4
    
5.
Gantz BJ, Wilkinson EP, Hansen MR. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope 2005;115:1734-40.  Back to cited text no. 5
    
6.
Marchioni D, Soloperto D, Rubini A, Villari D, Genovese E, Artioli F, et al. Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: Our experience. Int J Pediatr Otorhinolaryngol 2015;79:316-22.  Back to cited text no. 6
    
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McGuire JK, Wasl H, Harris T, Copley GJ, Fagan JJ. Management of pediatric cholesteatoma based on presentations, complications, and outcomes. Int J Pediatr Otorhinolaryngol 2016;80:69-73.  Back to cited text no. 7
    
8.
Hasaballah MS. Audiological and otological outcome in Bi-island chondroperichondrial graft type I tympanoplasty. Egypt J Ear Nose Throat Allied Sci 2014;15:183-8.  Back to cited text no. 8
    
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Karaman E, Duman C, Isildak H, Enver O. Composite cartilage island grafts in type 1 tympanoplasty: Audiological and ontological outcomes. J Craniofac Surg 2010;21:37-9.  Back to cited text no. 9
    
10.
Murphy TP. Hearing results in pediatric patients with chronic otitis media after ossicular reconstruction with partial ossicular replacement prostheses and total ossicular replacement prostheses. Laryngoscope 2000;110:536-44.  Back to cited text no. 10
    
11.
Prasad KC, Hegde MC, Prasad SC, Meyappan H. Assessment of eustachian tube function in tympanoplasty. Otolaryngol Head Neck Surg 2009;140:889-93.  Back to cited text no. 11
    
12.
Prasad V. A study of middle ear reconstruction, the degree of functional restoration and causes of graft failure following chronic ear disease. Egypt J Ear Nose Throat Allied Sci 2014;15:103-8.  Back to cited text no. 12
    
13.
Eisenbeis JF, Herrmann BW. Areolar connective tissue grafts in pediatric tympanoplasty: A pilot study. Am J Otolaryngol 2004;25:79-83.  Back to cited text no. 13
    
14.
Uyar Y, Keleş B, Koç S, Oztürk K, Arbaǧ H. Tympanoplasty in pediatric patients. Int J Pediatr Otorhinolaryngol 2006;70:1805-9.  Back to cited text no. 14
    
15.
Pignataro L, Grillo Della Berta L, Capaccio P, Zaghis A. Myringoplasty in children: Anatomical and functional results. J Laryngol Otol 2001;115:369-73.  Back to cited text no. 15
    
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Gamra OB, Nacef I, Abid W, Hariga I, Mbarek C. Myringoplasty in children: Our results. Egypt J Ear Nose Throat Allied Sci 2015;16:41-6.  Back to cited text no. 16
    
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Yurttas V, Yakut F, Kutluhan A, Bozdemir K. Preparation and placement of Cartilage Island graft in tympanoplasty. Braz J Otorhinolaryngol 2014;80:522-6.  Back to cited text no. 17
    
18.
Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: A comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 2007;264:985-9.  Back to cited text no. 18
    
19.
Indorewala S. Dimensional stability of free fascia grafts: Clinical application. Laryngoscope 2005;115:278-82.  Back to cited text no. 19
    
20.
Neto JA, Neiva FC, Brodskyn F, das Neves Palumbo M, Bittar AC, Petrilli RN, et al. Plug cartilage tympanoplasty in children. Braz J Otorhinolaryngol 2008;74:890-5.  Back to cited text no. 20
    
21.
Rickers J, Petersen CG, Pedersen CB, Ovesen T. Long-term follow-up evaluation of mastoidectomy in children with non-cholesteatomatous chronic suppurative otitis media. Int J Pediatr Otorhinolaryngol 2006;70:711-5.  Back to cited text no. 21
    
22.
Alper CM, Dohar JE, Gulhan M, Ozunlu A, Bagger-Sjobak D, Hebda PA, et al. Treatment of chronic suppurative otitis media with topical tobramycin and dexamethasone. Arch Otolaryngol Head Neck Surg 2000;126:165-73.  Back to cited text no. 22
    
23.
Mandel EM, Casselbrant ML, Rockette HE, Fireman P, Kurs-Lasky M, Bluestone CD, et al. Systemic steroid for chronic otitis media with effusion in children. Pediatrics 2002;110:1071-80.  Back to cited text no. 23
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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