Modified technique of tympanoplasty with functional results of 494 cases after 3 years

Anatomical and Functional Results of Medial and Lateral Surface of Temporal Muscle Fascia in Type 1 Tympanoplasties

AIM

The aim of this study is to investigate whether there is a difference in the anatomical success of the graft and the functional gain of hearing as a result of the medial or lateral surface application of the temporalis muscle fascia graft.

MATERIALS AND METHODS

Seventy-three patients who underwent tympanoplasty (myringoplasty) type 1 surgery due to tympanic membrane perforation between December 2017 and December 2019 were included in this study. The gender and age of the patients during this study were determined. Preoperative tympanic membrane perforation types were grouped as central, marginal subtotal, and total. Airway pure tone average threshold values were evaluated preoperatively at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz.

FINDINGS

Seventy-three patients were included in the study. Medial surface of the temporalis muscle fascia was placed onto the manubrium mallei of the malleus with over-underlay method in group 1 (n = 37) and similarly, lateral surface of the temporalis muscle fascia was placed onto the manubrium mallei of the malleus with over-underlay method in group 2 (n = 36). After tympanoplasty, it was seen that 79.5% of the grafts were intact. Graft success was lower in total perforations than other types; 51.7% of the patients with intact graft were group 1, and there was no significant relationship between graft success and groups. As a result of the assessment made in terms of hearing gain, a statistically significant change was detected in the hearing in the postoperative sixth month compared to the preoperative period in both groups.

CONCLUSION

In this study, we demonstrated that there is no difference in terms of the anatomical success of the graft and the functional gain of hearing with type 1 tympanoplasty surgery.

Bioactive glass-ceramics in ear surgery: animal studies and clinical results

In the search for better materials for middle ear reconstruction, ceramics have been suggested as an alternative. The bioactive glass-ceramic Ceravital was made available to us for animal experiments and clinical trials. To test its suitability in ear surgery, 101 ear operations were carried out in 53 rabbits including the reconstruction of 78 posterior auditory canal walls and the insertion of 174 middle ear implants. Parameters studied include the effects of bone paté in inducing new bone growth, the chronological course of bone apposition and remodeling, microscopic examination of mucous membrane growth on the implants and degree of lysis of the implant. In the past two and one half years some 250 ossicular prostheses have been implanted in man for reconstruction of the ossicular chain. A statistical analysis of 119 tympanoplasties after a follow-up of one and one half years shows no perforations of the tympanic membrane over the implants or rejection of the prosthesis from the middle ear. The audiological results achieved were more favorable with the use of ossicular prostheses made of bioactive glass-ceramic than those using allogenic ossicular grafts. On the basis of the histologic findings and observed clinical results, the bioactive material Ceravital is remarkably well suited for reconstruction of the posterior auditory canal wall and for implantation in direct contact with the tympanic membrane.

Findings in surgery for chronic otitis media. A retrospective data-analysis of 2225 cases followed for 2 years

Data on middle ear disease and follow-up was recorded and analysed in 2225 ears operated on for chronic otitis media between 1958 and 1975. The closure rate of tympanic membrane perforations (70-80%) was not influenced by the presence of otorrhoea, but it was significantly lower in patients aged below 15 or over 40 yr and especially when tympanic membrane homograft had been used. For all types of tympanoplasty the mean improvement in air-conduction threshold was most marked at the lower frequencies, being some 10 dB in Type I, 15 dB in Type II and 8 dB in Type III and IV and it decreased by some 3 dB per octave. The combination of cholesteatoma and tympanosclerosis appeared to be rare. The post-operative incidence of otorrhoea was 10-15% after modified radical mastoidectomy and 20-25% after radical mastoidectomy.