Retraction Pockets and Perforations
James R. Tysome, Rahul G. Kanegaonkar in Hearing, 2015
Tympanoplasty is surgery for perforations and comprises the placement of some form of autologous or synthetic graft under or within the perforation. The most commonly used grafts are autologous materials such as temporalis fascia, cartilage or perichondrium. Surgery is usually performed under general anaesthesia and the graft is placed within the middle ear underneath the perforation (Figure 10.6). The ossicular chain is also assessed and surgical reconstruction can be undertaken to improve the hearing (see Chapter 13: Ossiculoplasty). Many surgeons will define success of surgery as an intact TM. Rates of success quoted in the literature vary from 60–99%.1 Typically, a success rate of over 80% would be considered acceptable for a surgeon performing this procedure.
The ear, nose and sinuses
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Active mucosal COM implies a perforation with otorrheoa (ear discharge) due to inflamed middle ear mucosa with or without granulation tissue. Inactive mucosal COM implies a dry perforation without inflamation. Surgery in the form of tympanoplasty (repair of the perforation) is indicated in patients getting recurrent infection (to reduce symptoms of otorrheoa and prevent further deterioration of the hearing due to the ototoxic effects of infection) and where there is a likelyhood that it will restore hearing in the operated ear to 30 dB or better or to within 15 dB of the contralateral ear (this is known as the Belfast rule of thumb).
Treatment Of Lightning Injury
Christopher J. Andrews, Mary Ann Cooper, Mat Darveniza, David Mackerras in Lightning Injuries: Electrical, Medical, and Legal Aspects Editors, 1992
Charring of the ear canal is sometimes seen, and there may be bleeding between the layers of the eardrum, although this is quite rare. It is tempting to consider early exploration of the middle ear and performance of tympanoplasty. However, lightning injury of the tympanic membrane has some similarities to welding injuries of the ear in that there is marked edema, burning and charring of the external auditory canal and drum, and other inflammatory changes which suggest damage to the local vasculature. Spontaneous healing of the perforation may occur.
Bone-conduction hearing aid is effective in congenital oval window atresia
Published in Acta Oto-Laryngologica, 2021
Mengdie Gao, Chunli Zhao, Jinsong Yang, Peiwei Chen, Yujie Liu, Danni Wang, Shouqin Zhao
Congenital oval window atresia usually present with high rates of missed diagnoses in clinical practice, and require a close examination of medical history, audiology results, and temporal bone CT outcomes. Tympanoplasty cannot improve hearing in some patients, and it may instead increase the incidence of complications such as sensorineural deafness, while conventional surgical methods like stapedectomy do not guarantee long-term benefits. This study showed that BB implantation is beneficial for congenital oval window atresia. Furthermore, the patients were considerably satisfied with the treatment, particularly those with bilateral ear deformities. During the follow-up period, there was an obvious improvement in the patients’ hearing ability and their ability to recognize words and sentences, which can improve the quality of life and confidence. However, BB has several shortcomings. BCI placement is limited by the developmental conditions of the skull and degree of mastoid gasification, due to which a number of children cannot receive surgical treatment at an early stage. Further clinical studies are needed to investigate the causes and solutions of poor sound field hearing improvements at low-frequencies. Nevertheless, bone-conduction hearing aids remain undeniably effective in treating congenital oval window atresia.
Comparison of clinical outcome between endoscopic and postauricular incision microscopic type-1 tympanoplasty
Published in Acta Oto-Laryngologica, 2021
Yonglan Zhang, Wei Wang, Kaixu Xu, Ming Hu, Yuanxu Ma, Peng Lin
The complications of traditional microscopic tympanoplasty are injury to the chorda tympani nerve or facial nerves, TM perforation, dislocation of the ossicular chain, vertigo, tinnitus, hearing loss and secondary cholesteatoma. Of these, injury to the chorda tympani nerve ranks first because: (i) it is difficult to fully expose the chorda tympani nerve in the tympanic groove through the narrow and curved EAC under the direct vision of a microscope; (ii) damaging the chorda tympani nerve can occur when elevating the tympanomeatal flap. However, an endoscopy can pass through the narrow and curved part of the EAC flexibly, expose the chorda tympani nerve, and avoid injuring it. Another common complication of otoendoscopic surgery is the dislocation of the auditory ossicular chain (especially if observing the tympanic cavity structure and the ostium of the eustachian tube with an angled endoscopy). It is very easy for the front of the endoscopy to touch the incus–stapes joint, resulting in the dislocation of auditory ossicular chain or stapes, and severe hearing loss. Close attention must be paid to this potential complication.
Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts
Published in Acta Oto-Laryngologica, 2019
Serkan Cayir, Serkan Kayabasi, Omer Hizli
The general status of all patients was investigated by complete blood count and coagulation tests, electrocardiography, and chest radiography. Patients with coexisting diseases like hypertension, diabetes mellitus or chronic cardiopulmonary disease were preoperatively consulted to relevant physicians. Tympanoplasty operations were performed under general anesthesia via postauricular approach, using an operation microscope (Möller-Wedel Optical; Hamburg, Germany), in line with the general principles of ear surgery. After a postauricular incision, anteriorly based Palva flap was elevated. Weitlaner self-retaining retractor was used to avoid hanging of the flap. Then, posterior external auditory canal skin was elevated to the annulus and the incision was made approximately 5 mm lateral to the annulus. Temporalis fascia was used as the graft material in the fascia group and was harvested and shaped according to the perforation size. The grafting procedure was performed in an over-underlay fashion (over the malleus, under the annulus) in all patients. In the perichondrium group, tragal cartilage perichondrium was used as the graft material and skin incision was made 1 mm inside, on the medial side of the tragus to avoid a visible scar at the beginning of the surgery. An inferior cut was made as low as possible to gain the whole tragal cartilage perichondrium. The perichondrium was harvested and shaped according to the perforation and grafting was performed in an over-underlay fashion as well. In this method, tragal cartilage was protected and any cosmetic deformity in the tragal area and external auditory canal was avoided.
Related Knowledge Centers
- Ear Canal
- Middle Ear
- Necrosis
- Ossicles
- Perforated Eardrum
- Stapes
- Surgery
- Eardrum
- Otorhinolaryngology
- Graft