Elsevier

American Journal of Otolaryngology

Volume 40, Issue 2, March–April 2019, Pages 205-208
American Journal of Otolaryngology

Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect

https://doi.org/10.1016/j.amjoto.2018.11.012Get rights and content

Abstract

Purpose

To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD).

Methods

A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated.

Results

The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05).

Conclusion

It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.

Introduction

The ideal goals of surgical treatment of chronic otitis media are complete eradication of disease to produce a dry, safe ear and subsequent reconstruction of the sound conduction system to preserve or improve hearing, within a single stage surgical procedure if possible. Traditionally, canal wall down (CWD) and canal wall up (CWU) techniques are the most commonly used approaches by otologists. CWD mastoidectomy is considered to be the gold standard for this purpose, particularly in cases of chronic otitis media with cholesteatoma or granulation. CWD provides excellent intraoperative exposure of the tympanum and mastoid, and this aids in total disease elimination with low recurrence rate. Besides removing the disease and preventing the recurrence, procedures for restoration of social hearing is another important aim.

Ossicular chain reconstruction (OCR) is to establish ossicular continuity to restore the mechanical transmission of sound from the tympanic membrane to the oval window with a well-aerated mucosa-lined middle ear. Manufactured partial and total ossicular prostheses (PORP and TORP) are popular choices for repairing of the ossicular chain defect during ossiculoplasty. To achieve better hearing outcomes, Sheehy et al. [1,2] advocated staged surgery when addressing a chronically draining ear. Mucous membrane problems were the most common reason for staging. Iseri et al. [3] reported that reconstruction with a titanium prosthesis offered good functional results when performed during CWD surgery for advanced cholesteatoma, as a single stage procedure. Staged operations with middle ear prostheses were significant cost and risks of a second procedure [4].

So there still exists significant difference in opinion regarding the optimal surgical strategy. The aim of this retrospective study is to evaluate the hearing results of titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with severe mucosa lesions.

Section snippets

Surgical methods

The primary canal wall down (CWD) mastoidectomies were performed. All ossiculoplasties were carried out in single stage surgery. Ossicular chain reconstruction (OCR) (n = 206) was performed using total ossicular replacement prosthesis (TORP, 4.0 mm, Spiggle & Theis, Overath, Germany) in the absence of stapes superstructure and partial ossicular reconstruction prosthesis (PORP, 1.0 mm, Spiggle & Theis, Overath, Germany) in the presence of stapes superstructure. The intraoperative status of the

Patient demographics

A total of 206 patients were identified who had undergone titanium ossicular chain reconstruction (OCR) in single stage canal wall down (CWD) tympanoplasty. One hundred and eighteen patients were men, and 88 patients were women. The age of patients varied from 15 to 70 years, and the average age at the time of surgery was 46 years. There were 106 right-sided affected ears and 100 left-sided affected ears. The follow-up duration was ranged from 6 months to 6 years, with an average of 30 months.

Anatomic outcomes

Discussion

According to the literature, the ossicular chain reconstruction (OCR) for patients underwent tympanoplasty could be performed at staged or concurrent procedure. It was reported that planned, staged ossiculoplasty was helpful to establish an air-containing middle ear cavity and an intact tympanic membrane with a higher success rate of hearing results. Shelton and Sheehy reported that closure of the ABG to 20 dB or less occurred in 68% of 400 staged patients with intact stapes [2]. Ho and Kveton [

Conclusion

It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored. And the concurrent TORP is available, though the final effect is not as good as PORP.

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