The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes.
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BACKGROUND: Otitis media is the most common medical problem in young children. The usual surgical treatment is myringotomy with insertion of tympanostomy tubes. There is debate about the usefulness of concomitant adenoidectomy or adenotonsillectomy. We examined the effects of these adjuvant procedures on the rates of reinsertion of tympanostomy tubes and rehospitalization for conditions related to otitis media. METHODS: Using hospital discharge records for the period 1995 through 1997, we examined the results of surgery for all 37,316 children (defined as persons 19 years of age or younger) in Ontario, Canada, who received tympanostomy tubes as their first surgical treatment for otitis media. We determined the time to the first readmission for conditions related to otitis media and the time to the first reinsertion of tympanostomy tubes. RESULTS: As compared with treatment involving the insertion of tympanostomy tubes alone, adjuvant adenoidectomy was associated with a reduction in the likelihood of reinsertion of tympanostomy tubes (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001) and the likelihood of readmission for conditions related to otitis media (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001). The risk of these outcomes was further reduced if an adjuvant adenotonsillectomy was performed. The effect was age-related. Children as young as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of an adjuvant adenoidectomy was apparent in two-year-olds and was greatest for children three years of age or older. CONCLUSIONS: Performing an adenoidectomy at the time of the initial insertion of tympanostomy tubes substantially reduces the likelihood of additional hospitalizations and operations related to otitis media among children two years of age or older. (+info)
Tympanoplasty after war blast lesions of the eardrum: retrospective study.
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AIM: To establish whether hearing loss after eardrum blast injury could be recovered by tympanoplasty performed immediately after injury and what material is the most suitable for eardrum closure. METHODS: Tympanoplasty was performed in 119 (a total of 181 injuries) out of 651 patients examined for blast injury of the ear between 1991 and 2000. The study included a total of 106 patients who underwent tympanoplasty: 51 patients with unilateral and 55 with bilateral blast eardrum rupture (a total of 161 injuries). Three different materials were used for eardrum rupture closure: temporal fascia in 81, perichondrium in 61, and heterograft in 19 cases. Injuries were divided in 4 groups, according to the time elapsed between the injury and tympanoplasty (0-20, 21-60, 61-180, and 181 days and more). Otomicroscopic finding, audiometry, and tympanometry were used for definitive evaluation of tympanoplasty outcome. RESULTS: Eardrum rupture was successfully closed with temporal fascia in 91%, perichondrium in 92%, and heterograft in 89% of the cases (p=0.429). There were no statistically significant differences in either values of postoperative air- bone gap (p=0.210) or in eardrum perforation closure rate (p=0.951) with respect to the time period between the injury and tympanoplasty. Also, there was no correlation between the postoperative air-bone gap and the number of days elapsed between the rupture and tympanoplasty (r=-0.037, p=0.641). CONCLUSION: Small ruptures of the eardrum should be left to heal spontaneously. The patients with subtotal and total rupture and rupture that did not heal spontaneously in three months should undergo tympanoplasty. Temporal fascia, perichondrium from tragus, and heterograft are equally acceptable materials for eardrum closure after blast injury. (+info)
Subjective evaluation and overall satisfaction after tympanoplasty for chronic simple suppurative otitis media.
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A questionnaire survey was conducted in 324 patients with chronic, simple, suppurative otitis media who had undergone tympanoplasty 6 months or more previously to investigate post-operative hearing, tinnitus, vertigo, occlusive feeling of the ear and otorrhea. In addition, the overall satisfaction with tympanoplasty was assessed by VAS value. Subjective hearing improvement was observed in 73.1% of the patients whose hearing was poor and in 50% of those whose hearing was good before the operation. The degree of satisfaction assessed by VAS value corresponded with the subjective hearing assessment. As to tinnitus, 66.2% of the patients became aware of the disappearance or alleviation of symptoms. In the case of patients who had tinnitus before the operation, the degree of awareness of tinnitus and the degree of satisfaction assessed by VAS value coincided. However, no changes in the VAS value were observed in those who did not have tinnitus before the operation. As for vertigo, 30.5% of the patients who had vertigo preoperatively became aware of the disappearance of the symptoms after the operation. The degree of satisfaction assessed by VAS value corresponded with the presence or absence, severity and frequency of vertigo. As to the fullness of the ear, alleviation of the symptoms was subjectively noted by 85.9% of the patients who had symptoms before the operation. The degree of satisfaction assessed by VAS value corresponded with the severity of the symptoms in those who had symptoms before the operation. As for otorrhea, the disappearance of the symptoms was subjectively noted by 85.5% of the patients who had otorrhea before the operation. The degree of satisfaction assessed by VAS value corresponded with the post-operative changes in otorrhea. Based on the above results, it was assumed that the patients placed greatest expectation on hearing improvement when they underwent tympanoplasty. VAS is considered a useful method to evaluate the degree of satisfaction of patients after surgery. (+info)
Closed tympanoplasty in middle ear cholesteatoma surgery.
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OBJECTIVE: To determine the effect of closed tympanoplasty surgery for middle ear cholesteatoma and to compare the postoperative results with the outcomes of canal-wall-down mastoidectomy. METHODS: Seventy patients with middle ear cholesteatoma were involved in the study. Pneumo-otoscopy, pure-tone audiometry, anamnestic and clinical data were evaluated before the surgery. Modified radical mastoidectomy was performed for 31 patients. Thirty-nine patients were treated with closed tympanoplasty surgery, including intact canal wall mastoidectomy, endaural atticotomy, lateral attic and aditus wall reconstruction and tympanoplasty. The follow-up examination was carried out 12 months after the surgery. The recurrence of cholesteatoma, otorrhea and hearing level were evaluated postoperatively. RESULTS: Otorrhea was estimated in 4 cases (10.3%) after closed tympanoplasty surgery and in 6 cases (19.4%) after modified radical mastoidectomy. Among the patients who were operated using closed tympanoplasty technique the middle ear cholesteatoma recurrence rate was 12.8% and among those, who underwent modified radical mastoidectomy recurrent disease occurred in 9.7% of the cases. The hearing improvement was found in 15 cases (38.46%) after closed tympanoplasty, while there was no hearing improvement after modified radical mastoidectomy. CONCLUSIONS: We conclude that despite the fact, that cholesteatoma recurrence rate after closed tympanoplasty is relatively high, this surgical method permits to preserve adequate hearing level and releases from postoperative cavity care problems as compared with modified radical mastoidectomy. (+info)
Tympanoplasty: surgical results and a comparison of the factors that may interfere in their success.
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Chronic otitis media has a high prevalence on the population and their treatment continuous to be a challenge for the otorhinolaryngologists. AIM: To demonstrate the factors that could interfere in the tympanoplasty success and the surgical results during 2002. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: were included 37 patients with chronic otitis media non cholesteatoma (COMNC) undergo to tympanoplasty (in lay or underlay, with homologous graft). All the patients were submitted to a survey pre and postoperative include clinical, physical examinations, flexible nasal endoscope and audiometry. RESULTS: The age, the dimension and localization of the tympanic membrane perforation; the condition of middle ear mucosa; number of otorrhea/year; smoking; parents history of otorrhea and hearing loss; personals history of otological surgery; monthly family income; the graft, technique and access used were not significantly to repair tympanic membrane perforations. The closure rate was 65% and the gain in air-bone gap was 100%. CONCLUSION: The timpanoplasty must be considerate in the treatment of the COMNC. (+info)
Intracranial aspergillosis involving the internal auditory canal and inner ear in an immunocompetent patient.
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We report the MR imaging findings in a case of intracranial aspergillosis involving the internal auditory canal (IAC) and inner ear in an immunocompetent patient. The presence of rim enhancement of the vestibulocochlear nerve, abnormal signal intensity involving the labyrinth, and adjacent meningeal enhancement might help clinicians to make a correct diagnosis in patients with a mass in the IAC and previous history of ear surgery. (+info)
Latex biomembrane: a new method to coat the open cavity in tympanomastoidectomies.
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The new cavity created after an open cavity tympanomastoidectomy (OCTM) is filled with an antibiotic impregnated cotton pack (cotton tape, umbilical tape, gauze). The removal of this pack usually causes some bleeding and discomfort for the patient. We propose the use of a latex biomembrane to cover the cavity, which will act as an interface between the raw bone surface and the packing. STUDY DESIGN: clinical prospective. AIM: To study the performance of the latex biomembrane as an interface between the raw bone surface and the pack, and to analyze its role in cavity epithelization. MATERIAL AND METHODS: 64 ears of patients submitted to OCTM were studied. The biomembrane was used in the packing of 54 ears and in the 10 remaining ears the regular cotton tape packing was used. RESULTS: In the majority of the cases where the biomembrane was used the packing was removed much easier with no bleeding or pain for the patient and also showed an earlier cavity epithelization. CONCLUSION: The use of the latex biomembrane has proven to be an effective method to cover the mastoid cavity facilitating epithelization and removal of mastoid cavity packing. (+info)
The effect of timpanoplasty on tinnitus in patients with conductive hearing loss: a six month follow-up.
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Tympanoplasty is done to eradicate ear pathology and to restore the conductive hearing mechanism (eardrum and ossicles). Some patients, however, do not tolerate tinnitus and question physicians about the results of surgery when tinnitus persists. AIM: to evaluate the progression of tinnitus in patients with conductive hearing loss after tympanoplasty. STUDY DESIGN: a prospective cohort study. MATERIAL AND METHODS: 23 consecutive patients with tinnitus due to chronic otitis media underwent tympanoplasty. The patients underwent a medical and audiological protocol for tinnitus before and after tympanoplasty. RESULTS: 82.6% of patients had improvement or elimination of tinnitus after tympanoplasty The mean score of postoperative intolerance to tinnitus (1.91 for 30 and 180 days) was significantly different from preoperative scores (5.26). As to hearing loss, patients improved medically 30 and 180 days after surgery (3.65 and 2.91) compared to the preoperative condition (6.56). Audiometry revealed improvement at all frequencies from 0.25 to 6KHz, except at 8KHz. The air-bone gap was closed or was within 10dB in 14 cases (61%). An intact tympanic membrane was achieved in 78% of the cases. CONCLUSION: Aside from the classical improvement of hearing loss, tympanoplasty also offers good control of tinnitus. (+info)