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Tympanoplasty in chronic otitis media patients with an intact, but severely retracted malleus: A treatment challenge

Hol M.K.S. Department of Otorhinolaryngology, University Medical Centre, St Radboud, Route nr. 377, 6500 HB, Nijmegen, Netherlands|
Linder T.E. | Pabst G. | Schlegel-Wagner C. Department of Otorhinolaryngology, Head and Neck Surgery, Lucerne, Switzerland| Nguyen D.Q. Cho Ray Hospital, Ho Chi Min City, Viet Nam|

Otology and Neurotology Số 9, năm 2010 (Tập 31, trang 1412-1416)

ISSN: 15317129

ISSN: 15317129

DOI: 10.1097/MAO.0b013e3181f0c67d

Tài liệu thuộc danh mục: Scopus

Article

English

Từ khóa: article; audiology; auditory ossicle; auditory threshold; chronic disease; ear surgery; follow up; human; incus; malleus; methodology; myringoplasty; necrosis; otitis media; pathology; retrospective study; tympanoplasty; Audiology; Auditory Threshold; Chronic Disease; Ear Ossicles; Follow-Up Studies; Humans; Incus; Malleus; Myringoplasty; Necrosis; Otitis Media; Otologic Surgical Procedures; Retrospective Studies; Tympanoplasty
Tóm tắt tiếng anh
OBJECTIVE: To analyze the outcome of patients with chronic otitis media (COM) with an intact, but markedly medialized ossicular chain, treated by removing the malleus head and interposing an autologous incus and then an underlay myringoplasty. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center. PATIENTS: The search criteria within the prospective surgical database was COM with a central perforation (without cholesteatoma) with a markedly medialized malleus handle (the umbo adherent to the promontory) with an intact ossicular chain (study, n = 15) or an incus necrosis at the lenticular process (incus, n = 23). Only primary surgeries performed at our otorhinolaryngology department were included. INTERVENTION: All patients underwent the same surgical procedure consisting of an autologous incus interposition and underlay myringoplasty with temporalis fascia. MAIN OUTCOME MEASURE: The patients' audiological and follow-up data were retrieved from the database. The postoperative audiogram (0.5-3 kHz) with the longest follow-up was used. RESULTS: The preoperative air-conduction thresholds were less impaired in the study group than in the incus group. After their surgery, all, except 3 patients, improved their hearing, and 97% had an intact tympanic membrane at a mean follow-up of 2 years. The air-bone gap was closed within 20 dB in 80% (study) and in 87% (incus), in one third of all patients even within 10 dB. Although the largest improvement was seen in the lower frequencies, closure of the air-bone gap at 4 kHz was difficult to achieve. CONCLUSION: Patients presenting with COM, a (central) perforation, a medially rotated malleus and intact ossicular chain are a treatment challenge. Lateralizing the malleus handle may require disconnection of the ossicular chain and an autologous incus interposition to bring back the reconstructed tympanic membrane in its original position and improve the hearing. � 2010, Otology & Neurotology, Inc.

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