In ears with advanced pathology, the functional and anatomical results of surgery are compromised by such factors as total perforation, tympanosclerosis, atelectasis, suppuration, or previous surgery Perichondrium cartilage composite grafts (PCCGs) were used for membrane grafting in 550 such cases over a period of 5 years In all, 197 tympanoplastic procedures of type I (25% with previous surgery) and 353 of type III (47% with previous surgery) were carried out The graft was obtained from the tragus and/or the concha Two slightly different surgical techniques of grafting were used

Closure of the eardrum perforation was successful in 92% of the procedures An air-bone gap of less than or equal to 30 dB was obtained in 924% of tympanoplasty type I procedures and in 79% of tympanoplasty type III procedures The conclusion drawn from the results is that PCCG is a reliable graft in cases of advanced destruction of the middle ear

Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology

The aim of this study is to evaluate anatomical and audiological results of cartilage tympanoplasty compared to fascia tympanoplasty in the reconstruction of tympanic membrane perforations. We carry a retrospective study about 380 patients operated in our department between 1998 and 2005. Patients were classified into two groups: 90 (23.6%) undergo cartilage tympanoplasty and 290 (76.4%) fascia tympanoplasty. In each group, we calculated the average of pre and postoperative air bone gap (ABG) and the average air conduction gain (ACG) at 250–4,000 Hz. The surgical technique is explained in detail. We detail and analyze the audiological and anatomical results in each group. Successful closure of the tympanic membrane perforation was achieved in 97% of the cartilage group as compared to 94% of the fascia group. The average ACG was 21 ± 11 dB in cartilage group and 20 ± 22 dB in fascia group. With an average follow-up of 2 years, residual perforation was observed in 2.2% in cartilage group. Reperforation of fascia graft and retraction were noted in 2.1 and 1%, respectively. The authors show the great reliability of cartilage tympanoplasty to close tympanic membrane perforations. We recommend using cartilage as a first choice, especially in stable or evolutive chronic otitis media, and in recurrent perforation of the tympanic membrane.

Cartilage graft in type I tympanoplasty: audiological and otological outcome

Importance Satisfactory functional results following ossicular chain reconstruction mainly depend on a stable connection between the tympanic membrane and the stapes, which is in turn dependent on the type of prosthesis used. Knowledge about the safety and functional outcome of the commercially available middle ear prostheses is therefore of great importance. Objective To evaluate the efficacy and safety of the Kurz TTP-Variac System partial ossicular replacement prosthesis (PORP) in ossiculoplasty. Design, Setting, and Participants Retrospective review of all ossiculoplasties performed by 1 surgeon at a secondary referral center from August 2006 through July 2012. Participants were patients with cholesteatoma, chronic otitis media, or ossicular chain disruption in the absence of inflammatory disease who underwent ossicular reconstruction. Exposure Ossiculoplasty using a Kurz TTP-Variac System PORP. Main Outcomes and Measures Mean preoperative and postoperative air-bone gaps (ABGs) and improvements in ABG were analyzed for each frequency by means of a 4-frequency pure-tone average. Successful postoperative hearing was defined as postoperative ABG smaller than 20 dB. Results Eighty-nine ears in 83 patients aged 7 to 85 years were included. Transmeatal tympanoplasty was performed in 17 ears (19%). Seven ears (8%) underwent tympanoplasty with canal wall–down mastoidectomy, and 65 ears (73%) underwent canal wall–up (combined approach) tympanoplasty with mastoidectomy. The study population comprised 61 primary tympanoplasties (69%) and 28 revision cases (31%). Mean follow-up was 13 months. Overall, the ABG significantly improved from a mean (SD; range) of 26.19 (11.53; 3.75-51.25) dB to 15.58 (9.80; 0-48.75) dB ( P P Conclusions and Relevance The titanium Kurz TTP-Variac System PORP is an effective prosthesis to reconstruct the ossicular chain. Complications are rare, illustrating the safety of the prosthesis.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/1752297/ooi130069.pdf

Middle Ear Reconstruction Using the Titanium Kurz Variac Partial Ossicular Replacement Prosthesis Functional Results

Conclusions The results show that, in humans, activation of the contralateral EAR makes the PTC narrower at 1 kHz but wider at 4 kHz. These data are consistent with those reported previously in ani...

Effects of efferent acoustic reflex activation on psychoacoustical tuning curves in humans.

Results of surgical treatment for chronic noncholesteatomatous otitis media in the pediatric population.

The functional and anatomical results of a series of 181 consecutive allograft tympanoplasties for ears with drum perforation and an intact ossicular chain were retrospectively reviewed and related to preoperative factors. Drum closure was realized in 92% (166 of 181 cases evaluated 1 year after surgery), and 96.6% of the reconstructed drums were still intact 3 years after surgery (118 cases evaluated). An air-bone gap of less than 21 dB was reached in 79.6% (of a total of 162 cases) 1 year after surgery, and in 78% (of a total of 118 cases) 3 years after surgery. Age, contralateral pathology, the wet or dry status of the ear preoperatively, and the preoperative air-bone gap had no influence on anatomical results. The preoperative air-bone gap did not predict the postoperative air-bone gap. The influence of age and existence of contralateral pathology on hearing gain was only visible in some of the strictly defined patient groups. The wet preoperative status of the ear generally predicted lower functional gain.

Allograft tympanoplasty: predictive value of preoperative status.

This normative study presents a clinically applicable method with which to obtain Psychoacoustical Tuning Curves: data are obtained with clinical audiometers, and measurements are performed on normal-hearing non-trained volunteers. A simultaneous masking method with test frequency of 4 000 Hz was used, with masking being incremented in 5 dB or 1 dB steps. One group of subjects was tested three times with 5 dB incrementing steps to evaluate the method's reproducibility. A second group of subjects was measured twice with 1 dB incrementing steps, to compare the reproducibility of the 1-dB step measurements, and the difference between the 1-dB step and 5-dB step measurements. All the data were evaluated as normative values. The method presented proves to have a good reproducibility. Although testing with 1-dB incrementing steps provides more accurate measurements and curves with steeper slopes, the 5-dB incrementing step method is more practicable. Intertest variability evaluation indicates that differences b...

Psychoacoustical tuning curves. Normative data for clinical use.

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Allograft tympanoplasty: predictive value of preoperative status.

Psychoacoustical tuning curves. Normative data for clinical use.