Tympanoplasty Outcomes: A Review of 789 Cases

Document Type: Original

Authors

1 DNB Institution and Research, Indorewala ENT Hospital, Nashik, India

2 Department of Otorhinolaryngology Head and Neck Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria.

Abstract

Introduction:
Tympanoplasty is indicated to restore hearing disability and prevent recurrent otorrhea.
 Materials and Methods:
This study was a retrospective review of patients who underwent tympanoplasty with or without mastoidectomy over a 1-year period.
 Results:
A total of 789 tympanoplasties were reviewed, with a male-to-female ratio of 1:1.1. In total, 91% and 9% of tympanoplasties were performed without and with mastoidectomy, respectively. Complete graft take was observed in 98.6% of cases. Approximately 25% of patients had an air-bone gap (ABG) gap ≤20dB pre-operatively, increasing to 75.6% post-operatively. ABG closure improved from 0.8% to 46.7%. Mean ABG improved from 26.30 ±8.1dB pre-operatively to 14 ± 10.41dB post- operatively (t=28.7, P<0.001). Generally, over 86% of patients had improvement in their hearing function post-operatively (mean= 12.5 ±9.5dB) (χ2= 104.2, P<0.001).
 Conclusion: 
Tympanoplasty is an effective procedure that can lead to improvement in hearing function in patients and prevention of recurrent ear discharge. Optimal results can be achieved through use of the appropriate surgical technique.

Keywords

Main Subjects


1.  Adoga A, Nimkur T, Silas O. Chronic suppurative otitis media: Socio-economic implications in a tertiary hospital in Northern Nigeria.Pan Afr Med J. 2010; 4(3).

2.  Acuin JM. Chronic suppurative otitis media: a disease waiting for solutions. Comm Ear Hearing H 2007; 4(6):17–19.

3.  Okafor BC. The chronic discharging ear in Nigeria. J Laryngol Otol 1984; 98(2):113–9.

4.  Olusesi AD, Opaluwah E,  Hassan SB. Subjective and objective outcomes of tympanoplasty surgery at National Hospital Abuja, Nigeria 2005-2009. Eur Arch Otolaryngol 2011;268(3):367–72.

5. Lasisi AO, Sulaiman OA, Afolabi OA. Socio-economic status and hearing loss in chronic suppurative otitis media in Nigeria. Ann Trop Paediatr 2007;27(4):291–6.

6.  Akinpelu OV, Amusa YB, Komolafe EO, Adeolu AA, Oladele AO, Ameye SA. Challenges in management of chronic suppurative otitis media in a developing country. J Laryngol Otol 2008;122(1):        16–20.

7.  Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G.Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function Acta Otorhinolaryngol Ital 2011; 31(6):366–71.

8. Wullstein H. Theory and practice of myringoplasty. Laryngoscope. 1956;66:1076–93.

9.  Zollner F. The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol 1955; 69: 637–52.

10.  Faramarzi A, Hashemi SB, Rajaee A. Mucosal pocket" myringoplasty: a modification of underlay technique for anterior or subtotal perforations. Am J Otolaryngol 2012; 33(6):708–13.

11. Vartiainen E, Nuutinen J. Success and pitfalls in myringoplasty: follow-up study of 404 cases. Am J Otol 1993;14(3):301–5.  

12. Mishra P, Sonkhya N,  Mathur N. Prospective study of 100 cases of underlay tympanoplasty with superiorly based circumferential flap for subtotal perforations. Indian J Otolaryngol Head Neck Surg 2007; 59(3):225–8.

 13. Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 2007; 264(9):985–9.

 14. Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I
tympanoplasty. Eur Arch Otorhinolaryngol 2011; 268(3):471–4.

15. Mauri M, Lubianca Neto JF, Fuchs SC. Evaluation of inlay butterfly cartilage tympanoplasty: a randomized clinical trial. Laryngoscope 2001; 111(8):1479–85.

16.  Indorewala S, Pagare R, Aboojiwala S, Barpande S. Dimensional Stability of the Free Fascia Grafts: A Human Study.The Laryngoscope 2004;114(3):543–7.

17. Indorewala S. Tympanoplasty (Author’s Technique). In Atlas of Operative Otorhinolaryn- gology and Head & Neck Surgery, Vol. 1:1st ed, (Hathiram B, Khattar V. eds) Jaypee Brothers Medical Publishers (P) Ltd New Delhi India; 2013 page 67-74.

18. Nardone M, Sommerville R, Bowman J, Danesi G. Myringoplasty in simple chronic otitis media: critical analysis of long-term results in a 1,000-adult patient series. Otol Neurotol 2012;33(1):48–53.

19. Te GO, Rizer FM, Schuring AG. Pediatric tympanoplasty of iatrogenic perforations from ventilation tube therapy. Am J Otol 1998; 19(3):       301–5.

20. Nelson LJ, Hussain SSM. Management of granular myringitis: A systematic review JLO 2008; 122:3–10.

21.  El-Seifi A, Fouad B. Granular Myringitis: Is It a Surgical Problem?Am J Otol2000; 21:462–7.

22.  Indorewala S. The anterior tympanotomy. IJO & HNS 1997; 49(2):122–4.

23.  Sheehy JL, Anderson RG. Myringoplasty. A review of 472 cases. Ann Otol Rhinol Laryngol 1980; 89(4 Pt 1):331–4.

24. Karela M, Sandeep B, Watkins A, J.Phillipps J. Myringoplasty: surgical outcomes and hearing improvement: is it worth performing to improve hearing? Eur Arch Otorhinolaryngol 2008;265(9):        1039–42.

 25.  Lee P, Kelly G, Mills RP. Myringoplasty: does the size of the perforation matter? Clin Otolaryngol Allied Sci. 2002; 27:331–4.

 26. Ogisi FO, Adobamen P. Type 1 Tympanoplasty in Benin: a 10- year review. Niger Postgrad Med J 2004; 11(2):84–7.