Eustachian tube patency and function in tympanoplasty with cartilage palisades or fascia after cholesteatoma surgery.
OBJECTIVE
To compare the Eustachian tube patency and function after tympanoplasty with either cartilage palisades or fascia grafting after one-stage surgery in children with tensa cholesteatoma.


METHODS
In children operated for tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. The patency of the Eustachian tube was evaluated by the Valsalva maneuver before the operation, 1 to 3 months after the operation, and at a follow-up examination 46(1/2) months later (median). Eustachian tube function was evaluated by the nine-step inflation/deflation tympanometric test and the Toynbee test at the follow-up examination. Otomicroscopy and hearing evaluation were performed before and after surgery as well as at the follow-up.


METHODS
Eustachian tube patency and function. Hearing, postoperative eardrum perforation/retraction, and cholesteatoma recurrence.


RESULTS
The Valsalva maneuver was positive in 30% of the ears before the operation, in 65% primarily after the operation, and in 78% at the follow-up examination. A poor tubal function was found in 57% at follow-up. Overall, the late functional hearing results were better in ears with a positive Valsalva maneuver. There were no differences in tubal patency or function in relation to graft material, cholesteatoma, and tympanoplasty type. In ears with a poor tubal function, the hearing results were significantly better in the palisade group (63% success), compared with the fascia group (17% success). All of the four perforations, most of the retractions, and a single moist eardrum were found in the fascia group at the reevaluation. We found no correlation between the condition of the eardrum and the Eustachian tube function at the last evaluation. However, in ears with a poor tubal function, a nonretracted, nonperforated drum was found with higher frequency in the palisade group. Decision matrix analysis showed that the last postoperative Valsalva maneuver was the best predictor of the drum condition at the reevaluation.


CONCLUSIONS
The Eustachian tube patency frequently improves after tympanoplasty after cholesteatoma surgery in children, regardless of graft material. The patency and function of the Eustachian tube seem to be without relation to graft material, cholesteatoma, or tympanoplasty type. Cartilage palisade tympanoplasty may be a better reconstruction technique after cholesteatoma surgery, especially in ears with a poor tubal function.
Uzun
Cem
C
Department of Otolaryngology, Gentofte University Hospital of Copenhagen, Denmark. cemuzun@yahoo.com
Cayé-Thomasen
Per
P
Andersen
Janne
J
Tos
Mirko
M
D000158:Acoustic Impedance Tests; D000293:Adolescent; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000503:physiopathology / Q000601:surgery*; D003661:Decision Support Techniques; D005064:Eustachian Tube / Q000503:physiopathology*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006320:Hearing Tests; D006801:Humans; D008297:Male; D013506:Otologic Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*; D014636:Valsalva Maneuver