Modification of closed tympanoplasty in middle ear cholesteatoma.
BACKGROUND
Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear cholesteatoma.


METHODS
Eighty-three patients were recruited in this study based on the following two criteria: each patient had middle ear cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis (TORP) or partial ossicular replacement prosthesis (PORP) and membrane repair with conchal cartilage-perichondral complex.


RESULTS
All the 83 cases had dry ears with membranes healed within 4 - 6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with cholesteatoma recurrence (6.02%). Function tests after one postoperative year exhibited an improvement of pure tone audiometry (PTA) in 27 cases that was more than 30 dB, in 33 cases between 20 - 29 dB, 14 cases with improvement between 10 - 19 dB, and in 9 cases there was no improvement.


CONCLUSIONS
The modified closed tympanoplasty procedure for middle ear cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.
Zhang
Zhi-gang
ZG
Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
Liu
Xiang
X
Chen
Sui-jun
SJ
Chen
Bin
B
Zheng
Yi-qing
YQ
D000293:Adolescent; D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult