title: [Results of revision surgery for hearing failure in intact canal wall up tympanoplasty for chronic otitis media without cholesteatoma].
abstract: OBJECTIVE
  This study assessed the audiometric results of revision surgery in patients on whom previous canal wall up tympanoplasty had been performed for chronic otitis media without cholesteatoma, and investigated reasons for hearing improvement failure which required revision surgery.
  
  
  METHODS
  Seventy-two patients (49 females, 23 males; mean age 35.4+/-12.9 years; range 11 to 64 years) suffering from chronic otitis media without cholesteatoma, who had intact canal wall up tympanoplasty and revision surgery due to bad hearing results between March 2004 and September 2009, were evaluated retrospectively. After evaluation of patients' files, operative and audiological records, findings during the surgery, postoperative follow-up, audiometric results before revision surgery and the results in the last control after revision surgery were analysed.
  
  
  RESULTS
  Preoperative mean air-bone gap (ABG) decreased in all patients from 31.2 dB to 19.9 dB after followed up for mean 26.7 months. Air-bone gap values below 20 dB were 67%, below 30 dB were 83%, hearing gain above 10 dB was found to be 58%. Comparision of pre- and postoperative ABG values of the patients revealed statistically significant difference (p<0.001). In addition to hearing loss, the reasons for revision surgery were mucosal disease relapse in 10 patients, graft perforation in 43 patients, otorrhea control in 15 patients. Findings during revision surgery were relapse of mucosal diseases in 15 patients, insufficient mastoidectomy in six patients, problems related to prosthesis in 29 patients, ossicular limitations (brid, hyalen and granulation) in 30 patients, and ossicular necrosis in six patients. The decision for four patients was changed from canal wall up tympanoplasty to canal wall down tympanoplasty. Postoperative total hearing loss developed in one case.
  
  
  CONCLUSIONS
  The most important problem in revision of tympanoplasty patients with hearing loss is related with stabilisation of columella. To get successful hearing results, it is important to control disease and provide a stable and safe continuity between the tympanic membrane and vestibule.
authors.affiliation: Ankara Eğitim ve Araştirma Hastanesi, Ankara, Turkey. haticecelik66@gmail.com
authors.forename: Hatice
authors.initials: H
authors.lastname: Çelik
authors.forename: Sevim Aslan
authors.initials: SA
authors.lastname: Felek
authors.forename: Necmi
authors.initials: N
authors.lastname: Arslan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Islam
authors.forename: M Asım
authors.initials: MA
authors.lastname: Safak
authors.forename: Ilknur Haberal
authors.initials: IH
authors.lastname: Can
authors.forename: Yunus
authors.initials: Y
authors.lastname: Kantekin
mesh_terms: D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone; D002648:Child; D002781:Cholesteatoma; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D019933:Ossicular Replacement / Q000379:methods; D010033:Otitis Media / Q000601:surgery*; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data*; D014432:Tympanic Membrane / Q000601:surgery; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods*