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Long-term hearing results following retrograde tympanomastoidectomy with canal reconstruction by using mastoid isolation/obliteration

Presenting Author: Chih-Hung Wang

Published online by Cambridge University Press:  03 June 2016

Chih-Hung Wang  and
Chao-Yin Kuo
Chih-Hung Wang
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Chao-Yin Kuo
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Abstract

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Learning Objectives:

Introduction: Besides mastoid obliteration as enrolled in this study, we offered another surgical technique–mastoid isolation by using several pieces of bony plates and bone chips placed on the preserved canal wall and tegmen tympani to complete the reconstruction of the EAC defect in a one-stage surgical procedure.

Methods: A total of 99 patients resulted in 102 ears underwent retrograde tympanomastoidectomy in a single stage procedure, 6 of them underwent two-stage ossiculoplasty. The main outcome measures included surgical procedures of reconstruction, types of tympanoplasty, complications, and hearing outcomes.

Results: In >71% of ears, the audiometric tests were monitored more than 2 years. The results of hearing assessments indicated a significant improvement in hearing gain after surgery in view of the postoperative change of air-conduction (AC) thresholds and air-bone gaps (ABGs) (p < 0.001). Linear regression analysis of pure-tone average (PTA) before and after surgery at different frequency showed patients benefit postoperative hearing gain largely at low and middle frequencies but may deteriorate their hearing at frequency of 8000 Hz. Among 72 cases with non-serviceable hearing preoperatively, 25 of them (34.7%) would achieve serviceable hearing outcomes postoperatively (p < 0.001). The postoperative improvement of hearing degree for patients with moderate, severe or profound hearing loss showed statistically significant difference (p = 0.04). Tympanoplasty of type III-i increased the hearing gain markedly, followed by type III-c, I, and IV-c. Two-stage ossiculoplasty can provide a better air gain at 500, 1000, and 2000 Hz. The overall rate of complication was 8.8% (9 of 102).

Conclusions: We conclude that reconstruction of the EAC and mastoid via mastoid isolation/obliteration using bone chips/paté can be considered as an alternative procedure following retrograde tympanomastoidectomy. It gives excellent surgical results and has fewer complications.