Oval Window Temperature Changes in an Endoscopic Stapedectomy.

OBJECTIVES: Following the initial use of endoscopes in otology, the pros and cons of these instruments have been questioned increasingly. These instruments cause an increase in temperature that needs to be investigated. In this study, the authors aimed to investigate the temperature increase caused by endoscopes and light sources in the perilymph by performing a stapedotomy in an animal model under anesthesia. STUDY DESIGN: The study was performed in a guinea pig model. METHODS: In the animal model, a simulated otologic stapes surgery was performed at room temperature. The body temperatures of the guinea pigs were monitored; the temperature increase caused by the 0-degree rigid endoscopes with diameters of 3 and 4  mm as well as the light sources, including halogen, light-emitting diode (LED), and xenon lamps, were monitored following the stapedotomy to measure and document the continuous temperature increase in the perilymph using sensors placed at the oval window. RESULTS: Rigid endoscopes cause a temperature increase in the tympanum regardless of their diameter when used with xenon and halogen light sources. The LED light caused a relatively small temperature increase. CONCLUSIONS: The endoscopic instruments used in the stapes operation caused a temperature increase in the oval window. The authors concluded that this heat could easily be transmitted to the cochlea by the perilymph, which has obstructed contact with the outer environment following stapedomy, resulting in neurosensorial damage.

Boomerang-shaped vs. shield-shaped chondroperichondrial cartilage grafts for type 1 tympanoplasty in children: A study of 121 patients.

Many techniques and graft materials have been used for the reconstruction of the tympanic membrane. We conducted a retrospective study to compare anatomic and functional outcomes of type 1 tympanoplasty that we performed with boomerang-shaped chondroperichondrial cartilage grafts (BSGs) and shield-shaped chondroperichondrial cartilage grafts (SSGs) in pediatric patients. Our study population was made up 121 patients-61 boys and 60 girls, aged 7 to 16 years (mean: 12.4)-who had undergone a type 1 tympanoplasty. Patients were divided into two groups according to the grafting technique used; there were 59 patients in the BSG group and 62 patients in the SSG group. Ear examinations were performed at postoperative months 3, 6, 12, and 24, and pure-tone average (PTA) for air-conduction threshold values and air-bone gaps (ABGs) were evaluated at 0.5, 1.0, 2.0, and 4.0 kHz at the same visits. We also investigated the impact of the graft material on functional graft success and intergroup differences (if any) in surgical success. Mean postoperative follow-up periods were 30.5 and 30.2 months in the BSG and SSG groups, respectively. We found that the success rates for tympanic membrane reconstruction were not significantly different in the two groups (91.5 and 88.7%). Postoperatively, the mean PTA and ABG values in both groups at 3, 6, 12, and 24 months were significantly lower than the preoperative values (p < 0.05). There were no significant differences in mean PTA values between the two groups at 3, 6, 12, and 24 months. However, the extent of the decrease in PTA values in the BSG group at 3 months was significantly greater than that of the SSG group (p < 0.05). There were no significant differences in mean ABG values between the two groups at 3, 6, and 12 months, but at 24 months, the value was significantly higher in the BSG group (p < 0.05). Finally, the extent of the decrease in ABG in the BSG group at both 3 and 6 months was significantly greater than that of the SSG group (p < 0.05). We conclude that the BSG procedure is a reliable and safe method of performing pediatric tympanoplasty.

Treatment of Large Tympanic Membrane Perforations: Medial to Malleus Versus Lateral to Malleus.

The perforation size affects the success of tympanic membrane (TM) reconstruction, in addition to the surgical technique used. Large TM perforations present a surgical challenge. The perforation size has been reported to be a prognostic factor, and poorer results are obtained with large versus small perforations. We aimed to evaluate patients who had undergone tympanoplasty for large perforations at our clinic using either the underlay or over-underlay technique and to compare the results in terms of re-perforation, retraction, lateralization, and improvement of hearing. Of 302 patients with chronic otitis media, 114 who had a perforation that involved over 50 % of the pars tensa were enrolled in the study. The underlay technique was used in 61 patients, and the over-underlay technique in 53 patients. In the underlay group, the preoperative mean perforation size was 30.11 ± 5.35 mm(2) (range 20.00-52.00 mm(2)) (n = 61). In the over-underlay group, the preoperative mean perforation size was 31.41 ± 8.65 mm(2) (range 22.00-48.00 mm(2)) (n = 53). The graft success rate of tympanoplasty performed using the underlay technique was 89.1 % in 61 patients. Seven (10.9 %) patients had graft failure. The graft success rate with the over-underlay technique in 53 patients was 90.5 %. Five (9.5 %) patients had graft failure in this group. Three graft lateralizations (5.6 %) and two retractions (3.8 %) were observed at 12 months postoperatively in the over-underlay group. However, in the underlay group, no graft lateralization but five retractions (8.2 %) were observed at 12 months. The graft-take rates and hearing improvement results in both groups were successful and compatible with those in the literature.

Surgical success of boomerang-shaped chondroperichondrial graft in pediatric chronic otitis media cases.

OBJECTIVES: To reveal the success of boomerang-shaped chondroperichondrial graft (BSCPG) in pediatric chronic otitis media cases. METHODS: A total of 43 pediatric patients (age 7-16 years) who had undergone type 1 tympanoplasty with the diagnosis of chronic otitis media between March 2010 and March 2013 were included in this retrospective study. The main outcome measures were the graft success rate and level of hearing improvement. RESULTS: Graft intake success rate was 90.7%. Mean preoperative and postoperative air-bone gap values were 20.51 ± 4.34 dB SPL and 9.32 ± 5.64 dB SPL, respectively (p < 0.001). Mean preoperative and postoperative pure tone average values were 28.6 ± 3.52 and 12.24 ± 5.22 respectively (p < 0.001). Air-bone gap was improved to ≤ 10 dB in 38 (88.37%) patients during the postoperative period. CONCLUSIONS: Boomerang-shaped chondroperichondrial grafting technique seems to be a successful alternative in the management of pediatric chronic otitis media cases. It has relatively higher grade graft success rate.