Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap.

OBJECTIVE: Unstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water due to risk of infection or that are subject to frequent infection and otorrhoea. The objective of this study is to address the problem of troublesome mastoid cavities, with the performance of secondary mastoid obliteration and canal wall reconstruction, using a novel posterior auricular artery (PAA) fascia-periosteum flap. MATERIALS AND METHODS: A prospective study was designed, only secondary obliterations were included. Unstable mastoid cavities were defined as Merchant grade 2 or 3 and were included for surgery. RESULTS: At 12 months of follow up, a complete external auditory canal (EAC) and a self-cleaning ear were achieved in all 23 patients. Completely dry ears were achieved in 21 patients (91.3%). An air-bone gap improvement of 5dB was achieved. CONCLUSION: Mastoid obliteration and EAC reconstruction are effective procedures to treat troublesome post canal wall down mastoid cavities. They improve quality of life and enable patients to overcome ear discharge. A standard EAC size enables the utilization of conventional hearing aids, it also reduces the need for constant mastoid cleaning and decreases healthcare expenses. The PAA flap seems to be an effective procedure to achieve all these features, as it is used to obliterate the mastoid and becomes a structural component of the neo-EAC.

Mastoid obliteration and canal wall reconstruction with posterior auricular artery (PAA) fascia-periosteum flap

Objective: Unstable cavities are defined as cavities with cerumen accumulation that need frequent cavity cleaning in the out-patient clinic, cavities that are intolerant to water due to risk of infection or that are subject to frequent infection and otorrhoea. The objective of this study is to address the problem of troublesome mastoid cavities, with the performance of secondary mastoid obliteration and canal wall reconstruction, using a novel posterior auricular artery (PAA) fascia-periosteum flap.Materials and methodsA prospective study was designed, only secondary obliterations were included. Unstable mastoid cavities were defined as Merchant grade 2 or 3 and were included for surgery.ResultsAt 12 months of follow up, a complete external auditory canal (EAC) and a self-cleaning ear were achieved in all 23 patients. Completely dry ears were achieved in 21 patients (91.3%). An air-bone gap improvement of 5dB was achieved.ConclusionMastoid obliteration and EAC reconstruction are effective procedures to treat troublesome post canal wall down mastoid cavities. They improve quality of life and enable patients to overcome ear discharge. A standard EAC size enables the utilization of conventional hearing aids, it also reduces the need for constant mastoid cleaning and decreases healthcare expenses. The PAA flap seems to be an effective procedure to achieve all these features, as it is used to obliterate the mastoid and becomes a structural component of the neo-EAC. (AU)

Objetivo: Las cavidades inestables se definen como cavidades que presentan acumulación de cerumen que requieren limpieza en la consulta de manera frecuente, son cavidades intolerantes al agua por su elevado riesgo de infección o tienen frecuentes infecciones y otorrea. El objetivo de este estudio es abordar el problema de las cavidades mastoideas problemáticas con una obliteración mastoidea secundaria y reconstrucción del conducto auditivo externo (CAE) usando un colgajo fascio-perióstico de la arteria auricular posterior.Materiales y métodosSe diseñó y realizó un estudio prospectivo, solo se incluyeron obliteraciones secundarias. Las mastoides inestables fueron definidas según la clasificación de Merchant como grado 2 o 3 y fueron incluidas para la cirugía.ResultadosA los 12 meses de seguimiento, se consiguió un CAE completo y autolimpiable en los 23 pacientes. Se lograron oídos completamente secos en 21 casos (91,3%). Se obtuvo una mejoría media en la brecha aire-hueso de 5dB.ConclusiónLa obliteración mastoidea y la reconstrucción del CAE son procedimientos eficaces para tratar mastoides problemáticas posmastoidectomías abiertas. Mejoran la calidad de vida de los pacientes y son efectivas para solventar la otorrea recurrente. La obtención de un CAE de tamaño estándar es importante para permitir que el paciente pueda utilizar una audioprótesis estándar, además de reducir la necesidad de limpieza de la cavidad de manera constante y la dependencia del paciente a los controles en la consulta, disminuyendo así el gasto en sanidad. El colgajo de arteria auricular posterior parece ser una herramienta útil para lograr todas estas características, y también es usado para obliterar las mastoides y se convierte en un componente estructural del neo-CAE. (AU)

Type 1 Revision Tympanoplasty Using Tragal Cartilage in a Tertiary Care Centre: A Prospective Observational Study.

To evaluate graft success rate and hearing outcome in type 1 revision tympanoplasty using tragal cartilage graft. It is a prospective observational study conducted at Department of ENT, Bangalore Medical College and Research Institute from July 2017 to June 2019. Forty four patients between the age group 18-60 years undergoing type 1 revision tympanoplasty, with conductive hearing loss were enrolled.There were 27 males and 17 female patients in the study group. Cartilage tympanoplasty was done using thin tragal cartilage graft . Postoperative hearing gain and graft uptake was assessed at third month. Graft uptake and hearing improvement was assessed 3 months postoperatively in 44 patients. Forty patients had graft uptake (90.90%). The postoperative hearing gain was 7.12 ± 2.99 dB (p = 0.001) which was statistically significant. Tragal cartilage is a good option as graft material in revision cases in terms of ease of graft placement, better graft uptake and audiological outcome with no complications like lateralization of graft, medialization of graft, epithelial pearl formation and anterior blunting.

Revision of cartilage tympanoplasty with endoscopic butterfly inlay myringoplasty.

PURPOSE: While the use of cartilage graft for revision tympanoplasty is quite common, the data on the revision of cartilage tympanoplasty are limited. Our study aims to present the results of our patients who underwent endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty. METHODS: Demographic data, ear sides, perforation locations, graft success rates and hearing results of the patients who underwent endoscopic butterfly inlay myringoplasty for revision of cartilage tympanoplasty between Sep 2017 and Jan 2020 were evaluated. RESULTS: A total of 17 patients with 7 (41%) females and 10 (59%) males were included in our study. Eight of the ears (47%) were right and nine (53%) were left. Perforation locations included ten (59%) anterior, six (35%) inferior, and one (6%) posterior. The graft success rate of our study was 100%. No changes were observed in post-operative air conduction, bone conduction and air-bone gap values compared to the pre-operative period (p > 0.05). CONCLUSIONS: Endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty is considered to be a safe surgical technique with satisfactory anatomical and hearing results.

Comparative Analysis of Fascia Lata and Cartilage Graft in Revision Type 1 Tympanoplasty.

To evaluate graft epithelialization and hearing outcome in type 1 revision tympanoplasty using fascia lata and cartilage as graft material. In this study 33 revision cases of dry central perforations were divided into two groups, group 1 (n = 21) in which cartilage was used as a graft and group 2 (n = 12) in which fascia lata was used. Group 1 patients were divided according to the technique used as group 1a (n = 16) cartilage perichondrium composite island graft and group 1b (n = 5) cartilage butterfly inlay graft. Patients were followed up for at least 12 months postoperatively, mean 15.63 (± 4.21) months. Outcome among the two groups were measured and compared in terms of graft epithelization and hearing improvement measured as the difference between pre and post operative mean air bone gap (ABG) at 1 year. The graft epithelialization of group 1 was 85.72% (87.5% group 1a/80% group 1b) and of group 2, 83.34%. Statistically no significant difference was found in the success rate between the two groups (p = 0.6). No significant difference was found in the hearing outcome as well (p = 0.44). The overall hearing improvement was significant in both groups (p = < 0.001) including the sub groups 1a and 1b separately. 21 out of 33 patients (63.63%) operated had a mean postoperative ABG of 20 db or less. The results of cartilage and fascia lata as graft are comparable in terms of graft epithelialization and hearing outcome in revision tympanoplasty.