Estudio retrospectivo de 544 timpanoplastias con cartílago y pericondrio: resultados anatómicos y funcionales / A retrospective study of 544 tympanoplasty with cartilage and perichondrium: anatomical and functional results

Introducción: el cierre de las perforaciones timpánicas se realiza con diferentes materiales, entre ellos el cartílago y el pericondrio. En este estudio se compararon los resultados anatómicos y funcionales obtenidos con ambos materiales, y se evaluaron posibles factores asociados con los buenos resultados. Material y métodos: estudio retrospectivo en pacientes intervenidos de timpanoplastia sin mastoidectomía entre el 1 de enero de 2001 y el 31 de diciembre de 2018. Resultados: se incluyeron 544 timpanoplastias. En la mayoría se utilizó cartílago (78,5 %) y en el resto pericondrio. El cartílago se utilizó con mayor frecuencia en los menores de 18 años (p=0,001), perforaciones totales y subtotales (p=0,000) y timpanoplastias secundarias y terciarias (p=0,008). No hubo diferencias en el tiempo de seguimiento (15,68 ± 22,18 meses frente al 12,86 ± 14,9 meses, p=0,169). La tasa de éxito anatómico fue mayor en el grupo de cartílago, sin diferencias en los resultados auditivos (82 % con cartílago y 78,3 % con pericondrio). El éxito anatómico se relacionó con la técnica utilizada para la reconstrucción con cartílago, mientras que los resultados auditivos se asociaron significativamente con el estado de la mucosa del oído medio y la cadena de huesecillos en el momento de la cirugía y el éxito anatómico posquirúrgico. Conclusiones: con el cartílago se consiguieron mejores resultados anatómicos que con el pericondrio, sin diferencias a nivel funcional. Sin embargo, los resultados funcionales empeoraron si había patología a nivel del oído medio y en ausencia de restauración anatómica.

Introduction: Different materials are used to close tympanic perforations. This stu-dy aimed to compare anatomical results obtained with cartilage and perichondrium and evaluate factors associated with successful results. Material and method: Re-trospective study of patients who underwent tympanoplasty without mastoidectomy between January 1, 2001, and December 31, 2018. Demographic data, ear pathology, surgical intervention, and anatomical and functional results were collected. Results:544 tympanoplasty were included. Cartilage was the most used (78.5%). Cartilage was used more frequently in children under 18 years (p = 0.001), to reconstruct total and subtotal perforations (p = 0.000) and in secondary and tertiary tympanoplasty (p = 0.008). Follow-up time did not differ between the two groups (15.68 ± 22.18 months vs. 12.86 ± 14.9 months, p = 0.169). The anatomical success rate was higher in the cartilage group, with no significant differences in hearing outcomes (82% with cartilage and 78.3% with perichondrium). Anatomical success was related to the technique used for cartilage reconstruction (monoblock or palisade). Hearing re-sults were significantly associated with the state of middle ear mucosa at the time of surgery, the state and mobility of the ossicle chain, and post-surgical anatomical suc-cess. Conclusions: Cartilage achieved better anatomical results than perichondrium. Both materials were comparable on a functional level. However, the functional re-sults worsen if there is pathology of the middle ear (mucosa or chain of ossicles) and anatomical restoration is not achieved.

Miringoplastias. Un análisis retrospectivo de nuestros resultados / Myringoplasties. A retrospective analysis of our surgical outcomes

Objetivo: El objetivo de este trabajo es presentar, de forma detallada, nuestros resultados en la cirugía de la reconstrucción de la membrana timpánica y sobre todo los diferentes factores que influyen en los resultados con el fin de contrastar su valor pronóstico. Métodos: Hemos revisado un total de 126 miringoplastias desde 2006 hasta 2010, recopilando los datos del paciente, la descripción del defecto anatómico y los aspectos más relevantes de la propia intervención. Resultados: Las perforaciones subtotales (35,7%) fueron las más frecuentes. En el 89,7% se realizó el abordaje transcanal. La técnica medial (underlay) fue la más empleada (97,6%). Como injerto se utilizó principalmente el cartílago (82,5%). Se consiguió un cierre completo de la perforación en el 71,1% a los 6 meses de seguimiento. Las reperforaciones fueron de tipo puntiforme en el 11,9%, parcial en el 11,1% y dehiscencia de los fragmentos de cartílago en el 4,8%. El tiempo medio en el cual se registró el defecto de la cirugía fue a los 3,82 meses. La ganancia auditiva media fue de 12,8 dB a los 6 meses de la intervención. Conclusiones: La miringoplastia constituye una técnica adecuada para la restitución de la integridad timpánica y para la obtención de un beneficio funcional. Un estado de la caja seco y las perforaciones posteriores parecen relacionarse con un mejor pronóstico funcional (AU)

Objective: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. Materials and methods: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. Results: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. Conclusions: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results (AU)

[Myringoplasties. A retrospective analysis of our surgical outcomes]. / Miringoplastias. Un análisis retrospectivo de nuestros resultados.

OBJECTIVE: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. MATERIALS AND METHODS: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. RESULTS: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. CONCLUSIONS: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results.

Comparación de las complicaciones dermatológicas entre el dermatomo y el colgajo en «U» en la cirugía del BAHA / Comparison of skin complications between dermatome and U-graft technique in BAHA surgery

Introducción y objetivo: Las complicaciones dermatológicas son las complicaciones postoperatorias más frecuentes relacionadas con las prótesis BAHA (bone anchored hearing aid). En este estudio comparamos y evaluamos estas complicaciones con dos técnicas quirúrgicas diferentes: el dermatomo BAHA y el colgajo en «U». Material y método: Se estudió a 53 pacientes intervenidos en nuestro centro entre 2001 y 2008. La comparación de las complicaciones se realizó según la clasificación de Holgers et al. Hemos registrado, además, el número de curas que se requieren hasta la estabilización de la piel. Resultados: Hemos utilizado el dermatomo en 27 pacientes y el colgajo en «U» en 26 pacientes. En el grupo dermatomo hemos tenido el 74% de complicaciones (20 pacientes), que contrastan con el 34% (9 pacientes) con el colgajo en «U». La media de curas por paciente con el dermatomo y con el colgajo en «U» es de 4,1 y 2,7, respectivamente. Las diferencias encontradas son estadísticamente significativas para un intervalo de confianza del 95%. Conclusiones: En nuestra experiencia, el uso del dermatomo eléctrico en la cirugía del BAHA es un método que nos ofrece un mayor número de complicaciones dermatológicas que el colgajo en «U». Dado que ambas técnicas tienen una serie de ventajas y desventajas, quizás la selección de la técnica por utilizar según las características de cada paciente de forma individualizada permita obtener mejores resultados en el futuro (AU)

Introduction and objective: The most common postoperative complications related to BAHA prosthetic surgery are skin complications. In this study we compare and evaluate these reactions with two different surgical techniques, the BAHA dermatome and the U-graft technique. Material and method: Fifty-three patients who underwent implantation of a BAHA at our hospital between 2001 and 2008 were studied. The comparison of the skin reactions was carried out according to Holgers' classification. We also recorded the number of cures required until the skin was stabilized. Results: We used the dermatome in 27 patients and the U-graft in 26 patients. In the dermatome group we have reported a total of 74% of skin reactions (20 patients), in contrast with the 34% (9 patients) observed in the U-graft group. The average number of cures for patients in the dermatome group and those in the U-graft group was 4.1 and 2.7, respectively. The differences found were statistically significant and had a 95% confidence interval. Conclusions: In our experience, the use of the electric dermatome in BAHA surgery offers a higher incidence of skin complications in comparison with the U-graft technique. Since both techniques have a number of advantages and disadvantages, it may be that the selection of the technique to be employed according the individual characteristics of each patient may offer better results in the future (AU)

[Comparison of skin complications between dermatome and U-graft technique in BAHA surgery]. / Comparación de las complicaciones dermatológicas entre el dermatomo y el colgajo en "U" en la cirugía del BAHA.

INTRODUCTION AND OBJECTIVE: The most common postoperative complications related to BAHA prosthetic surgery are skin complications. In this study we compare and evaluate these reactions with two different surgical techniques, the BAHA dermatome and the U-graft technique. MATERIAL AND METHOD: Fifty-three patients who underwent implantation of a BAHA at our hospital between 2001 and 2008 were studied. The comparison of the skin reactions was carried out according to Holgers' classification. We also recorded the number of cures required until the skin was stabilized. RESULTS: We used the dermatome in 27 patients and the U-graft in 26 patients. In the dermatome group we have reported a total of 74% of skin reactions (20 patients), in contrast with the 34% (9 patients) observed in the U-graft group. The average number of cures for patients in the dermatome group and those in the U-graft group was 4.1 and 2.7, respectively. The differences found were statistically significant and had a 95% confidence interval. CONCLUSIONS: In our experience, the use of the electric dermatome in BAHA surgery offers a higher incidence of skin complications in comparison with the U-graft technique. Since both techniques have a number of advantages and disadvantages, it may be that the selection of the technique to be employed according the individual characteristics of each patient may offer better results in the future.

[Baha: a new longitudinal incision with fixture out of the incision]. / BAHA: nueva incisión longitudinal con implante fuera de ésta.

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years' experience with BAHA. We present a new longitudinal incision with the fixture out of the incision.

BAHA: nueva incisión longitudinal con implante fuera de ésta / Baha: a new longitudinal incision with fixture out of the incision

Desde la introducción de las prótesis osteointegradas tipo BAHA (bone anchored hearing aid) hace unas décadas, su uso se ha generalizado por ser un método efectivo. Las complicaciones más frecuentes relacionadas con el BAHA son las dermatológicas, por lo que se han producido múltiples cambios en la técnica quirúrgica con el objetivo de disminuir su frecuencia. Hemos analizado el manejo de la piel y los tejidos blandos durante 8 años de experiencia con el BAHA. Presentamos una nueva incisión longitudinal con el implante situado fuera de ésta (AU)

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years experience with BAHA. We present a new longitudinal incision with the fixture out of the incision (AU)

[Revision stapedectomy]. / Cirugía de revisión de las estapedectomías.

OBJECTIVE: The aim of the study was to determine the causes of failure in otosclerosis surgery. MATERIAL AND METHOD: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. RESULTS: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). CONCLUSIONS: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients.

Cirugía de revisión de las estapedectomías / Revision stapedectomy

Objetivo: Determinar las causas del fracaso en la cirugía de revisión de la estapedectomía. Material y método: Se realizaron 23 cirugías de revisión de estapedectomías en el período comprendido entre enero de 2000 y abril de 2005. El tiempo transcurrido desde la primera cirugía varió desde un mínimo de 3 meses a un máximo de 25 años, con una media de 5,2 años. Los motivos más frecuentes de la revisión quirúrgica fueron, en primer lugar, los pacientes con cierre de umbral diferencial auditivo (UDA) inicial y pérdida auditiva posterior en el 56,52 %, y en segundo lugar, los pacientes sin ganancia auditiva inicial en el 39,12 %. Resultados: Los principales hallazgos quirúrgicos son los siguientes: prótesis corta en posición correcta (13,04 %), prótesis desplazada (60,87 %), bridas sobre la ventana oval (65,22 %), necrosis de rama larga del yunque (26,2 %) y platina reobliterada (26,09 %). En cuanto a los resultados audiométricos, obtuvimos un cierre completo del UDA en el 60,8 % (n = 14), cierre parcial del UDA del 13,2 % (n = 3), persistencia del UDA inicial en el 21,7 % (n = 5) y cofosis en el 4,3 % (n = 1). Conclusiones: La migración de la prótesis es la causa más frecuente de fracaso de la estapedectomía. Obtuvimos un cierre completo del UDA en dos tercios de los pacientes

Objective: The aim of the study was to determine the causes of failure in otosclerosis surgery. Material and method: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. Results: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). Conclusions: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients