2009 Volume 52 Issue 1 Pages 16-22
In cases with an adhesive tympanum, such as that associated with adhesive otitis media, pars tensa cholesteatoma or pars flaccida cholesteatoma with adhesion of the posterior part of the pars tensa, eardrum re-formation tends to be associated with postoperative re-adhesion, and therefore, poor postoperative hearing results. Until now, in treatment of such cases with pars tensa adhesion of the eardrum, we employed a surgical method in which an indwelling ventilation tube was placed through a fascia graft during tympanoplasty. Also, we employed a staged operation in which a silastic sheet was inserted in the tympanic cavity in some cases. Despite the use of the above surgical approaches, re-adhesion was still observed in some cases and the postoperative hearing results remained poor. Therefore, we attempted to perform cartilage tympanoplasty to prevent postoperative re-adhesion after eardrum re-formation. When the cases were analyzed at least half a year postoperatively, 94.4% of all cases showed no depression or adhesion of the reconstructed eardrum, with maintenance of a good morphology. The overall postoperative success rate was 62.5%. Successful hearing results were obtained in 77.8% of cases that underwent type III-c tympanoplasty and 42.9% of cases that underwent type IV-c tympanoplasty. These results were superior to our previous hearing results.
These findings indicate that cartilage tympanoplasty is superior to the other surgical methods employed by us previously for an adhesive tympanum, for obtaining a good morphology of the reconstructed eardrum and hearing improvement. However, we observed the postoperative changes of the reconstructed eardrum only until five years after the surgery in this study. The long-term postoperative changes and hearing results must be evaluated in future studies.
