Stapedectomy: effect of type of anaesthesia on outcome results

The ideal type of anaesthesia which could offer maximum hearing results and least complications still a point of controversy in stapes surgery. This study was conducted on 20 patients suffering from conductive hearing loss [CHL] due to otosclerosis. Patients were classified into 2 groups; group [L] included 10 patients and were operated upon under local anaesthesia and group [G], included 10 patients, operated upon under general anaesthesia. All operations were performed at Otorhinolaryngology department; Benha Teaching Hospital. Our aim was to study the effect of type of anaesthesia, whether local or general on the outcome results of stapes surgery. Our results showed hearing gain in low and mid tone frequencies in both groups with no significant difference of air-bone gap posoperatively, while the high tone frequency in group [G] had a lower bone conduction threshold compared with that in group [L], indicating the more suffering of the cochlea. We concluded that stapes surgery is better to be operated under local anaesthesia than to be operated under general anaesthesia as it gives the surgeon and the patient good chance to protect the inner ear and to test the hearing on the operative table to the satisfactory level for both. However, general anaesthesia should be used with some indviduals especially anxious ones

Effect of primary T-tube insertion in a cartilage-perichondrium graft in tympanoplasty

Cartilage/perichondrium composite graft with concomitant placement of a ventilation tube is a common practice among otologists to repneumatize the middle ear, and to reverse atelectasis in poor Eustachian tube function. We conducted this study to investigate the necessity of a ventilation tube primarily incorporated into the cartilage/perichondrium graft for reconstruction of the tympanic membrane[TM] in tympanoplasty with a potential Eustachian tube dysfunction to improve the rate of graft success. A prospective clinical trial. Benha Teaching Hospital. Twenty patients with chronic suppurate otitis media [CSOM], were included in the study, for tympanoplasty. They were randomly divided into 2 groups. In Group [A], 10 patients underwent reconstruction of the TM with cartilage/perichondrium graft and intra-operative T-tube insertion, and in Group[B], 10 cases were operated upon using the same procedure without ventilation tube insertion. Outcome measures were: graft taking success, improvement of hearing, and postoperative complications. Analysis of the results was performed by Student's paired t test. The level of significance was set at 5%. Significant postoperative improvement of pure tone air-conduction threshold averages and air-bone gap averages were reported in the two groups. The postoperative air-bone gap averages showed statistically significant difference between Group A and B, with a better results in group A. In group A, there were one failed case, postoperative otorrhea in 2 cases which were resolved within 3 weeks follow up by medical treatment, and three plugged tubes were also encountered on the tenth day which managed successfully. In group B, we had two failed cases and another 2 post-operative otorrhea which were resolved medically. Primary insertion of a ventilation T-tube during simultaneously tympanoplasty with cartilage/perichondrium graft in cases of [CSOM] with, potential poor Eustachian tube function may improve the success rate of graft taking and hearing gain