Hearing results in the second stage of open mastoidectomy: A comparison of the different techniques.

OBJECTIVE: The goal of this study was to compare the hearing results obtained through different hearing-restoration techniques in open-cavity mastoidectomy. METHODS AND MATERIAL: A total of 116 ears operated on during the second stage of open mastoidectomy were studied. The hearing gain was registered as the difference between preoperative and 1-year postoperative conversational frequency means (500, 1000, 2000 Hz). High-pitched frequencies (4000 Hz) were used equally. Two groups of studies were carried out: in one study the stapes was intact, and in the other the stapes arch was absent. The columella techniques we examined, from a hearing point of view, are total and partial ossicular replacement prostheses, ossiculoplasty, cartilage with or without perichondrium, and the myringostapediopexy. RESULTS AND CONCLUSIONS: In the group of patients in whom the stapes was intact, the differences in high-pitched frequencies found between the different techniques were negligible, but the differences were quite significant in conversational frequencies, where the partial ossicular replacement prosthesis turned out to be the technique with the worst results. In ears in which only the footplate was present, the total ossicular replacement prosthesis gave better results than any other technique, both in conversational frequencies and in 4000-Hz frequency.

[Meatoplasty by intra-aural approach]. / La meatoplastia con abordaje endaural.

INTRODUCTION: The object of this communication was to discuss our experience with a new type of endaural meatoplasty. Auricular meatoplasty was described by Viennese otologists in the late nineteenth century. A hundred years later the procedure still is necessary for every open mastoidectomy. Most surgeons prefer to perform meatoplasty following traditional guidelines via a retroauricular incision. However, we have developed a new meatoplasty method using an endaural approach, similar to that described by Osborne Farrior and Fleury but performed at the beginning of the operation. The advantage of the procedure is that the size and shape of the cartilage to be removed are easily calculated. Therefore, the width of the future external canal can be predicted. Using this meatoplasty, the tragal cartilage can be removed as a whole piece with its perichondrium. This is important for middle-ear reconstruction. MATERIAL AND METHODS: Two hundred twenty-seven meatoplasties via an endaural approach were performed in the last 6 years, most as a step in open mastoidectomy. The procedure is described in detail for the cases in which it was used. RESULTS: Two parameters were considered in the evaluation of results: permanence of a dry and stable mastoid cavity and an intact eardrum. Only 3 (1.4%) ears out of 223 remained unstable after 3 years and 5 (2.24%) continued with a perforated eardrum. DISCUSSION: Meatoplasty via an endaural approach allowed us to design precisely the size and shape of the conchal cartilage to be removed and to calculate the volume of the future external canal. This approach can be used to remove a cartilaginous conchal fragment with its perichondrium. This piece is useful for the reconstruction of the middle ear or mastoid. Realization of this meatoplasty at the beginning of the procedure produces a broad exposure of the mastoid.

[Trans-canal mastoidectomy]. / Mastoidectomía transcanal.

UNLABELLED: The controversy regarding the best procedure for treating middle ear cholesteatoma has lasted over 100 years. This paper discusses our current methods for dealing with cholesteatoma, always through external ear or transmeatal mastoidectomy. We present the results of three years of follow-up. MATERIAL AND METHODS: A prospective study was made of 215 ears operated for cholesteatoma using a transcanal approach with one of three techniques: "on demand" DAA mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy with obliteration. Three parameters were used to evaluate results: stability of the mastoid cavity, integrity of the neotympanum, and evolution of hearing. RESULTS: The rate of cholesteatoma recurrence in ears operated with these techniques was much lower than that found in canal-wall-up techniques. Only 3 of the 215 cases (1.4%) remained unstable due to different causes three years after surgery. DISCUSSION AND CONCLUSIONS: Due to the high rate of cholesteatoma recurrence, canal-wall-up mastoidectomy has been abandoned in our clinic. Open techniques using a transmeatal approach, with or without obliteration, and the so-called "on demand" mastoidectomy, have yielded more stable results, although postoperative care is more critical.

[Results of three different stapedectomy techniques: a comparative study]. / Estudio comparativo de los resultados de tres tipos diferentes de estapedectomía.

We perform a comparative study on the results obtained through three stapedectomy techniques. The hearing gain was evaluated in 107 ears with total footplate removal, Shea prosthesis and connective tissue graft, in 81 ears with particular footplate removal, the same prosthesis, and no tissue graft, and in 66 ears with stapedectomy. The differences between the three groups in the air-bone gap closure or postoperative complications were not statistically significant. We conclude that results depend more on the surgeon than on the technique.

[Mastoid obliteration in open cavities]. / Obliteración mastoidea en cavidades abiertas.

The obliteration of a large or irregular mastoidectomy cavities with hard-to-control areas is a common problem for ENT surgeons. Numerous obliteration techniques have been proposed in the last 50 years. We report our experience of obliteration of mastoid cavities in 74 ears using autogenous mastoid cortical bone chips and rib cartilage. Our procedure, a partial obliteration with meatoplasty, has yielded good results. Almost 92% of these ears were dry three years after surgery. There were no cases of recurrent cholesteatoma between bone chips.

[Revision of stapedectomy (110 ears)]. / Revisión de estapedectomía (110 oídos).

We have carried out a retrospective study of 110 ears in patients affected with otosclerosis who underwent revision of stapedectomy, from 1979 to 1991, because they did not achieve hearing improvement or still presented persistent dizziness after primary stapedectomy. In our series, the most common causes of surgical failure after the first surgery are: displacement of the prosthesis (36.3%), ossicular chain alterations (21.8%) and regrowth of otosclerotic bone in the oval window (19.9%). One year after surgery, hearing test was compared with preoperatory tonal audiometry, finding and improvement in 48.1% (closure of 20 dB HL or more of the air-bone GAP), no changes in 43.6% and deterioration of the audition in 8.1%. Finally, we give some advises to prevent hearing loss in the revision of stapedectomy.