The Laryngoscope · 2013
Air space reduction tympanomastoidectomy repairs difficult perforations more reliably than tympanoplasty.
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Redleaf Miriam I
Аннотация
OBJECTIVES/HYPOTHESIS: Air space reduction tympanomastoidectomy improves outcomes over tympanoplasty in repairing tympanic membrane perforations in the presence of unfavorable risk factors.
STUDY DESIGN: Retrospective review of 67 subjects' 87 operations.
METHODS: Interventions were tympanoplasty versus air space reduction tympanomastoidectomy. Risk factors were contracted mastoid air cells, previous failed operations, descent from the indigenous peoples of the Americas, and middle/ear mastoid volumes l<3 CC. Favorable outcomes were closure of the perforation, no decline in hearing, and creation of a self-cleaning mastoid bowl.
RESULTS: Five out of 46 air space reduction tympanomastoidectomies failed to close their perforations (11%). Pure-tone threshold (PTA) worsened in 13/46 ears (28%). Four of 46 required mastoid bowl cleaning (9%). In contrast, 21 of 41 tympanoplasties failed to close (51%). PTA worsened in 9/34 ears (26%). All four tympanoplasty failures treated with an air space reduction tympanomastoidectomy closed. Three of the seven tympanoplasty failures treated with a second tympanoplasty did not close. Statistical analysis found two risk factors more prevalent among the air space reduction tympanomastoidectomies: contracted mastoids (P = .019) and middle ear volumes <3 CC (P = .0001). Increased closure of perforations occurring after the air space reduction tympanomastoidectomy was also statistically significant (P = .0002). Descendants of indigenous peoples of the Americas trended toward better PTAs after their air space reduction tympanomastoidectomies than their tympanoplasties and showed statistically significant increases in closure of perforation (P = .0046).
CONCLUSIONS: Air space reduction tympanomastoidectomy is an effective and safe method for closing tympanic membrane perforations.
STUDY DESIGN: Retrospective review of 67 subjects' 87 operations.
METHODS: Interventions were tympanoplasty versus air space reduction tympanomastoidectomy. Risk factors were contracted mastoid air cells, previous failed operations, descent from the indigenous peoples of the Americas, and middle/ear mastoid volumes l<3 CC. Favorable outcomes were closure of the perforation, no decline in hearing, and creation of a self-cleaning mastoid bowl.
RESULTS: Five out of 46 air space reduction tympanomastoidectomies failed to close their perforations (11%). Pure-tone threshold (PTA) worsened in 13/46 ears (28%). Four of 46 required mastoid bowl cleaning (9%). In contrast, 21 of 41 tympanoplasties failed to close (51%). PTA worsened in 9/34 ears (26%). All four tympanoplasty failures treated with an air space reduction tympanomastoidectomy closed. Three of the seven tympanoplasty failures treated with a second tympanoplasty did not close. Statistical analysis found two risk factors more prevalent among the air space reduction tympanomastoidectomies: contracted mastoids (P = .019) and middle ear volumes <3 CC (P = .0001). Increased closure of perforations occurring after the air space reduction tympanomastoidectomy was also statistically significant (P = .0002). Descendants of indigenous peoples of the Americas trended toward better PTAs after their air space reduction tympanomastoidectomies than their tympanoplasties and showed statistically significant increases in closure of perforation (P = .0046).
CONCLUSIONS: Air space reduction tympanomastoidectomy is an effective and safe method for closing tympanic membrane perforations.