THE EFFICACY OF ONE-STAGE TYMPANOPLASTY WITH MASTOID OBLITERATION AND TYMPANOPLASTY BY TRANSCANAL APPROACH

Purpose: To confirm the effect of one-staged tympanoplasty with mastoid obliteration and tympanoplasty by transcanal approach using ceramic prosthesis. Materials and Methods: A retrospective chart review was performed on 516 patients undergoing ossicular chain reconstruction between June 2001 and December 2005. We use one-stage tympanoplasty with mastoid obliteration, a modified canal wall down procedure for chronic otitis media with aeration trouble in mastoid. On the other hand, we use a tympanoplasty by transcanal approach for chronic otitis media without aeration trouble in mastoid. Results: In modified canal wall down, mean ABG for partial ossicular replacement prostheses was 29.5 Db postoperatively. Mean ABG for total ossicular replacement prostheses was 38.1 Db. Mean hearing gain in the P-type ceramic group was 10.3 dB. Mean hearing gain for patients following placement of T-type ceramic group was 9.3 dB. On the contrary, in tympanoplasty by transcanal approach, postoperative mean ABG for partial ossicular replacement prostheses was 40.4 dB. Mean ABG for total ossicular replacement prostheses was 42.7 dB. Mean hearing gain in the P-type ceramic was 7.8 dB. Mean hearing gain for patients following placement of T-type ceramic was 6.2 dB. A modified canal wall down group using ceramic P-type and ceramic a T-type group had 33.3% and 67% success rates. A tympanoplasty by transcanal approach using ceramic P-type and ceramic T-type had 10% and 20% success rates. Discussion: We confirmed that the total ossicular reconstruction using ceramic T-type was satisfactory for one-stage tympanoplasty with mastoid obliteration. However, the patients requiring tympanolasty by transcanal approach had significantly worse results than those with one-stage tympanoplasty with mastoid obliteration. In this study, we considered that patients undergoing a tympanoplasty by transcanal approach had more severe disease including tympanosclerosis than those requiring one-stage tympanoplasty with mastoid obliteration. In addition, our results showed that hearing results tended to be worse in unplanned revision surgery. Conclusion: We hope that a variety of material for reconstruction of the ossicular chain will be used in the near future in Japan as well.