Renovation of surgical procedures and hearing results of type 1 tympanoplasty

We renovated surgical procedures of type 1 tympanoplasty and performing these procedures from September 1999. The purposes of the renovations are for the better postoperative hearing, the shorter period of healing and the shorter days of hospital treatment. The renovated points are as follows. Enlargement of facial recess approach e.g., the buttress is removed to visualize the tympanic cavity as much as we can. Neither the posterior meatal skin nor annulus is elevated to prevent a postoperative swollen of the meatal skin and keep the original position of the tympanic membrane. The repair of perforation of the tympanic membrane is performed via the external auditory canal using underlay method. Our criteria of performing these procedures are as follows. The subjects are patients with simple chronic otitis media. The ossicular chain exists. The condition of otitis media e.g. proliferation of granulation, is independent. As exception, type 3 tympanoplasty will be chosen when there is no malleus handle. Twenty-six patients with simple chronic otitis media underwent this renovated type 1 tympanoplasty. Postoperative hearing was evaluated according to the criteria proposed by Otological Society of Japan. The hearing result was considered as successful when the postoperative hearing level satisfied with at least one of three conditions as follows: 1) air-bone gap less than 15dB, 2) hearing gain more than 15dB, or 3) hearing level above 30 dB. Success rate was 96.2 %. The average of postoperative air-bone gap, hearing gain and hearing level were 2.5 dB, 11.6 dB and 26.2 dB, respectively. These results indicate that our renovation of the tympanoplasty is useful for the better postoperative hearing results.