The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Shinichi Haginomori - One of the best experts on this subject based on the ideXlab platform.
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postoperative middle ear aeration and hearing results after canal wall down Tympanoplasty with soft wall reconstruction
Otolaryngology-Head and Neck Surgery, 2014Co-Authors: Shinichi Haginomori, Takahiro Ichihara, Atsuko Mori, Atsuko Kanazawa, Akira Nishikado, Ryo KawataAbstract:Objectives:(1) Estimate the degree of postoperative aeration in the middle ear after canal wall down Tympanoplasty with soft-wall reconstruction (CWD Tympanoplasty with SWR) for cholesteatoma. (2) Characterize the relationship between postoperative middle ear aeration and hearing outcome. (3) Propose an ideal state of middle ear aeration in order to obtain satisfactory hearing outcome after CWD Tympanoplasty with SWR.Methods:This retrospective study was conducted in our tertiary referral hospital between 2001 and 2013. Seventy-eight ears with cholesteatoma treated surgically at our hospital by planned two-stage CWD Tympanoplasty and SWR were included. Postoperative middle ear aeration was scored one year after second-stage surgery by computed tomography (CT). The patients were divided into 4 bins according to postoperative audiometric air-bone (A-B) gaps: 0-10, 11-20, 21-30, and >30 dB.Results:Postoperative middle ear aeration was significantly greater in the smaller A-B gap bins (0-10 and 11-20 dB) compa...
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residual cholesteatoma incidence and localization in canal wall down Tympanoplasty with soft wall reconstruction
Archives of Otolaryngology-head & Neck Surgery, 2008Co-Authors: Shinichi Haginomori, Atsuko Takamaki, Ryuzaburo Nonaka, Hiroshi TakenakaAbstract:Objective To compare the incidence and localization of residual cholesteatomas in canal wall down Tympanoplasty with soft-wall reconstruction with results with the canal wall down and open Tympanoplasty or canal wall up Tympanoplasty. Design Retrospective case-series study. Setting Tertiary care university hospital. Patients Eighty-five patients (85 ears) with fresh extensive cholesteatomas who underwent canal wall down Tympanoplasty with soft-wall reconstruction as first-stage surgery and a second operation after 1 year to confirm residual cholesteatomas and perform ossiculoplasty. Main Outcome Measures The incidence and localization of residual cholesteatomas in the middle ear were compared between surgery using the canal wall down and open Tympanoplasty and canal wall up Tympanoplasty. Possible technical causes of the residua were reviewed in a retrospective videotape analysis of the first-stage operations. Results Of the 85 ears operated on, 18 had residual cholesteatomas, for an overall incidence of 21%, with 1 residuum per ear. Six cholesteatomas were located in the epitympanum (33%), 3 in the sinus tympani (17%), 3 in the antrum (17%), 2 on the stapes (11%), 2 on the tympanic membrane (11%), 1 on the tympanic portion of the facial canal (6%), and 1 just under the skin of the external auditory canal (6%). The retrospective videotape analysis revealed that the main cause of residual cholesteatomas in the epitympanum and sinus tympani was incomplete removal of the matrix under an indirect surgical view because of insufficient drilling. Residual matrix in a bony defect in the middle cranial fossa or facial canal was the cause of residual cholesteatomas in the antrum or facial canal. Inappropriate keratinizing epithelium rolling during tympanic membrane or external auditory canal reconstruction was the cause of residual cholesteatomas in the tympanic membrane or external auditory canal. Conclusions The incidence of residual cholesteatomas in patients who underwent canal wall down Tympanoplasty with soft-wall reconstruction was similar to that in patients who underwent surgery involving the canal wall down and open Tympanoplasty or canal wall up Tympanoplasty. In terms of localization, with canal wall down Tympanoplasty with soft-wall reconstruction, there is the possibility of residua not only in the tympanic cavity but also in the antrum or mastoid cavity, as with the canal wall up method. Results of this study suggest that in patients with extensive cholesteatoma, canal wall down Tympanoplasty with soft-wall reconstruction should be followed by a second procedure to detect any residual cholesteatomas in the tympanic cavity, antrum, or mastoid cavity.
Paul R Lambert - One of the best experts on this subject based on the ideXlab platform.
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the impact of canalplasty on outcomes of medial graft Tympanoplasty
Otology & Neurotology, 2019Co-Authors: Daniel R Morrison, Brendan P Oconnell, Paul R LambertAbstract:OBJECTIVE Both medial and lateral graft techniques are commonly employed in Tympanoplasty with acceptable closure rates. Canalplasty is routinely performed to obtain adequate exposure in the lateral graft technique; this usually entails removal of the anterior canal wall skin with subsequent replacement as a free graft. While formal canalplasty can also be performed in conjunction with medial graft technique to improve exposure, it is not commonly described. The current study seeks to examine the impact of canalplasty on outcomes of medial graft Tympanoplasty. METHODS A retrospective chart review was performed for patients undergoing Tympanoplasty for chronic otitis media with the senior author. Audiometric data were recorded both preoperatively and postoperatively. Primary outcome measure was perforation closure with audiometric outcomes examined as secondary outcome measures. RESULTS One hundred seventy tympanoplasties without ossiculoplasty were included in our study. The overall rate of perforation closure postoperatively was 77%. Cartilage use portended a higher closure rate (100%) when compared with nonuse (75%) (p = 0.04). The success rates with lateral grafts (94%) and medial grafts with canalplasty (92%) were considerably higher than obtained with medial grafts without canalplasty (69%) (p = 0.005 and 0.02, respectively). In cases with anterior perforations greater than 25% of the tympanic membrane, our results demonstrated a significant advantage in performing canalplasty (p = 0.04). CONCLUSIONS Data from the current study suggest that canalplasty offers benefit regarding closure rate in medial graft Tympanoplasty. Use of cartilage also portended a higher rate of perforation closure. Canalplasty should be considered when using medial graft techniques if exposure is limited due to bony canal anatomy.
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hearing results after primary cartilage Tympanoplasty
Laryngoscope, 2000Co-Authors: Matthew J Gerber, John C Mason, Paul R LambertAbstract:Objectives/Hypothesis: Cartilage-perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Few studies in the literature address hearing results after cartilage Tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage Tympanoplasty and compare them with results after primary Tympanoplasty with temporalis fascia. Study Design: A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed. Methods: Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma. Pre- and postoperative speech reception thresholds and air-bone gaps at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz were compared. Results: Eleven patients comprised the cartilage study group, and there were 11 age- and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air-bone gap closures between the two groups. Conclusions: These results demonstrate that hearing results after cartilage Tympanoplasty are comparable to those after temporalis fascia Tympanoplasty. Therefore, when indicated, a cartilage-perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing.
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intact canal wall mastoidectomy with Tympanoplasty for cholesteatoma in children
Laryngoscope, 1998Co-Authors: Edward E Dodson, George T Hashisaki, Todd C Hobgood, Paul R LambertAbstract:Objective/Hypothesis: Cases of cholesteatoma in pediatric patients were reviewed to determine which factors influence the outcome of surgical treatment. Cholesteatoma is considered a more aggressive disease in children than in adults. The outcomes of intact canal wall (ICW) mastoidectomy and canal wall down (CWD) mastoidectomy were assessed, as comparisons of different surgical technique. Study Design: A retrospective analysis of all cases of pediatric cholesteatoma treated at a single institution by the senior author (P.R.L.) over a period of 11 years was conducted. Methods: Patient information was collected from an otology database, patient records, and audiology files. Results: Sixty-six patients, aged 10 months to 18 years, were treated and followed for an average of 37.7 months (range 12.2 months to 12. 5 y). ICW mastoidectomy with Tympanoplasty was the primary surgical treatment in 41 patients. Nineteen percent had residual disease at a planned second stage surgery and 22% developed recurrent cholesteatoma for a total recidivism rate of 41%. A SRT of less than 30 dB HL was achieved in 75% of these patients. Seventeen patients underwent CWD mastoidectomy with Tympanoplasty initially. Two patients (12%) had residual cholesteatoma found at a planned second state procedure, and no recurrent cholesteatoma was encountered Seventy-two percent maintained a SRT of less than 30 dB HL. Conclusions: These results support the continued use of ICW mastoidectomy with Tympanoplasty for pediatric cholesteatoma. If planned second stage surgery is necessary, the long-term results of an ear with useful hearing and few problems with chronic medical care are gratifying. For reasons of anatomy or in an only hearing ear, CWD mastoidectomy with Tympanoplasty provides a safe ear and good hearing results. Mastoid cavity care must be maintained indefinitely in many cases.
Ryo Kawata - One of the best experts on this subject based on the ideXlab platform.
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postoperative middle ear aeration and hearing results after canal wall down Tympanoplasty with soft wall reconstruction
Otolaryngology-Head and Neck Surgery, 2014Co-Authors: Shinichi Haginomori, Takahiro Ichihara, Atsuko Mori, Atsuko Kanazawa, Akira Nishikado, Ryo KawataAbstract:Objectives:(1) Estimate the degree of postoperative aeration in the middle ear after canal wall down Tympanoplasty with soft-wall reconstruction (CWD Tympanoplasty with SWR) for cholesteatoma. (2) Characterize the relationship between postoperative middle ear aeration and hearing outcome. (3) Propose an ideal state of middle ear aeration in order to obtain satisfactory hearing outcome after CWD Tympanoplasty with SWR.Methods:This retrospective study was conducted in our tertiary referral hospital between 2001 and 2013. Seventy-eight ears with cholesteatoma treated surgically at our hospital by planned two-stage CWD Tympanoplasty and SWR were included. Postoperative middle ear aeration was scored one year after second-stage surgery by computed tomography (CT). The patients were divided into 4 bins according to postoperative audiometric air-bone (A-B) gaps: 0-10, 11-20, 21-30, and >30 dB.Results:Postoperative middle ear aeration was significantly greater in the smaller A-B gap bins (0-10 and 11-20 dB) compa...
Sandra C Fuchs - One of the best experts on this subject based on the ideXlab platform.
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evaluation of inlay butterfly cartilage Tympanoplasty a randomized clinical trial
Laryngoscope, 2001Co-Authors: Marcelo Mauri, Jose Faibes Lubianca Neto, Sandra C FuchsAbstract:Objectives/Hypothesis In 1998 Eavey described a new inlay technique for Tympanoplasty in the pediatric age group using a cartilage graft through a transcanal approach. This technique was found to be effective and comfortable (no external canal incisions or ear packing). This study evaluated the efficacy of modified-inlay cartilage Tympanoplasty compared with the conventional underlay Tympanoplasty. Study Design Randomized clinical trial. Methods Patients were enrolled from December 1998 to March 2000. Seventy tympanoplasties were done in adults with medium-sized tympanic membrane (TM) perforations: 34 inlay tympanoplasties and 36 underlay tympanoplasties (control group). The main outcome measures were the “take rate” on the 30th postoperative day and the audiometric result at the second postoperative month. Secondary outcome measures include subjective postoperative hearing, postoperative pain, duration of surgery, and cost of the procedures. Results The “take rate” did not differ between groups on the 30th postoperative day (88.2% in the inlay Tympanoplasty group vs 86.1% in the underlay Tympanoplasty group;P = .8). After a mean follow-up of 7.5 ± 3.8 months (range, 3–16 mo), the “take rate” was 85.3% in the inlay Tympanoplasty group and 83.3% in the underlay Tympanoplasty group (P = .8). In the inlay Tympanoplasty group there was closure of the air–bone gap (ABG) to within 10 dB in 64.7% and to within 20 dB in 94.1%. The corresponding numbers to underlay Tympanoplasty were 75% and 97.2%. In only 2 cases (5.9%) in the inlay Tympanoplasty group and in 1 case (2.8%) in the underlay Tympanoplasty group the ABG was greater than 20 dB. No audiometric difference was observed between groups (P = .6). Most patients in the inlay Tympanoplasty group reported immediate improvement in their hearing (P <.0001). Pain was reported by 10 patients in the inlay Tympanoplasty group and by 30 patients in the underlay Tympanoplasty group on the first postoperative day (P <.0001). The duration of the surgery (mean ± standard deviation) was 33.6 ± 7.8 minutes for the inlay Tympanoplasty group and 62.9 ± 12.7 minutes for the underlay Tympanoplasty group (P <.0001). The estimated charge for inlay Tympanoplasty at our institution was 65% less expensive than underlay Tympanoplasty. Conclusion The “take rate” and audiometric results following inlay cartilage Tympanoplasty or underlay Tympanoplasty were similar. Inlay butterfly cartilage Tympanoplasty did not require general anesthesia, was less expensive, and more comfortable to the patient.
Hiroshi Takenaka - One of the best experts on this subject based on the ideXlab platform.
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residual cholesteatoma incidence and localization in canal wall down Tympanoplasty with soft wall reconstruction
Archives of Otolaryngology-head & Neck Surgery, 2008Co-Authors: Shinichi Haginomori, Atsuko Takamaki, Ryuzaburo Nonaka, Hiroshi TakenakaAbstract:Objective To compare the incidence and localization of residual cholesteatomas in canal wall down Tympanoplasty with soft-wall reconstruction with results with the canal wall down and open Tympanoplasty or canal wall up Tympanoplasty. Design Retrospective case-series study. Setting Tertiary care university hospital. Patients Eighty-five patients (85 ears) with fresh extensive cholesteatomas who underwent canal wall down Tympanoplasty with soft-wall reconstruction as first-stage surgery and a second operation after 1 year to confirm residual cholesteatomas and perform ossiculoplasty. Main Outcome Measures The incidence and localization of residual cholesteatomas in the middle ear were compared between surgery using the canal wall down and open Tympanoplasty and canal wall up Tympanoplasty. Possible technical causes of the residua were reviewed in a retrospective videotape analysis of the first-stage operations. Results Of the 85 ears operated on, 18 had residual cholesteatomas, for an overall incidence of 21%, with 1 residuum per ear. Six cholesteatomas were located in the epitympanum (33%), 3 in the sinus tympani (17%), 3 in the antrum (17%), 2 on the stapes (11%), 2 on the tympanic membrane (11%), 1 on the tympanic portion of the facial canal (6%), and 1 just under the skin of the external auditory canal (6%). The retrospective videotape analysis revealed that the main cause of residual cholesteatomas in the epitympanum and sinus tympani was incomplete removal of the matrix under an indirect surgical view because of insufficient drilling. Residual matrix in a bony defect in the middle cranial fossa or facial canal was the cause of residual cholesteatomas in the antrum or facial canal. Inappropriate keratinizing epithelium rolling during tympanic membrane or external auditory canal reconstruction was the cause of residual cholesteatomas in the tympanic membrane or external auditory canal. Conclusions The incidence of residual cholesteatomas in patients who underwent canal wall down Tympanoplasty with soft-wall reconstruction was similar to that in patients who underwent surgery involving the canal wall down and open Tympanoplasty or canal wall up Tympanoplasty. In terms of localization, with canal wall down Tympanoplasty with soft-wall reconstruction, there is the possibility of residua not only in the tympanic cavity but also in the antrum or mastoid cavity, as with the canal wall up method. Results of this study suggest that in patients with extensive cholesteatoma, canal wall down Tympanoplasty with soft-wall reconstruction should be followed by a second procedure to detect any residual cholesteatomas in the tympanic cavity, antrum, or mastoid cavity.
