Postoperative Results of Tympanoplasty Type III and IV

Chon, Kyong Myong; Goh, Eui Kyung; Lee, Il Woo

Abstract

BACKGROUND AND OBJECTIVES: The treatment goal of both chronic and cholesteatomatous otitis media is to irradicate inflammation and to improve hearing. Recently, it has become more important to improve hearing acuity, and thus ossicular reconstruction has become essential in middle ear surgery. To find out the effective method of ossiculoplasty, we analysed tympanoplasty cases, especially type III and IV by Wullstein, performed in our hospital. MATERIALS AND METHOD: 120 cases of type III and IV tympanoplasty performed from January 1995 to December 2000 were analysed. Age and sex distribution, success rate of hearing improvement, recurrence rate of infection, and extrusion rate were analysed according to implanted material and type of surgery.
RESULTS
1) Success rate of hearing improvement according to the implanted material were 35.7%, 33.3%, 43.5%, and 29.2% in fascia, TORP, PORP, and autologous ossicle, respectively. The success rate was highest for the PORP group and with the average of 37.5%. 2) Recurrence rate of infection according to implanted material were 4.8%, 4.2%, 4.3% with fascia, TORP, and PORP, respectively. Infection was the highest in the autologous ossicle (12.3%), and the average recurrence rate was 6.7%. 3) Extrusion rates according to implanted material were 12.5% (TORP), 4.3% (PORP), and 0%(autologous ossicle). The average was 5.1%. 4) Success rate of hearing improvement according to type of surgery were 51%, 46.7%, and 33.3% in atticotomy, intact canal wall mastoidectomy and open cavity mastoidectomy, respectively. The surgery which conserves the middle ear structure tended to have high success rate. 5) Recurrence rate of infection according to type of surgery were 8%, 6.7%, 6.1% in atticotomy, intact canal wall mastoidectomy, and open cavity mastoidectomy, respectively.
CONCLUSION
To obtain better results by operating, we should consider the kind of implantation material and proper type of operation. For better hearing improvement, it is preferable to use TORP or PORP instead of autologous ossicles. Although TORP and PORP tend to extrude more frequently than ossicles, they are still better than autologous ossicles if recurrence of infection is considered. Therefore, it is more preferable to use biocompatible materials such as TORP and PORP with adequate type of operation for tympanoplasty III and IV cases.