Veysel YURTTAŞ, Ahmet URAL, Ahmet KUTLUHAN, Kazım BOZDEMİR

Prognostic factors for graft success in tympanoplasty with mastoidectomy

Amaç: Çalışmanın amacı mastoidektomili timpanoplastide greft başarısı üzerinde etkisi olabilecek faktörleri araştırmaktır. Yöntem: Bu retrospektif çalışma, Eylül 2004 ile Temmuz 2010 arasında mastoidektomili timpanoplasti amliyatı geçiren olguların verileri kullanılarak yürütüldü. Epitimpanik açıklık, kulağın kuru kalış süresi, preoperatif otore olup olmaması, perforasyonun yeri, orta kulak mukozasının ve timpanik membranın durumunun postoperatif greft başarısı üzerindeki etkisi araştırıldı. İstatistiksel analiz için ki-kare ve Fisher exact testleri kullanıldı. Bulgular: Çalışmada toplam 130 hasta (56 kadın, 74 erkek; yaş ortalaması: 35.7, yaş aralığı: 11-56) dahil edildi. Greft başarı oranı %75 olarak belirlendi. Kulağın 3 aydan daha uzun süre kuru kalması, preoperatif olarak kulak akıntısı olmaması, preoperatif normal orta kulak mukozası ve epitimpanik açıklık oluşu postoperatif greft başarısını anlamlı şekilde artırmıştır (p

Mastoidektomili timpanoplastide greft başarısını etkileyen prognostik faktörler

Objective: The aim of this study was to evaluate the different factors that may affect graft success in tympanoplasty with mastoidectomy. Methods: Patients who underwent tympanoplasty with mastoidectomy between September 2004 and July 2010 were included in this study. Patient data were collected retrospectively. The effects of the epitympanic patency, duration of the dry period of the ear, presence of preoperative otorrhea, location of the perforation, status of the middle ear mucosa, and status of the tympanic membrane on the rate of postoperative graft success in patients who underwent tympanoplasty with mastoidectomy were investigated. The chi-square test and Fisher's exact test were used for statistical analysis. Results: A total of 130 patients, 74 male and 56 female, with an average age of 35.7 (range: 11 to 56) years were included. The overall success rate for full postoperative graft success was 75%. A >3-month dry period of the ear, absence of preoperative otorrhea, preoperative normal middle ear mucosa, and presence of epitympanic patency significantly increased the postoperative success rate of graft (p<0.001). The presence of preoperative otorrhea and granulation tissue in the middle ear mucosa, presence of preoperative myringosclerosis, and lack of epitympanic patency were significantly associated with graft failure after tympanoplasty with mastoidectomy (p<0.001). Conclusion: Epitympanic patency, middle ear infection, and the morphology of the tympanic membrane and middle ear mucosa should be considered prognostic factors in patients who undergo tympanoplasty with mastoidectomy.

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1. Bluestone CD. Epidemiology and pathogensis of chronic suppu- rative otitis media: implications for prevention and treatment. In J Pediatr Otorhinolaryngol 1998;42:20723.
2. Tos M. Indications for surgery and preoperative management. In: Tos M, editor. Manual of middle ear surgery. New York, NY: Thieme; 1993. p. 5.
3. Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multi- variate analysis of otological, surgical and patient-related factors in determining success in myringoplasty. Clin Otolaryngol 2005;30: 11520.
4. Pignataro L, Grillo Della Berta L, Capaccio P, Zaghis A. Myringoplasty in children: anatomical and functional results. J Laryngol Otol 2001;115:36973.
5. Caylan R, Titiz A, Falcioni M, et al. Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg 1998;118:70913.
6. Adkins WY, White B. Type I tympanoplasty: influencing factors. Laryngoscope 1984;94:9168.
7. Sadé J , Berco E, Brown M, Weinberg J , Avraham S. Myringoplasty: short and long-term results in a training program. J Laryngol Otol 1981;95:65365.
8. Lee P, Kelly G, Mills RP. Myringoplasty: does the size of the per- foration matter? Clin Otolaryngol Allied Sci 2002;27:3314.
9. Kotecha B, Fowler S, Topham J . Myringoplasty: a prospective audit study. Clin Otolaryngol Allied Sci 1999;24:1269.
10. Koch WM, Friedman EM, McGill TJ , Healy GB. Tympanoplasty in children. The Boston Childrens Hospital experience. Arch Otolaryngol Head Neck Surg 1990;116:3540.
11. Sheehy JL. Mastoidectomy: the intact canal wall procedure In: Brackmann DE, editor. Otologic surgery. Philadelphia, PA: WB Saunders; 1994. p. 21124.
12. McGrew BM, Jackson CG, Glasscock ME 3rd. Impact of mas- toidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004;114:50611.
13. Lau T, Tos M. Long-term results of surgery for chronic granulat- ing otitis. Am J Otolaryngol 1986;7:3415.
14. Vartiainen E, Kansanen M. Tympanomastoidectomy for chronic otitis media without cholesteatoma. Otolaryngol Head Neck Surg 1992;106:2304.
15. Mutoh T, Adachi O, Tsuji K, Okunaka M, Sakagami M. Efficacy of mastoidectomy on MRSA-infected chronic otitis media with tym- panic membrane perforation. Auris Nasus Larynx 2007;34:9 13.
16. Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M. Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: is it necessary? Otolaryngol Head Neck Surg 1997;117: 5925.
17. Mishiro Y, Sakagami M, Takahashi Y, Kitahara T, Kajikawa H, Kubo T. Tympanoplasty with and without mastoidectomy for non- cholesteatomatous chronic otitis media. Eur Arch Otorhinolaryngol 2001;258:135.
18. Merenda D, Koike K, Shafiei M, Ramadan H. Tympanometric volume: a predictor of success of tympanoplasty in children. Otolaryngol Head Neck Surg 2007;136:18992.
19. Singh GB, Sidhu TS, Sharma A, Singh N. Tympanoplasty type I in children an evaluative study. Int J Pediatr Otorhinolaryngol 2005;69:10716.
20. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg 2008;139:38690.
21. Albu S, Babighian G, Trabalzini F. Prognostic factors in tym- panoplasty. Am J Otol 1998;19:13640.
22. Hulka GF, McElveen JT Jr. A randomized, blinded study of canal wall up versus canal wall down mastoidectomy determining the differences in viewing middle ear anatomy and pathology. Am J Otol 1998;19:57478.
23. Mishiro Y, Sakagami M, Kondoh K, Kitahara T, Kakutani C. Long-term outcomes after tympanoplasty with and without mas- toidectomy for perforated chronic otitis media. Eur Arch Otorhinolaryngol 2009;266:81922.