Hatice ÇELİK, Sevim ASLAN FELEK, Necmi ARSLAN, Ahmet İSLAM, M. Asım ŞAFAK, İlknur HABERAL CAN, Yunus KANTEKİN

Kolesteatomsuz kronik otitis media için uygulanan intakt kanal duvar timpanoplasti sonrası başarısız işitme için uygulanan revizyon cerrahisi sonuçları

Amaç: Bu çalışmada daha önce kanal duvar timpanoplasti uygulanan kolesteatomsuz kronik otitis medialı hastalarda revizyon cerrahisinin odyometrik sonuçları değerlendirildi ve revizyon cerrahisini gerektiren işitme düzeltmesindeki başarısızlık nedenleri araştırıldı.Hastalar ve Yöntemler: Mart 2004 - Eylül 2009 tarihleri arasında intakt kanal duvar timpanoplasti uygulanan ve kötü işitme sonucu nedeniyle revizyon timpanoplasti yapılan kolesteatomsuz kronik otitis medialı 72 hasta 49 kadın, 23 erkek; ort. yaş 35.4±12.9 yıl; dağılım 11-64 yıl geriye dönük olarak incelendi. Hastaların dosyaları, ameliyat ve odyolojik kayıtları incelendikten sonra, ameliyat sırasındaki bulgular, ameliyat sonrası takip bilgileri, revizyon ameliyatı öncesi ve sonrası son kontroldeki odyometrik sonuçları değerlendirildi.Bulgular: Tüm hastalarda ameliyat öncesi ortalama hava-kemik aralığı HKA ortalama 26.7 aylık takipte 31.2 dB’den 19.9 dB’e azaldı. Havakemik aralığı, 20 dB ve altında %67, 30 dB ve altında %83, 10 dB ve üzerinde işitmede elde edilen kazanç %58 olarak bulundu. Hastaların ameliyat öncesi ve sonrası HKA değerlerinin karşılaştırılması istatistiksel olarak anlamlı bulundu p

Anahtar Kelimeler:

İşitme kaybı, kemikcik zincir rekonstrüksiyonu, revizyon cerrahisi, timpanoplasti

Results of revision surgery for hearing failure in intact canal wall up tympanoplasty for chronic otitis media without cholesteatoma

Objectives: This study assessed the audiometric results of revision surgery in patients on whom previous canal wall up tympanoplasty had been performed for chronic otitis media without cholesteatoma, and investigated reasons for hearing improvement failure which required revision surgery. Patients and Methods: Seventy-two patients 49 females, 23 males; mean age 35.4±12.9 years; range 11 to 64 years suffering from chronic otitis media without cholesteatoma, who had intact canal wall up tympanoplasty and revision surgery due to bad hearing results between March 2004 and September 2009, were evaluated retrospectively. After evaluation of patients’ files, operative and audiological records, findings during the surgery, postoperative follow-up, audiometric results before revision surgery and the results in the last control after revision surgery were analysed. Results: Preoperative mean air-bone gap ABG decreased in all patients from 31.2 dB to 19.9 dB after followed up for mean 26.7 months. Air-bone gap values below 20 dB were 67%, below 30 dB were 83%, hearing gain above 10 dB was found to be 58%. Comparision of pre- and postoperative ABG values of the patients revealed statistically significant difference p<0.001 . In addition to hearing loss, the reasons for revision surgery were mucosal disease relapse in 10 patients, graft perforation in 43 patients, otorrhea control in 15 patients. Findings during revision surgery were relapse of mucosal diseases in 15 patients, insufficient mastoidectomy in six patients, problems related to prosthesis in 29 patients, ossicular limitations brid, hyalen and granulation in 30 patients, and ossicular necrosis in six patients. The decision for four patients was changed from canal wall up tympanoplasty to canal wall down tympanoplasty. Postoperative total hearing loss developed in one case. Conclusion: The most important problem in revision of tympanoplasty patients with hearing loss is related with stabilisation of columella. To get successful hearing results, it is important to control disease and provide a stable and safe continuity between the tympanic membrane and vestibule.

Keywords:

Hearing loss, ossicular chain reconstruction, revision surgery, tympanoplasty,

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