Document Detail

Should ossicular reconstruction be staged following tympanomastoidectomy.
MedLine Citation:
PMID:  16481808     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine whether ossicular reconstruction (OCR) performed concurrent with tympanomastoidectomy for cholesteatoma results in significantly different hearing results when compared to OCR performed in a separate, staged procedure. STUDY DESIGN: Retrospective. MATERIALS AND METHODS: Study subjects were patients undergoing OCR within a 2-year period. Intervention was OCR concurrent with tympanomastoidectomy for cholesteatoma (group 1) or staged following tympanomastoidectomy for cholesteatoma (group 2). Main outcome measures were mean postoperative air-bone gap (ABG), proportion achieving ABG closure to <20 dB and <30 dB for group 1 and group 2 overall and when controlling for type of mastoid cavity created (open or closed) and the status of the stapes suprastructure (TORP vs. PORP OCR). RESULTS: Eighty-three patients were identified. Forty underwent OCR concurrent with tympanomastoidectomy and 43 underwent a staged OCR after tympanomastoidectomy. Overall, similar hearing results were seen in the two groups. When considering the status of the stapes and mastoid cavity, concurrent OCR resulted in improved mean postoperative ABG in a closed mastoid cavity with an intact stapes suprastructure (P = .024). Furthermore, a greater proportion of patients who had concurrent OCR within this group achieved ABG <20 dB and ABG <30 dB, although this difference did not reach statistical significance (P = .092 and P = .078, respectively). By contrast, staged OCR resulted in improved mean postoperative ABG and ABG <30 dB in open mastoid cavities with an absent stapes suprastructure (P = .040, and P = .019, respectively). Similarly, a greater proportion achieved ABG <20 dB, approaching statistical significance (P = .055). CONCLUSIONS: Staged OCR is advantageous in those with most severe disease, whereas those with least severe disease may benefit from a concurrent OCR.
Harold H Kim; Robert A Battista; Arvind Kumar; Richard J Wiet
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Laryngoscope     Volume:  116     ISSN:  0023-852X     ISO Abbreviation:  Laryngoscope     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-02-16     Completed Date:  2006-03-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  47-51     Citation Subset:  IM    
Wilson Ear Clinic, Portland, Oregon 97209, USA.
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MeSH Terms
Audiometry, Pure-Tone
Cholesteatoma, Middle Ear / diagnosis,  surgery*
Chronic Disease
Combined Modality Therapy
Ear Ossicles / surgery
Follow-Up Studies
Hearing Loss, Conductive / diagnosis,  etiology
Middle Aged
Ossicular Replacement*
Otitis Media / diagnosis,  surgery*
Otologic Surgical Procedures / methods
Reconstructive Surgical Procedures / methods
Reference Values
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Treatment Outcome
Tympanoplasty / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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