Mediterr. J. Otol 2008; 4:(3)
The Effect
of Mobility of Ossicles and Surgical Approach on Hearing Results in Patients
with Tympanosclerosis
Hatice Çelik, Sevim Aslan Felek, Ahmet İslam, Necmi Arslan,
Munir Demirci, İlknur Haberal Can
Ministry of Health Ankara
Training and Research Hospital, The Department of Otorhinolaryngology and Head
and Neck Surgery, Ankara, Turkey saslanfelek@yahoo.com
Objective: To evaluate involvement of ossicular chain with tympanosclerosis and their effects on hearing loss and to compare the results of mobilization or stapedectomy in stapes fixed tympanosclerosis.
Materials and methods: Seventy three patients operated for tympanosclerosis were retrospectively analyzed. Sixty-four ears with tympanosclerosis were mobilized with Type I tympanomastoidectomy and 9 ears were applied total stapedectomy in a two-stage surgery. Pre-and postoperative air-bone gap pure tone average and the average hearing gain were analyzed using a four frequency (500,1000,2000,and 3000Hz). Six months to 3 years of follow-up are provided.
Results: Type III tympanosclerosis patients had the most severe hearing loss whereas type II tympanosclerosis patients had minimal hearing loss. With mobilization surgery preoperative air-bone gap of 23.5 dB in type II tympanosclerosis decreased to 12 dB postoperatively in 3 years whereas in type III and IV cases, preoperative air-bone gap of 34.5 and 28.2 dB decreased to 21.3 dB and 24 dB respectively. In 17 cases which their stapes were mobilized; preoperative air-bone gap of 29.7 decreased to 23.9 dB postoperatively in 2 years. In 9 cases which the stapedectomy was performed the air bone gap was decreased from 35.3 dB to 7.4 dB. Hearing gains among the cases which mobilization and stapedectomy were performed was found to be 7.2 dB and 25.3 dB respectively in 2 years.
Conclusion: Hearing results were negatively affected when stapes fixation in tympanosclerosis was treated by mobilization. The best hearing results in these cases were obtained in two conditions: (a) by applying total ossicular replacement prosthesis during stapedectomy in the second-stage surgery in case of attic fixation and incus-malleus could not be mobilized; and (b) by applying stapedectomy and inserting teflon piston in case of incus-malleus was managed to be mobilized.