MULTIFACTORIAL ANALYSIS OF THE CAUSES OF INEFFECTIVENESS OF CLOSED-TYPE TYMPANOPLASTY
DOI:
https://doi.org/10.37219/fy55sw19Keywords:
middle ear, chronic diseases, reconstructive surgery, closed-type tympanoplasty, Eustachian tube function, cholesteatoma, scarring, recurrent perforationAbstract
Topicality: Closed-type tympanoplasty is one of the leading methods of reconstructive surgery of the middle ear, aimed at restoring the anatomical integrity of the tympanic membrane and improving sound-conducting function in chronic middle ear diseases. Despite significant progress in the development of otologic methods and the improvement of surgical techniques, the proportion of unsatisfactory outcomes remains relatively high, which makes the study of factors affecting surgical efficacy particularly relevant.
Objective: To determine the complex of factors leading to the ineffectiveness of closed-type tympanoplasty in patients with chronic middle ear diseases.
Materials and Methods: The study included 41 patients who underwent closed-type tympanoplasty during the period 2020-2024. In 67% of patients, the primary surgery was performed in various clinics of the Republic of Uzbekistan. Revision surgeries and comprehensive examinations were carried out at the multidisciplinary clinic “Bakhtli Hayot” and included clinical-morphological, functional, and systemic analyses of factors influencing the outcomes of surgical treatment.
Results: Revision surgeries revealed a complex of morphological changes reflecting a combi-nation of chronic inflammation, impaired ventilation of the middle ear, and secondary tissue remodeling processes. The most frequent pathological finding was cicatricial-adhesive disease, observed in 25 patients (61%). In 61% of patients, diseases of the nasal cavity and paranasal sinuses were identified, including chronic rhinitis and rhinosinusitis, nasal septum deviation, hypertrophy of adenoid tissue, and allergic conditions. These disorders impaired middle ear ventilation and contributed to graft retraction.
Conclusion
1. Ineffectiveness of closed-type tympanoplasty is due to a combination of morphological changes, impaired Eustachian tube function, and technical aspects of the surgery.
2. The main factors of unfavorable out-comes are: scarring – 61%, rhinosinus pathology – 61%, cholesteatoma – 37%, recurrent perforation – 29%, and prosthesis instability – 24%.
3. Comprehensive preoperative diagnostics and timely correction of diseases of the nasal cavity and paranasal sinuses improve the effectiveness of reconstructive surgery
References
1. Wullstein H. Theory and practice of tympanoplasty. Laryngoscope. 1956 Aug;66(8):1076-93. doi: 10.1288/00005537-195608000-00008.
2. Shea JJ Jr. Vein graft closure of eardrum perforations. J Laryngol Otol. 1960 Jun:74:358-62. doi: 10.1017/s002221510005670x.
3. Tos M. Manual of middle ear surgery. Vol. 1: Approaches, myringoplasty, ossiculoplasty and tympanoplasty. Stuttgart: Thieme; 1993.
4. Mudry A. Tympanoplasty before tympanoplasty: Alea jacta erat! Otol Neurotol. 2022 Feb 1;43(2):276-280. doi: 10.1097/MAO.0000000000003382.
5. Sadé J, Ar A. Middle ear and auditory tube: middle ear clearance, gas exchange, and pressure regulation. Otolaryngol Head Neck Surg. 1997 Apr;116(4):499-524. doi: 10.1016/S0194-59989770302-4.
6. Poe DS. Diagnosis and management of the patulous eustachian tube. Otol Neurotol. 2007 Aug;28(5):668-77. doi: 10.1097/mao.0b013e31804d4998.
7. Pawankar R, Mori S, Ozu C, Kimura Y. Overview on the pathomechanisms of allergic rhinitis. Asia Pac Allergy. 2011 Oct;1(3):157-67. doi: 10.5415/apallergy.2011.1.3.157.
8. Dornhoffer JL, Friedman AB, Gluth MB. Management of acquired cholesteatoma in the pediatric population. Curr Opin Otolaryngol Head Neck Surg. 2013 Oct;21(5):440-5. doi: 10.1097/MOO.0b013e32836464bd.
9. Yung M. Long-term results of ossiculoplasty: reasons for surgical failure. Otol Neurotol. 2006 Jan;27(1):20-6. doi: 10.1097/01.mao.0000176173.94764.f5.
10. Merchant SN, Rosowski JJ, McKenna MJ. Eustachian tube, middle ear, and mastoid anatomy; physiology, pathophysiology, and pathogenesis of middle ear and mastoid diseases. In: Cummings Otolaryngology Head & Neck Surgery. 4th ed. Philadelphia: Mosby; 2005. p. 1845-1908.
11. Gutierrez JA 3rd, Cabrera CI, Stout A, Mowry SE. Tympanoplasty in the setting of complex middle ear pathology: a systematic review Ann Otol Rhinol Laryngol. 2023 Nov;132(11):1453-1466. doi: 10.1177/00034894231159000.
