Research Of Clinical Data And Ossicular Reconstruction In Patients With Tympanosclerosis

PartⅠClinical analysis of 118 patients with tympanosclerosisObjective To study the incidence of the tympanosclerosis(TS) and the major risk factors of hearing loss.Methods1.1 Material Retrospective review of complete collected data from the most of patients between January 2004 and May 2009.All patients presented with a history of chronic suppurative otitis media (CSOM) which have 118 patients with typanosclerosis and 265 patients with CSOM as control group.118 patients with typanosclerosis included 38 male and 80 female patients with a range of 12 to 66 years, the mean age was 34.49±12.58 years.The control group included 139 male and 126 female patients with a range of 6 to 70 years, the mean age was 35.53±13.12 years.Measure tool:GSI 61 clinical audiometer of American.1.2 Method1.2.1 Main research indication:According to history records, surgical records and pure tone audiometry we analysed 118 patients with tympanosclerosis with complete clinical data from January 2004 to May 2009 in otorhinolaryngology department from ZhuJiang hospital.The control group recorded at the same period gender, age, duration of a total of 265 cases, excluding cases of cholesteatoma otitis media. According to surgical record analysed cases of tympanic membrane tympanic sclerosis, and ossicular calcify or damage; According to preoperative pure-tone hearing threshold inspection analysed audiometry.1.2.2 The measure of audiologyThe indication of every variables:testing air conduction of 250,500,1000,2000, 4000,8000 Hz and bone conduction of 250,500,1000,2000,4000 Hz;500,1000 and 2000 Hz mean as average pure-tone hearing threshold (speech AC).The gap of Air-bone (ABG) is the margin of air conduction minus bone conduction at the same period of speech frequency. Air conduction limit:120 dB;bone conduction limit:80 dB;beyond, no lack of determination of the value of those targeted.1.2.3:Statistical Disposal:All data was analyzed statistically by spss 13.0, testing standard a=0.05.Results(1)Prevalence of the tympanosclerosis (TS) was 38.8% and 21.5%,mean age was(36.56±12.32)years and (30.13±12.16) years respectively for Female and male.which was significantly different in accordance with statistics. (2)The incidence of sclerosis from high to low was tympanic membrane,malleus, incus, incudomalleolar joint, other regions,ariticulus incudostapedius and stapes. The extent of tympanosclerosis (TS)in female patients was wider than in male ones.. (3)The hearing loss of those who had sclerosis or deterioration in ossicular chain was worse than others.Carhart notch occurred in 45 ears(32.85%),and the inverted "V"-shaped curve of air conductive audiometry near 2kHz occurred similarly in 47 ears(34.31%).The influential factors of hearing in the order of importance included incus, malleus, incudomalleolar joint, ariticulus incudostapedius,stapes, other regions, tympanic membrane and gender.Conclusion Female as gender reason maybe increase the risk of the tympanosclerosis.Carhart notch and the inverted "V"-shaped curve of air conductive audiograph indicates myringosclerosis or ossicular chain sclerosis.Abnormal ossicular chain is the most leading factor of hearing loss.PartⅡEffects of ossicular reconstruction with Partial Ossicular Replacement Prosthesis(PORP) in patients with tympanosclerosisObjective To compare the effectiveness of ossicular reconstruction with porous polyethylene polymer and bio-ceramic artificial bone Partial Ossicular Replacement Prosthesis(PORP) in patients with tympanosclerosis.Methods1.1 Clinicial data:Material Retrospective review of prospectively collected data from the most of patients with tympanosclerosis of typeⅡ(that is Malleus-incus complex fixed) between 1992 and 2009 was used, at the Zhu Jiang Hospital.In the study 33 cases with tympanosclosis included 12 males and 21 females.The average age of the patients was(32.33±11.98) years,with a range of 16 to 52 years.Clinical examination showed preoperative dry inactive ear over one month. All the cases were followed-up for 3-24 months.According to malleus-incus complex fixed,damage to ossicular to the use of porous polymer polyethylene artificial bone in 18 cases,bio-ceramic artificial bone in 15 cases.Measure tool:GSI 61 clinical audiometer of American. Of artificial bone materials, porous polymer polyethylene listening ear bone prostheses (Sheehy Partial Ossicular Prosthesis, POP, US-Medtronic company) Specifications:L=4.75mm, HD=3.0mm,SID=1.17mm. Bioceramic ossicles (bioceramic middle ear devices, biological materials, Wuhan Warwick Project Development Company) Size:PORP:Height are 2.0mm,2.5mm, 3.0mm,3.5mm,4.0mm 5 kinds, weight 10-20mg. 1.2 Method:1.2.1 Operation Method:external auditory meantus incision surgery are used, not cut mastoid with tympanoplasty, away from the tympanic membrane 6-8 mm flat for external auditory canal skin flap, separate flaps, provoke tympanic membrane into the middle ear, open attic tympanum, expose Malleus and Incus, detect ossicular chain, remove the complex fixed or destroyed malleus-incus, cut the chorda tympani nerve if it impede the operation.Through a standard transcanal approach, an ossicular reconstruction was carried out as follows:Partial Ossicular Replacement Prosthesis(PORP) placed between the intact, mobile stapes and the tympanic membrane. For accomplishing secure placement of the prosthesis, Fascia, cartilage or perichondrium must be interposed between the prosthesis and the undersurface of the tympanic membrane.Brake the head 1-2 d,prevent sneezing, conventional anti-infection, take the iodoform gauze out of the external auditory canal about 14d.1.2.2 Main Observation Indexs:In all the patients, Pure-tone air and bone-conduction thresholds were obtained before and after surgery. Both air conduction(AC)and bone conduction(BC)were tested at the frequency of 250, 500,1000,2000 and 4000Hz. Both speech frequency AC and BC were taken as the average of 500,1000 and 2000Hz values.ACand BC from the same test were used to calculate the air-bone gap(ABG).1.2.3 Hearing tests and follow-up:Preoperative 1-2d and postoperative 1-24 months electric audiometry test was taken at 250,500,1000,2000,4000 Hz air conduction and bone conduction. The speech frequency means 500,1000 and 2000Hz. Air-bone gap (ABG) for the same period of speech frequency air conduction minus bone conduction. Ceiling air conduction:120dB,bone conduction limit:80dB, and not measured by the value were missing data. After the last review hearing in order to prevail.Preoperatively acoustic impedance, the eustachian tube blowing tests, or ear endoscopy test were given. Follow-up observed whether the ear bone prostheses prolapse, prevention of infection, maintaining the external auditory canal dry-cleaning.1.2.4 Statistical disposal: All data of the two groups between the porous polyethylene group and the bio-ceramic group were compared by T-test (a=0.05, two-tailed). Constituent ratio compared by theχ2 test (a=0.05,two-tailed).SPSS13.0 package were used for statistical analysis.ResultsTwo groups of speech frequencies (0.5,1000,2000) after surgery improve at AC and ABG, there is a significant difference (P<0.05),but no significant difference between the two groups (P> 0.05).Two groups at 4000Hz postoperative air conduction and air-bone gap were no significant improvement. Bio-ceramic artificial bone get out of aural canal in 1 case, for the simple tympanic membrane with temporalis myofascial repair. Porous polyethylene artificial ear bone did not occurre prolapse cases.Tympanic membrane with cartilage repair person did not appear to artificial ossicles discharge. No lateral migration of new tympanic membrane healing, except one cases of bio-ceramic outer ear bone piercing other non-perforation of tympanic membrane.Postoperation the external auditory canal stenosis in 1 case, re-stenosis after surgery without hearing no effect. Patients achieved dry ear after 1 month. There were no postoperative sensorineural hearing loss.ConclusionPorous polymer polyethylene and bio-ceramic artificial ossicles reconstruct ossicles which can improve the hearing of typeⅡtympanosclerosis, short-term efficacy is confirmed, which is an effective method of treatment of tympanosclerosis. Prevention of complications should pay attention to fine surgical operation, artificial bone implant position, ensure a solid and accurate connections, prevent middle ear infections to reduce the postoperative inflammatory response, avoid vigorous activity and loud environment, prevent artificial ossicles displacement.