The use of total ossicular replacement prosthesis after radical tympanomastoidectomy.

OBJECTIVE

This paper presents our operative method for hearing recovery after the previous radical tympanomasto-idectomy, radical trepanation of the temporal bone (trepanatio radicalis ossis temporalis--TROT) in eight patients submitted to operations for giant cholesteatotoma.

METHODS

All the patients were admitted to our clinic after TROT. There were no signs of cholesteatoma or infection. The patients refused any stent implantations or any hearing aids due to possible aesthetic problems. The described procedure developed in two steps. The first one was to restore the destroyed cavum tympany and to covert with chondroperichondral new membrane with a pin-like "guide" as collumela. The second step was to insert a TORP (total ossicular replacement prosthesis) after guide excision.

RESULTS

After the first operation (stage one) there were no infections in the operated area nor chondroperichondral graft rejection. Postoperative audiometry (6 to 8 weeks) was done to demonstrate the improvement of air conduction. Three months following the first, the second (stage two) operation was performed and 2.5 to 3 months after this operation even greater audiometry revealed hearing improvement in air- and bone-conduction. The patients were dismissed from the hospital 2 days after each procedure without any complications. They did not experience any dizziness, vomiting nor a severe pain. Three months after the second operative stage, otoscopic findings were very good. The audiometry findings after a 3-months period (after stage one) and 3 months after final TORP insertion was done for each of the patients. After one year, the audiometric curve was the same. Clinical and audiometry follow up demonstrated a hearing recovery and closure of air bone gap (ABG) to values of 5 to 15 dB.

CONCLUSIONS

The use of TORP after radical tympanomastoidectomy is feasible. The first step of the procedure is the fixation of a neomembrane. A stabilized neomembrane is essential for light overpressure on the prosthesis and this is important for optimal or better conductivity. A better hearing recovery is confirmed with audiometric findings and ABG reduction to 5-15 dB. This method could be performed in all patients (with good bone-conduction) after radical tympanomastoidectomy for better hearing.