Al-Azhar Assiut Medical Journal (Jan 2016)
Ventilation tubes versus cartilage tympanoplasty with cortical mastoidectomy: a clinical and audiological comparative study in the treatment of middle ear atelectasis
Abstract
Background Atelectasis of the middle ear is a collapse of the middle ear space formed by extreme atrophy of the tympanic membrane. It is still a controversial issue regarding its etiology, and little has been published about its progression. Objective The aim of the study was to compare clinical and audiological outcomes in the treatment of atelectatic ear using ventilation tube versus cartilage tympanoplasty with cortical mastoidectomy. Patients and methods This study was conducted on 40 ears with atelectasis, diagnosed clinically, endoscopically, and audiologically. Twenty ears were subjected to ventilation tube insertion and the other 20 ears underwent cartilage tympanoplasty with cortical mastoidectomy. An audiogram was done 3 months postoperatively after the graft was fully taken and was then repeated after 6 months. Results Group 1 (cartilage tympanoplasty with cortical mastoidectomy group) included 20 ears, and group 2 (ventilation tube insertion group) included 20 ears. For group 1, the clinical results were the same at 3 and 6 months. Graft was taken in 18 (90%) ears and was broken with residual perforation in two (10%) cases. Mean hearing gain for this group was 17.44±7.35 dB after 3 months and 22.25±6.59 dB after 6 months. Mean air–bone gap was 22.25±3.55 dB preoperatively, 7.56±5.55 dB at 3 months, and 6.75±5.76 dB after 6 months. For group 2, after 3 months the tube was in place in all cases (100%). After 6 months, the tube was in place in 16 (80%) ears. There was extrusion in four (20%) ears − two (10%) of them had residual perforation, one (5%) had recurrent disease, and one retained normal hearing. Mean hearing gain for group 2 was 25.01±4.51 dB at 3 months and 21.83±5.42 dB at 6 months postoperatively. Air–bone gap was 21.14±3.48 dB preoperatively, 3.69±1.84 dB at 3 months, and 5.81±1.78 dB after 6 months. Conclusion Tube insertion showed a better clinical prognosis in second-stage atelectatic ears than in the third-stage ears. On the other hand, cartilage tympanoplasty showed better clinical prognosis in third-stage atelectatic ears than in second-stage ears.
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