The objective of this study is to determine the subjective and objective outcomes of tympanoplasty surgery carried out in patients with otitis media and to identify factors responsible for these outcomes. The study setting is tertiary care urban referral hospital in a developing economy and the study methodology is a prospective analysis of patients with diagnosis of chronic suppurative otitis media that had tympanoplasty with or without mastoidectomy between May 2005 and September 2009 at National Hospital Abuja. Subjects were evaluated for age, sex, size and site of perforation, status of operated ear(s) (dry/discharging), status of the contralateral ear, surgical technique, subjective and objective pre-operative and post-operative hearing scores, average post-operative follow-up time, and post-operative complications, and results were statistically analyzed. A total of 45 patients (51 ears) were operated. Age distribution was 8-52 years. Type 1 tympanoplasty was done in 41 patients and Type 3 in 4 patients. Seven of the patient had concomitant mastoid surgery (cortical mastoidectomy). 3/51 of the cases had discharging ears at surgery. 16/45 of the patients (19/51 ears) had cartilage graft tympanoplasty, while 29/45 (32 ears) had temporalis fascia tympanoplasty. 15/16 of the cartilage group as well as 26/29 of the fascia group reported subjective hearing improvement, whilst the actual graft take was 12/16 of the cartilage group and 23/29 of the fascia group. Objective hearing improvement was observed in all of the cartilage as well as 26/29 of the fascia group. This study confirms success of tympanoplasty among Nigerians, and recommends that subjective hearing assessment should form part of indicators for success following tympanoplasty.

Postauricular advancement flap is effective for closure of persistent cutaneous mastoid fistula.

The incidence of cholesteatoma among Nigerians is not well documented, as is the outcome of surgical treatment. A descriptive analysis of prospectively collected data of cases of cholesteatoma managed with tympanomastoidectomy at National Hospital Abuja between September 2005 and April 2012 is presented. Cases were analyzed for age, sex, type of cholesteatoma, intra-operative findings, and post-operative outcome after 6 months of follow up. A total of 28 ears from 25 cases of cholesteatoma had tympanomastoidectomy. Age range was 6-73 years (mean = 34.4, SD = 18.67). There were 13 females and 12 males. Primary acquired cholesteatoma was seen in 18 cases (20 ears), secondary acquired in 5 cases (six ears), and external auditory canal cholesteatoma was seen in 2 cases (two ears). The sites involved in middle ear cholesteatoma was attic, sinus and mesotympanum pars tensa (16/26), attic, sinus, antrum and mastoid cavity (5/26), attic, sinus, mesotympanum and mastoid antrum (4/26), and attic only (3/26).21/25 of cases (24 ears) managed had single stage intact canal wall (ICW) tympanomastoidectomy, while 4/25 (4 ears) had two-stage surgery with canal wall down tympanomastoidectomy in two of these, and revision surgery done within 12 months of first surgeries. 2/25 cases (in the two stage revision group) had postoperative persistent mastoid cutaneous fistula and were treated with post-auricular advancement flap. The commonest cholesteatoma type seen at National Hospital Abuja, Nigeria was primary acquired type, and involved the attic, sinus and mesotympanum pars tensa mainly, and most can be managed by single stage tympanomastoidectomy.