Ossicular Damage in Chronic Middle Ear Inflammation

Sadé, Jacob; Berco, E; Buyanover, D; Brown, Monique L.

doi:10.3109/00016488109133263

Cited by 57 publications

(59 citation statements)

References 9 publications

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“…Sade et al found a higher incidence, around 06.00%, of erosion of malleus in cases of safe CSOM. In unsafe disease they found malleus necrosis in 26.00% cases which correlates well with our finding [5].…”

Section: Discussionsupporting

confidence: 91%

“…Austin reported erosion of stapes at around 15.50% [16]. Sade et al reported stapes involvement in unsafe CSOM to be 36.00% [5]. Shreshtha et al found involvement of stapes superstructure in 15.00% cases of unsafe CSOM [18].…”

Section: Discussionmentioning

confidence: 99%

“…CSOM is thus an inflammatory process with a defective wound healing mechanism [4]. This inflammatory process in the middle ear is more harmful the longer it stays and the nearer it is to the ossicular chain [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

Varshney

Nangia

Bist

et al. 2010

Indian J Otolaryngol Head Neck Surg

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This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

Varshney

Nangia

Bist

et al. 2010

Indian J Otolaryngol Head Neck Surg

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show abstract

“…CSOM is thus an inflammatory process with a defective wound healing mechanism [7]. This inflammatory process in the middle ear is more harmful the longer it stays and the nearer it is to the ossicular chain [8].…”

Section: Discussionmentioning

confidence: 99%

“…This condition results in hearing sensitivities that are 10-20 dB superior to cases with an intact tympanic membrane and complete ossicular interruption. The 40-50 dB loss can be explained by a loss of ossicular coupling together with an enhancement of acoustic coupling of 10-20 dB, as compared to the normal ear [8]. The enhancement of acoustic coupling results from loss of the shielding effect of tympanic membrane, which in the normal ear attenuates middle ear sound pressure by 10-20 dB relative to ear canal sound pressure.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative Indicators of Ossicular Necrosis in Tubotympanic CSOM

Jayakumar

Inbaraj

Pinto

2016

Indian J Otolaryngol Head Neck Surg

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Ossicular necrosis and erosion is commonly seen in CSOM with cholesteatoma but can also occur in tubotympanic CSOM. This usually comes as a surprise during surgery. Preoperative knowledge of ossicular necrosis helps the surgeon to be better prepared for the surgery and ossicular construction if required. Hence, this study is intended to identify the pre-operative indicators of ossicular necrosis. This cross sectional study was conducted in Father Muller Medical College in Mangalore. Sixty nine consecutive patients with tubotympanic CSOM underwent a detailed clinical examination with pure tone audiometry and subsequently tympanoplasty with or without cortical mastoidectomy. All clinical findings, pure-tone audiometry, and intraoperative otomicroscopic observations were recorded. Incidence of ossicular necrosis was 23 %. The incus was most frequently eroded followed by malleus and then stapes. On bivariate analysis patients age above 30 years (p = 0.05), duration of CSOM more than 10 years (p = 0.02), presence of granulation (p \ 0.05), absence of tympanosclerosis (p = 0.01), moderately severe (45-60 dB) hearing loss (p = 0.01) and an air bone gap of more than 55.7 dB in the right ear and 63.95 dB in the left ear was found to be statistically significant (p \ 0.05). On multivariate analysis only presence of middle ear granulation tissue was found to be the significant predicator [(p = 0.005), OR 14.37, 95 % CI 2.26-90.0]. The presence of granulation tissue and a wide air bone gap on pure tone audiometry were the best indicators of ossicular necrosis. Preoperative identification of these indicators can help the surgeon to be better prepared for the surgery.

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'Tripod' Ossiculoplasty in Incudal Lesions

Sadé

Kremer²,

Luntz³

1989

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\A method of ossiculoplasty, in cases where the long process of the incus is eroded, is described. The defect created by the erosion of the incus is bridged by an autogenic or allogenic bone graft that leans on the stapes, the remaining part of the incus, and the side of the malleus. These three contact points allow for stability of the bony graft and account for the name tripod. The method was applied in 30 ears and was successful in all but three cases. All the rest (ie, 27 ears) achieved an average gain of 24.8 dB, leaving an average air-bone gap of 11.1 dB. The postoperative air-bone gap was 20 dB or less in all 27 ears that were successfully operated on; and in 21 of them (77.8%), it was no more than 10 dB. The average period of follow-up was 23.8 months. Operative success depended on both the technique chosen and the favorable selection of cases. (Arch Otolaryngol Head Neck Surg 1989;115:596-599) The lesion most commonly found to interrupt the continuity of the ossicular chain is a defect of the long process of the incus.1·2 The most fre¬ quent cause of such a lesion is chronic otitis media of one form or another.Numerous surgical techniques to overcome this defect, employing vari¬ ous materials (eg, bone, cartilage, and (Dr Sad\l =e' \).holoplastic material), have been described.232 Although a relatively high success rate is usually claimed for most of these methods, problems of graft extrusion and optimal airbone gap closure have not yet been entirely solved. This is a description of a new and simple technique that we have found to be very satisfactory in overcoming the effects of erosion of the long pro¬ cess of the incus in the presence of an intact stapes. We describe our tech¬ nique and our results in cases that, from our point of view, were suitable for ossiculoplasty. MATERIALS AND METHODSThe gap created between the stapes and the body of the incus, as a result of the erosion of its long process, is bridged by means of a bony graft that rests on three points (Pigs 1 through 3): the head of the stapes, the remaining portion of the long process of the incus, and the posterior surface of the handle of the malleus.A bony allograft is shaped to fit into the space between the three ossicles, and is wedged in to lean on the above three points, without touching the medial wall of the middle ear. The allograft is shaped like a pyramidal wedge, with the tip pointing upward toward the space between the rem¬ nant of the incus and the handle of the malleus. Because the graft leans on three points, we refer to it as a tripod. The allograft may also be placed or wedged into its appropriate position without even touching the drum.Our experience has shown that because of the graft's pyramidal shape it can usual¬ ly be fitted into a stable position in any of the various spatial situations that may arise following erosion of the long process of the incus. The defect and the resulting interossicular gap may be very small, requiring a very small tripod; while at other times, a longer or larger tripod will be nec...

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Ossicular Damage in Chronic Middle Ear Inflammation

Cited by 57 publications

References 9 publications

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults

Pre-operative Indicators of Ossicular Necrosis in Tubotympanic CSOM

'Tripod' Ossiculoplasty in Incudal Lesions

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