Objectives: This study assessed the audiometric results of revision
surgery in patients on whom previous canal wall up tympanoplasty had
been performed for chronic otitis media without cholesteatoma, and
investigated reasons for hearing improvement failure which required
Patients and Methods: Seventy-two patients (49 females, 23 males;
mean age 35.4±12.9 years; range 11 to 64 years) suffering from chronic
otitis media without cholesteatoma, who had intact canal wall up tympanoplasty
and revision surgery due to bad hearing results between
March 2004 and September 2009, were evaluated retrospectively.
After evaluation of patients files, operative and audiological records,
findings during the surgery, postoperative follow-up, audiometric
results before revision surgery and the results in the last control after
revision surgery were analysed.
Results: Preoperative mean air-bone gap (ABG) decreased in all
patients from 31.2 dB to 19.9 dB after followed up for mean 26.7 months.
Air-bone gap values below 20 dB were 67%, below 30 dB were 83%,
hearing gain above 10 dB was found to be 58%. Comparision of pre- and
postoperative ABG values of the patients revealed statistically significant
difference (p<0.001). In addition to hearing loss, the reasons for revision
surgery were mucosal disease relapse in 10 patients, graft perforation
in 43 patients, otorrhea control in 15 patients. Findings during revision
surgery were relapse of mucosal diseases in 15 patients, insufficient
mastoidectomy in six patients, problems related to prosthesis in 29
patients, ossicular limitations (brid, hyalen and granulation) in 30 patients,
and ossicular necrosis in six patients. The decision for four patients was
changed from canal wall up tympanoplasty to canal wall down tympanoplasty.
Postoperative total hearing loss developed in one case.
Conclusion: The most important problem in revision of tympanoplasty
patients with hearing loss is related with stabilisation of columella. To
get successful hearing results, it is important to control disease and
provide a stable and safe continuity between the tympanic membrane
FREE FULL TEXTAnahtar Kelimeler: İşitme kaybı; kemikcik zincir rekonstrüksiyonu; revizyon cerrahisi;timpanoplasti.