Surgical treatment of tympanosclerosis

Objective: To report the hearing results of the surgical treatment of tympa nosclerosis. Study Design: A retrospective review of surgically treated cases of tympano sclerosis. Setting: A tertiary referral center. Patients: One hundred fifteen patients with middle ear tympanosclerosis ope rated on between 1987 and 1996, with an average age of 36 years (range 18-5 9 years). Cases were classified into four groups according to Wielinga and Kerr. Those with an associated cholesteatoma were excluded. Intervention: D epending on the ossicular status, either mobilization of the major ossicles or epitympanic bypass procedure, mobilization of the stapes or stapedectom y. Main Outcome Measures: The postoperative pure-tone average was compared wit h the preoperative levels by use of conventional audiometry. The ail-bone S ap was measured. Results: The average postoperative air-bone gap was 18.0 +/- 10.2.1 dB in t he type II group (attic fixation of the malleus-incus complex with a mobile stapes). 21.8 +/- 9.5 dB in the type III group (mobile malleus-incus compl ex, if present, with stapes footplate fixation), and 22.92 +/- 10.03 dB in the type IV group (fixation of both the stapes footplate and the malleus-in cus complex). Patients with a fixed malleus and mobile stapes had significa ntly better hearing results than those with stapes fixation (p = 0.042, Man n-Whitney U test). Conclusion: In ossicular attic fixation, atticotomy and mobilization of oss icles yielded better results than did the epitympanic bypass procedure. The difference, however, did not reach statistical significance. Patients with fixed stapes treated with stapedectomy displayed good hearing results imme diately after surgery, but the air-bone gap deteriorated after some time.