[Experiences of second type Ⅰ tympanoplasty]

Objective:To analyze the failure reasons of the typeⅠtympanoplasty and to summarize the successful experiences of the reoperation. Method: A retrospective clinical study of 42 patients undergoing second type Ⅰtympanoplasty in the ENT department of Nanjing Drum Tower Hospital from 2007 to 2017 was performed. By reviewing the perioperative clinical data and by following up the patients for 3 months to summarize the failure reasons of the first tympanoplasty and successful experiences of the second tympanoplasty. Result:All of the 42 patients received second tympanoplasty under general anesthesia using the post auricular approach, harvesting the temporalis fascia as the graft material, enlarging the external canal to optimize of the operation vision and using underlay tympanoplasty technique. During the operation calcification was found in 12 cases, tympanosclerosis in 6 cases, handle of malleus attached to promontorium tympani in 7 cases, and remnant tympanic membrane adhered to promontorium tympani in 10 cases. Three months after the second tympanoplasty all of the perforations were closed. The air-bone gap(ABG) between 0.5-4.0 kHz before and after the second tympanoplasty were(26.4±8.7) dB HL and(14.0±7.3) dB HL, respectively. The difference is statistically significant(P=0.000). ABG less than 20 dB HL was found in 35 cases (83.3%) after the second tympanoplasty. Conclusion:Type Ⅰtympanoplasty is a delicate operation. Poor surgical outcomes of the first operation were due to inadequate exposure, mucosal lesion of the promontory, and inadequate gelatin sponge filling in the middle cavity. Post auricular approach, enlarged and straight external canal could optimize the operation vision, resolve the adhesion of the tympanum easily and acquire the adequate anterior overlap, which are benefit for success closure of the perforation and better hearing after surgery.