Ossiculoplasty in a patient with a cleft of the soft palate.A 38-year-old man with a history of a cleft of the hard and soft palates, which had been repaired during childhood, presented with a right recurrent cholesteatoma. He had previously undergone two intact canal-wall tympano-mastoidectomies at another institution. Two years prior to presentation, he had undergone a canal-wall-down mastoidectomy Mastoidectomy Definition Mastoidectomy is a surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective. This surgery is rarely needed today because of the widespread use of antibiotics. with tympanoplasty tympanoplasty /tym·pa·no·plas·ty/ (tim´pah-no-plas?te) surgical reconstruction of the tympanic membrane and establishment of ossicular continuity from the tympanic membrane to the oval window. . At that time, he received a total ossicular os·si·cle n. A small bone, especially one of the three bones of the middle ear. [Latin ossiculum, diminutive of os, bone; see ost- in Indo-European roots. replacement prosthesis prosthesis (prŏs`thĭsĭs): see artificial limb. prosthesis Artificial substitute for a missing part of the body, usually an arm or leg. (TORP TORP Torpedo TORP Tertiary Oil Recovery Project TORP Total Ossicular Replacement Prosthesis TORP Trans-Oceanic Research Project TORP Task Order Review Package ). During the short-term postoperative period, his hearing had improved. Over the succeeding 6 months, however, the tympanic membrane began to retract, and the patient reported that his hearing had deteriorated. Computed tomography revealed that the ossicular prosthesis had become dislodged. Desquamated epithelium could be seen surrounding the oval window niche and the displaced prosthesis. The patient underwent a revision ossiculoplasty and received a titanium TORP; a long-term ventilation tube was also inserted into the pars tensa. At the 1-year follow-up, the patient reported that his hearing was much improved. Although his audiogram au·di·o·gram n. A graphic record of hearing ability for various sound frequencies. Audiogram A chart or graph of the results of a hearing test conducted with audiographic equipment. showed a mixed hearing loss, he said he was able to use a standard telephone. Findings on otoscopic examination revealed that the prosthesis was in satisfactory condition (figure). [FIGURE OMITTED] The persistence of eustachian tube dysfunction in the face of repaired or unrepaired clefts of the soft palate poses a challenge with respect to hearing rehabilitation in this group of patients. From the Department of Otolaryngology--Head and Neck Surgery, University of Texas Health Science Center at Houston. |
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