1985, 10, 163-164

Clin. Otolar~v~gol.

Surgery of chronic adhesive otitis media

E. VARTIAINEN, R . H A R M A AND S. K A R J A L A I N E N

Department of Otolaryngology, University of Kuopio. Kuopio, Finland

Accepled for publication 13 February 1985

E., HARMAR. & KARJALAINEN

VARTIAINEN S. (1985) Clin. Otolaryngol. 10, 163-164
Surgery of chronic adhesive otitis media
The results of tympanoplasty operations in 55 ears with chronic adhesive otitis media
were analysed. In 34% of the ears, the tympanic cavity was found to be aerated on
follow-up examination. Hearing improved significantly in only 13 ears (24%). There
were severe complications of surgery in two ears (3.6%): one ear became totally deaf
and an iatrogenic cholesteatoma developed in the other. Because of these poor
results, tympanoplasty is not recommended in the treatment of chronic adhesive otitis
media.
Keywords otitis media adhesive process tyrnpanoplasty

Adhesive otitis media is a nonpurulent type

of chronic otitis media. It is characterized
by an atelectatic tympanum and tympano-
fibrosis. As a result of defective healing
after delayed restoration of tuba1 function,
the tympanic cleft becomes obliterated.
Calcification, fatty degeneration and scar
tissue prevent movement of the eardrum
and ossicles.’
The treatment of chronic adhesive otitis
media is controversial. Siirala’ has recom-
mended a tympanoplasty procedure during
which the air space of the tympanum is
maintained by means of a polyethylene
tube introduced through the operation
wound or the Eustachian tube. P a l ~ a , ~
however, reported that his experience with
this technique was not favourable.
Because there has been no discussion in
recent years about surgery in adhesive
otitis media, we have analysed our
findings. The results are presented in this
paper.
and methods
The material consisted of 55 ears operated
on for chronic adhesive otitis media in the
Department of Otolaryngology, University
of Kuopio, Kuopio, Finland, from 1966 to
1975. The follow-up time was at least 12
months. The mean follow-up period was
7.3 years.
During tympanoplasty, adhesions in the
tympanic cavity were freed and mucosal
cysts, cholesterol granulomas and fibrous
tissue were removed. The promontory was
covered with a large piece of Silastic, from
the orifice of the Eustachian tube to the
areas of the oval and round windows.
When the ossicular chain was broken it
was repaired using autogenous ossicle or
cortical bone. In some cases, a ventilation
tube was inserted through the tympanic
membrane. In 32 ears (58%) simple
mastoidectomy was performed simul-
taneously.

Correspondence: Dr Eero Vartiainen, Department of Otolaryngology, University of Kuopio, SF-70210

Kuopio, Finland.

163
164 E. V A R T I A I N E N , R . H A R M A A N D s. KARJALAINEN

The air and bone conduction thresholds
were determined using a Masden OB-70
audiometer calibrated according to I S 0
standards. The results are presented as
differences between air and bone con-
duction thresholds before operation and at
the final follow-up examination, comparing
mean pre-operative and post-operative
thresholds of air conduction (0.5, 1 and
2 kHz) with mean pre-operative thresholds
of bone conduction in the same frequency
ranges.
Results
Operation was successful (tympanic mem-
brane intact and mobile on follow-up
examination) in 34% of cases (Table 1). An
Table 1. Results of surgery
Condition of tympanic membrane
on follon~-upexamination Number of ears
Intact and mobile 19 (34%)
Adhesive 30 (55%)
Perforated 6 (11%)
Total 55
operative differences in air and bone
conduction thresholds was only 3.6 dB. In
13 ears (24%), hearing improved to a
social level (air conduction threshold 30 dB
or better at 0.5, 1 and 2 kHz).
Discussion
Our post-operative results relating to
surgical treatment of chronic adhesive
otitis media were quite poor. Hearing
improved to an extent of distinct benefit to
the patient in only 24% of ears which
underwent operation. In addition, there
were 2 severe complications of surgery.
One ear (2%) became totally deaf after the
operation. In another, an iatrogenic middle
ear cholesteatoma developed post-
operatively. The only problem which
adhesive otitis media causes to the patient
is hearing loss. Because of these poor
results we do not think that tympanoplasty
is indicated in this disease.
Prevention of chronic adhesive otitis
media is the best approach. This involves
intense use of antibiotics during acute
suppurative otitis media, with earlier and

Table 2. Hearing results

Pre-operative Post-operative Difference in air and bone conduction thresholds

Number of ACT ACT Pre-operative Post-operative Change
ears operated Mean s.d. Mean s.d. Mean s.d. Mean s.d. Mean s.d.
54 46.3 17.9 42.0 21.1 32.7 13.4 29.2 17.4 3.6 18.7

ACT = air conduction threshold

adhesive tympanic membrane continued to more frequent myringotomy and use of

be found in 55% of instances and a
perforation in 6 ears, of which 5 were dry
and 1 discharging.
One ear was stated to be totally deaf
immediately after operation. Another ear
started to discharge 6 years post-
operatively. on re-operation 7 years after
the primary operation, a large chole-
steatoma was detected.
Hearing are shown in 2*
The mean change between pre- and post-
ventilation tubes in the treatment of
secretory otitis media.
References
1 ZECHNERG . (1981) HistomorphoWcal data on
human auditory tube dysfunction. J . Laryngol. Oto.
95, 229-237
2 SIIRALAU. (1964) Pathogenesis and treatment of
adhesive otitis. Acta Otolaryngol. Suppl. 188, 9-18
3 PALVAT. (1964) Surgical treatment of adhesive
tympanum. Acta Otolarvngol. Suppl. 188, 3 3 7 4