Tympanosclerosis

Patient Information on surgery

All of the above investigations have a role to play in the diagnosis & management of CSOM, but the one investigation which should not be missed & which requires further elaboration is the gelfoam patch test.

The gelfoam patch test

PATCH TEST •  Good hearing prediction 2 stages ( Tympanosclerosis ) •  Which side first? •  Better masking efficiency •  Warning for decreased hearing post-op. (in pan-ossicular / stapedial fixation.) • Salvage Surgery

In addition to the usual investigations, the gelfoam patch test is extremely useful. The audiogram is repeated after closing the perforation with a patch of moist gelfoam. If the ossicular chain is intact & mobile the hearing will improve.

Why not a paper patch test? If the incus is necrosed & the stapes is mobile the paper patch test will show no improvement but the gelfoam patch test will show improvement because the moist gelfoam pushed through the perforation will contact the mobile stapes in the posterosuperior quadrant.

If the gelfoam patch test shows no improvement there is a possibility of coincident stapes fixation, which might require a 2 nd stage stapes surgery, so the patient can be warned in advance.

In bilateral C.S.O.M. it helps in selecting the side to be done first.

In bilateral C.S.O.M., for salvage surgery, we can confidently advise surgery on the side where there is an improvement with the patch in position.

In bilateral severe mixed loss, where inadequate masking is a problem, the increased hearing with the patch in position on the better side gives better masking efficacy and helps to evaluate the cochlear function of the worse ear.

Warning for decreased hearing after the first stage in stapes fixation because the round window path is blocked.

2) Sinus evaluation is essential because post operative autoinflation exercise may cause silastic extrusion if chronic sinusitis is undetected and untreated.

next