Over-under tympanoplasty

The Effect of Nitrous Oxide on the Outcomes of Underlay Tympanoplasty: A Prospective Study

The main aims of tympanoplasty are eradication of chronic middle ear disease, repair of the tympanic membrane, and restoration of hearing. Nitrous oxide (N₂O) is not a commonly preferred anesthetic agent for tympanoplasty because this agent may increase middle ear pressure and displace the graft. In this study, we researched the surgical outcomes of the underlay tympanoplasty performed with N₂O anesthesia. Patients who underwent tympanoplasty were included in this prospective study. A type 1 tympanoplasty was performed in all patients using the underlay technique. Patients were randomized to groups that did and did not receive N₂O. Preoperative and postoperative hearing thresholds were evaluated, postoperative pain scores were recorded, and the differences between the groups were statistically evaluated. There were 44 patients who received N₂O and 44 who did not. The graft success rate was 93.2% in the N₂O-receiving group and 84.1% in the nonreceiving group (P > .05). Hearing levels improved significantly after surgery in each group (P < .05), but the difference between the groups was not significant (P > .05). The postoperative pain score was 3.72 ± 1.3 in the N₂O-receiving group and 4.45 ± 2.3 in the nonreceiving group (P > .05). Nitrous oxide is a cheap, safe, and readily available anesthetic agent that provides acceptable success rates in patients undergoing tympanoplasty.

Double-Layer Tympanic Membrane Graft in Type I Tympanoplasty

Background:

Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques.

Materials and Methods:

A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement.

Results:

A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( P = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( P < .0001). Preoperative hearing levels ( P = .179), postoperative hearing ( P = .857), and decibels of hearing improvement ( P = .356) were the same for all 3 groups.

Conclusion:

Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.

Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review

Background

The study aims at reporting our experience with loop underlay tympanoplasty, a modification of the underlay technique previously reported, for the reconstruction of anterior, subtotal or total tympanic membrane perforations.

Methods

A retrospective review of charts of patients who have undergone loop underlay tympanoplasty from January 2002 to January 2012 was performed. One thousand one hundred patients were included. Hearing test results preoperatively and postoperatively were reported. On follow up visits, the closure of the tympanic membrane perforation and the improvement of hearing compared to preoperative measurements with absence of complications were considered as successful outcomes of the surgery.

Results

At the three-month follow-up visit, the perforation closure rate was found to be 99.3% and Air-Bone Gap closure rate to less than 10 dB was 99.5%. The complication rate, including post-operative infection, was 0.72%.

Conclusion

The loop underlay technique combines advantages of both underlay and overlay techniques with excellent postoperative outcomes.

Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques

OBJECTIVES

To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels.

METHODS

Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed.

RESULTS

One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively).

CONCLUSION

In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

Objectives

The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes.

Methods

Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed.

Results

A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P<0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%.

Conclusion

The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

Randomized Clinical Trial Comparing Bucket Handle and Cartilage Tympanoplasty Techniques for the Reconstruction of Subtotal or Anterior Tympanic Membrane Perforation

OBJECTIVE

The purpose of the study is to compare the clinical outcome of the two techniques of Bucket Handle Tympanoplasty and Cartilage Tympanoplasty in achieving success in graft survival as well as acceptable auditory results. 60 patients who suffered chronic otitis media with anterior perforation of the tympanic membrane were chosen. The patients were randomly assigned using Block Randomization Method of two groups including patients who underwent Bucket Handle Tympanoplasty (n = 30) or those that underwent Cartilage Tympanoplasty (n = 30). The patients were followed up for 1, 3, 6, and 12 months postoperatively.

RESULTS

The mean PTA was lower in Bucket Handle Tympanoplasty group as case group compared to Cartilage Tympanoplasty group as the control (P = 0.023). No significant statistical differences had identified passing through the time, in terms of PTA outcome (P Value = 0.547) and SRT outcome (P Value = 0.352), between Bucket Handle Tympanoplasty group and the Cartilage Tympanoplasty group. In total, postoperative tympanic membrane perforation was found in 10.0% of patients in Cartilage Tympanoplasty group and 13.3% in Bucket Handle Tympanoplasty group with no difference (P = 0.500).

CONCLUSIONS

Hearing improvements in both methods were similar.

REGISTRATION NUMBER

The trial is registered with IRCT2016022626773N1.

HIV Positivity per se Does Not Affect Tympanoplasty Outcomes

BACKGROUND

The English language literature finds no clear protocols for otologic surgery for HIV+ patients.

OBJECTIVE

To demonstrate that simple tympanoplasty and type III tympanoplasty in HIV+ patients with CD4 >400 cells/cc results in tympanic membrane closures and hearing improvements equivalent to the same procedures in controls.

MATERIALS AND METHODS

This retrospective review documents the otologic conditions and operative results of 32 HIV+ patients and 32 controls. The controls were healthy and had no opportunistic infections or other medications.

RESULTS

Genders, ages, sizes of tympanic membrane perforations, severity of air bone gaps, and type of operation were equivalent between the HIV+ and the control groups. Thirty of 32 patients in each group had closure of their perforations after 1 operation. Air bone gaps improved significantly for each group ( P = .001): 22 dB (SD = 11 dB) in the HIV+ group and 26 dB (SD = 10 dB) in the control group. And there was no statistically significant difference in change in hearing between the 2 groups. There were no complications of infection, wound dehiscence, worsened sensorineural levels, dizziness, or facial weakness in either group.

CONCLUSION

HIV+ patients whose CD4 counts are above 400 cells/cc can undergo simple tympanoplasty or type III tympanoplasty with acceptable outcomes.

Do the Angle and Length of the Eustachian Tube Affect the Success Rate of Pediatric Cartilage Type 1 Tympanoplasty?

OBJECTIVES

To investigate the relationships between the angle and length of the Eustachian tube (ET) (the ETa and the ETl) and the success rates of pediatric type 1 tympanoplasty.

STUDY DESIGN

A retrospective clinical chart review.

METHODS

In total, 51 children (31 females and 20 males; average age, 11.92 ± 3.46 years; age range: 7-18 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared.

RESULTS

The ETa values of diseased ears of males and females were, respectively, 26.60 ± 6.42° and 23.29 ± 6.51°, compared to 27.25 ± 5.23° and 23.32 ± 4.61° for normal male and female ears, respectively. In group A, the ETa was 26.46 ± 6.82° in males and 22.95 ± 7.50° in females. In group B, the ETa was 26.85 ± 6.12° in males and 23.90 ± 4.45° in females. In group A, the mean ETl was 41.0 mm (29.6-45.3 mm) in males and 37.9 mm (32.0-44.5 mm) in females. In group B, the mean ETl was 40.5 mm (30.5-47.1 mm) in males and 38.0 mm (32.8-45.0 mm) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears, the ETa was higher in males than females (P = 0.020 and P < 0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P > 0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P > 0.05).

CONCLUSIONS

Neither the ETa nor the ETl affected the success rate of pediatric cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of pediatric tympanoplasty.

Concept, Importance and Practice of Lateral Tucking in Tympanoplasty

The current study aims at observing the technique and results of doing lateral tucking during tympanoplasty surgery. It is intended to provide additional support to the graft and prevent displacement as well. 98 cases included in the study and the graft uptake rate of 97.96% noted. Average pre operative air bone gap (ABG) was 31.12 db and average post operative ABG observed to be 14.01 db. Gain of 17.11 ± 7 db achieved by the procedure. Lateral tucking is a concept that requires to be inculcated in routine tympanoplasty surgeries, especially where canal skin incisions are used. It is easy to practice and the results are good and complications are minimal.

Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique

INTRODUCTION

Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane.

OBJECTIVE

To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty.

METHODS

A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results.

RESULTS

Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant.

CONCLUSION

Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique

INTRODUCTION

Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane.

OBJECTIVE

To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty.

METHODS

A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results.

RESULTS

Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB while in Group B; it was 22.5±3.5dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant.

CONCLUSION

Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Role of circumferential subannular tympanoplasty in anterior and subtotal perforations

Objective:

This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations.

Methods:

This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement.

Results:

This technique had a surgical success rate of 97 per cent and led to significant hearing improvement.

Conclusion:

Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.

Endoscopically Guided Transtympanic Balloon Catheter Dilatation of the Eustachian Tube: A Cadaveric Pilot Study

OBJECTIVE

To assess the feasibility, safety, and efficacy of transtympanic balloon catheter dilatation of the Eustachian tube (ET) in a cadaver model.

PATIENTS AND INTERVENTIONS

A cadaveric study of 10 cadaver heads, which underwent unilateral transtympanic dilatation of the ET with a 3 × 20 mm balloon catheter with full endoscopic guidance and visualization.

RESULTS

Procedural safety was demonstrated, with no damage to any essential structures found. Feasibility of the procedure was demonstrated in all cadavers with 100% success rate, despite a small number of encountered difficulties. Statistically significant efficacy was also demonstrated in both radiologic and manometric data.

CONCLUSION

With full endoscopic visualization, the transtympanic approach to balloon catheter dilatation of the ET seems to be a feasible and safe procedure in the cadaver model.

Outcomes of type I tympanoplasty using a cartilage shield graft in patients with poor prognostic factors

OBJECTIVE

Although fascia is widely used as the grafting material in tympanoplasty (TP), unsatisfactory outcomes can result in patients with poor prognostic factors. Recently, cartilage has emerged as a graft material in TP. This study examined the operative outcomes of type I TP using a cartilage shield graft (CSG) in patients with poor prognostic factors.

METHODS

This study reviewed the medical records of patients who underwent type I TP using CSG performed by the same surgeon, with over 24 months of follow-up.

RESULTS

There were 94 patients (mean age 46 years). Preoperatively, 39 patients had near-total perforation, 29 had a previous TP or myringoplasty, 14 had adhesive otitis media, and 12 had a marginal perforation covering ≥50% of the tympanic membrane area. The mean postoperative air-bone gap was significantly (p<0.0001) reduced compared to preoperative measurements. Postoperatively, tympanic membrane perforation occurred in 2.1% and otorrhea in 6.4%. There were no cases of retraction, adhesion, or lateralization. One subject complained of autophonia and ear fullness.

CONCLUSION

Type I TP using CSG has excellent surgical results and minimal complications, even in patients with poor prognostic factors, and should thus be considered in those patients.

Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties

Introduction

Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient.

Objective

To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties.

Methods

In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7–18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant.

Results

The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females.

Conclusions

Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.

The Effect of the Angle and Length of the Eustachian Tube on the Success Rate of Cartilage Type 1 Tympanoplasty

OBJECTIVES

To explore the relationships between the angle and length of the eustachian tube (ET) (the ETa and the ETl) and the success rates of type 1 tympanoplasty.

STUDY DESIGN

A retrospective clinical chart review.

METHODS

In total, 160 patients (81 females and 79 males; average age, 37.12 ± 12.46 years; age range: 18-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. A P value <0.05 was considered to reflect statistical significance.

RESULTS

In group A, the ETa of diseased ears was 27.74 ± 12.06° in males and 21.87 ± 7.58° in females. In group A, the ETa of normal ears was 27.53 ± 4.15° in males and 22.25 ± 4.67° in females. In group B, the ETa of diseased ears was 28.85 ± 6.19° in males and 22.91 ± 5.65° in females. In group B, the ETa of normal ears was 27.71 ± 5.23° in males and 23.72 ± 6.20° in females. In group A, the mean ETl of diseased ears was 42.1 mm (28.9-45.1) in males and 38.2 mm (31.0-44.7) in females. In group A, the mean ETl of normal ears was 41.9 mm (29.2-45.8) in males and 37.4 mm (30.5-44.1) in females. In group B, the mean ETl of diseased ears was 40.8 mm (30.2-47.4) in males and 37.9 mm (31.8-45.2) in females. In group B, the mean ETl of normal ears was 41.6 mm (30.0-45.0) in males and 39.1 mm (30.0-43.7) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears the ETa was higher in males than females (P =0.002 and P <0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P >0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P >0.05).

CONCLUSION

Neither the ETa nor the ETl affected the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of type 1 tympanoplasty.

Impact of the Degree of the Mastoid Pneumatization on Cartilage Type 1 Tympanoplasty Success

OBJECTIVES

To evaluate the effect of the degree of the mastoid pneumatization on the success rate of cartilage type 1 tympanoplasty.

STUDY DESIGN

A retrospective clinical chart review.

METHODS

In total, 90 patients (44 females and 46 males; average age, 38.40 ± 11.12 years; age range: 21-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The mastoid air cell volumes of each groups were compared.

RESULTS

The mean mastoid pneumatization in groups A and B was 5.32 ± 1.96  and 5.06 ± 2.12 cm, respectively. The mastoid pneumatization of diseased ears did not differ between the groups (P > 0.05). The mastoid pneumatization of diseased ears did not differ between males and females (P > 0.05). The mastoid pneumatization of normal ears did not differ between the groups (P > 0.05). The mastoid pneumatization of normal ears did not differ between males and females (P > 0.05).

CONCLUSIONS

The degree of mastoid pneumatization did not affect the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to evaluate the relationship between the degree of the mastoid pneumatization and anatomical outcomes after placement of various graft types.

Comparison of Modified Cartilage Shield Tympanoplasty with Tympanoplasty Using Temporalis Fascia Only: Retrospective Analysis of 142 Cases

The current study compares outcomes of modified cartilage shield tympanoplasty (CST) with temporalis fascia tympanoplasty in type I procedures in Indian patients. Graft uptake rates are better with the CST technique and hearing results are almost equivalent with both techniques except at 8000 Hz where improvement in hearing was found better with the use of temporalis fascia alone. The CST technique used in the study is unique.

Total tympanic membrane reconstruction: AlloDerm versus temporalis fascia

BACKGROUND AND OBJECTIVE: Patients who require surgery for chronic otitis media with perforation and cholesteatoma frequently provide no residual tympanic membrane that is usable in grafting procedures. A novel technique of total tympanic membrane reconstruction (TTMR) is described that maximizes perforation closure rate in these situations while minimizing mucosalization, incomplete healing, and anterior blunting. The specific aim of this report is to assess the safety and efficacy of TTMR and to compare the results obtained with AlloDerm compared with temporalis fascia as a grafting material.

METHODS: The records of 50 patients operated within the years 1999 and the 2004 were reviewed. TTMR with intact canal wall was performed in all cases. Both clinical and audiometric data were analyzed.

RESULTS: Overall perforation closure rate was 92%. There was no statistical significance in closure rate when grafting with AlloDerm versus temporalis fascia. A statistically significant shortened healing time was observed with AlloDerm grafting.

CONCLUSIONS: TTMR is a highly effective and safe technique.

Mediolateral Graft Tympanoplasty for Anterior or Subtotal Tympanic Membrane Perforation

OBJECTIVE: To describe and evaluate the mediolateral graft tympanoplasty for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation.

STUDY DESIGN AND SETTING: Retrospective study of 100 patients who underwent the mediolateral graft tympanoplasty at community and tertiary care centers from 1995 to 2001. All patients underwent preoperative and postoperative audiograms. Posterior tympanomeatal flap is elevated same as in the medial (underlay) graft tympanoplasty. Anterior-medial canal skin is elevated down to the annulus. At the annulus, only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial (underlay) to the posterior half of the perforation and lateral (overlay) to the anterior half of the de-epithelialized TM perforation, up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second-layer closure. Patients were followed for at least 6 months. Outcome was considered successful if the TM is intact.

RESULTS: There were 3 failures (97% success rate), attributable to a postoperative infection, anterior blunting, and recurrent cholesteatoma, respectively. There was no significant postoperative hearing loss compared with preoperative hearing. More than 70% of the operated ears had hearing improvement of 0-40 dB (0-10 dB in 19% of ears, 11-20 dB in 44%, 21-30 dB in 7%, and 31-40 dB in 4%) even without ossiculoplasty. With ossiculoplasty using either partial ossicular replacement prosthesis (PORP, 15%) or total ossicular replacement prosthesis (TORP, 11%), there were various degree of hearing improvement from 11 to 30 dB.

CONCLUSION AND SIGNIFICANCE: The mediolateral graft method is superior to the traditional medial or lateral graft technique for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or total TM perforation. EBM rating: C-1.

Comparative Study of Permeatal Sandwich Tympanoplasty and Postaural Underlay Technique

INTRODUCTION

Tympanoplasty is the most common operation performed by an Otolaryngologist right from the period of residency. During the last hundred years various modifications in this surgical technique have come up because of continued efforts made by otologists all over the world to achieve the best surgical outcome.

AIM

To compare the graft take up and complications associated with the Permeatal Sandwich Tympanoplasty performed with the use of Otoendoscope and traditional Postaural Underlay technique of Tympanoplasty from 1(st) September 2014 to 30(th) August 2015.

MATERIALS AND METHODS

Patients attending the ENT OPD, suffering from Chronic Suppurative Otitis Media (CSOM) were selected on the basis of type of perforation and their workup was done to assess the candidature for tympanoplasty.

RESULTS

A total of 100 patients were included in the study and the overall graft take was 92.3% in cases of Permeatal Sandwich technique as compared to 64.58% in the case of postaural underlay technique, with a majority of the failures in the large central perforation group rendering a p = 0.021 for patients operated for Large perforations, p = 0.036 for moderate perforations and p = 0.476 for small perforations. The overall p = 0.000649 which is highly significant. On comparing the complications there were only 2 cases in Permeatal Sandwich Technique compared to 25 cases in Postaural Underlay technique rendering a highly significant p-value 0f 0.000000348. There was a difference in hearing improvement with majority of the cases improving to the range of 16-25 dB in Permeatal Sandwich technique compared to 26-45 dB in Postaural Underlay technique.

CONCLUSION

Permeatal Sandwich technique produce much better results when compared with Postaural approach in terms of graft take up, complications and hearing improvement.

How I do it: Anterior pull-through tympanoplasty for anterior eardrum perforations

Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003).

Recovery time for inflamed middle ear mucosa in chronic otitis media

CONCLUSION

The present study shows that 2-3 weeks after medical treatment the status of middle ear mucosa in draining ears is similar to that of dry ears for at least 3 months.

OBJECTIVE

To measure the time required for an inflamed middle ear mucosa to return into optimal state after appropriate medical treatment in chronic suppurative otitis media (CSOM). To assess optimal timing for elective surgical treatment of draining ears in uncomplicated CSOM.

METHODS

In this prospective study, the Eustachian tube (ET) mucociliary clearance time (MCT) was used as the method to demonstrate the status of middle ear mucosa. In group 1 (28 patients) ET-MCT was measured in ears that were free of drainage for at least 3 months. In Group 2 (21 patients), ET-MCT was measured in draining ears, who responded to 10-14 days medical treatment, at presentation, after 10 days and 1 month.

RESULTS

The ET-MCT was 8.63 ± 1.32 min in group 1 and 28.96 ± 8.19 min in group 2 at presentation; and the difference was statistically significant (p < 0.001). The ET-MCT was 14.76 ± 5.11 min after 10 days and 9.31 ± 2.33 min after 1 month in group 2. The ET-MCT was indifferent between groups 1 and 2 after 1 month (p = 0.235).

Outcome of Interlay Grafting in Type 1 Tympanoplasty for Large Central Perforation

A prospective, cohort, clinical study was conducted at Dr. D. Y. Patil Hospital, Kolhapur from August 2010 to August 2013. The aim was to evaluate the results of type 1 interlay tympanoplasty with respect to graft uptake, hearing improvement and complications. Total of 100 cases with a mucosal type of chronic suppurative otitis media and a large central perforation (involving more than 50 % of tympanic membrane) were operated for type 1 tympanoplasty where the graft was placed by interlay method (below the fibro-squamous layer and above the mucosal or endothelial layer). Patients were followed up with ear microscopy at each follow up visit and an audiometry at the end of 3rd month. Statistical analysis was done by statcal software using paired t test and two sample t test for proportion. 96 (96 %) cases had a successful graft uptake. The mean pre-operative air-bone gap was 36.42 ± 12.0 dB; whereas the mean post-operative air-bone gap was 9.7 ± 6.71 dB. Except for residual perforation in four patients and partial tympanomeatal flap necrosis in two patients no other complications were encountered. Thus, we conclude that, the interlay tympanoplasty is a safe and effective method of graft placement for large central perforation.

Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study

Objective:

This study aimed to compare the success rate of type I tympanoplasty in active (wet) and inactive (dry) mucosal chronic otitis media.

Methods:

A prospective study was performed of 35 patients each with dry ear and wet ear undergoing type I tympanoplasty in the Otolaryngology Department, Postgraduate Institute of Medical Education and Research, India. All patients underwent type I tympanoplasty between January 2010 and June 2011 by the post-auricular approach. Samples of the remnant tympanic membrane were sent for histopathological examination.

Results:

After a minimum follow up of one year, the success rate was 88.6 per cent for dry ears and 80 per cent for wet ears. Neither the type (p = 0.526) nor the presence (p = 0.324) of discharge influenced the success rate. Histopathological examination of the tympanic membrane margins was performed for 46 patients: of these, 19 showed evidence of vascularity and 27 did not. There was no significant difference in success rate between groups (p = 0.115).

Conclusion:

The success rate was not influenced by the presence of ear discharge at the time of surgery, and tympanic membrane vascularity did not influence graft uptake.

Treatment of Large Tympanic Membrane Perforations: Medial to Malleus Versus Lateral to Malleus

The perforation size affects the success of tympanic membrane (TM) reconstruction, in addition to the surgical technique used. Large TM perforations present a surgical challenge. The perforation size has been reported to be a prognostic factor, and poorer results are obtained with large versus small perforations. We aimed to evaluate patients who had undergone tympanoplasty for large perforations at our clinic using either the underlay or over-underlay technique and to compare the results in terms of re-perforation, retraction, lateralization, and improvement of hearing. Of 302 patients with chronic otitis media, 114 who had a perforation that involved over 50 % of the pars tensa were enrolled in the study. The underlay technique was used in 61 patients, and the over-underlay technique in 53 patients. In the underlay group, the preoperative mean perforation size was 30.11 ± 5.35 mm(2) (range 20.00-52.00 mm(2)) (n = 61). In the over-underlay group, the preoperative mean perforation size was 31.41 ± 8.65 mm(2) (range 22.00-48.00 mm(2)) (n = 53). The graft success rate of tympanoplasty performed using the underlay technique was 89.1 % in 61 patients. Seven (10.9 %) patients had graft failure. The graft success rate with the over-underlay technique in 53 patients was 90.5 %. Five (9.5 %) patients had graft failure in this group. Three graft lateralizations (5.6 %) and two retractions (3.8 %) were observed at 12 months postoperatively in the over-underlay group. However, in the underlay group, no graft lateralization but five retractions (8.2 %) were observed at 12 months. The graft-take rates and hearing improvement results in both groups were successful and compatible with those in the literature.

Three-point fix tympanoplasty

CONCLUSION

The three-point fix tympanoplasty procedure is a stable and effective technique - with a high degree of graft take and satisfactory hearing results - for reconstruction of most tympanic membrane (TM) perforations.

OBJECTIVE

It is difficult to repair a TM perforation, including subtotal perforation, involving the anterior part of the annulus. Reperforation can occur when an underlay graft technique is used. An overlay graft technique may result in anterior blunting/lateralization. We introduce a three-point fix tympanoplasty procedure, which can provide additional support to yield a stable graft.

METHODS

The study enrolled a total of 234 patients who underwent a three-point fix tympanoplasty procedure from November 2005 to June 2011. Anatomic success was defined as an intact, repaired TM, while functional success was defined as a significant decrease in the air-bone gap at the end of follow-up compared with preoperative hearing (air-bone gap). The complication rate was also analyzed.

RESULTS

The anatomic success rate was 93.2% (218/234 patients). The functional success rate after an average of 1 year was 73.5%. The postoperative average pure-tone air-bone gap (15.4 ± 11.4 dB) decreased successfully in comparison with the preoperative average air-bone gap (20.6 ± 12.1 dB). There were few postoperative complications (7.7%).

Comparison of Partial Thickness and Full Thickness Tragal Cartilage Graft During Modified Cartilage Shield Tympanoplasty for Type I Procedures

To compare the results, in terms of graft uptake and hearing improvement, of modified cartilage shield technique of tympanoplasty using either partial thickness tragal cartilage or full thickness tragal cartilage for type I procedures. 35 patients were included in group A where a partial thickness tragal cartilage was used and 27 patients included in group B where a full thickness tragal cartilage was used for modified cartilage shield tympanoplasty. Audiometry done at 4 months after surgery and the results compared. The graft take up rate for both these techniques is excellent. There had been no statistically significant difference in hearing gain between these two groups, except at 4,000 Hz, where hearing gain had been more in group A than group B with P value being 0.027. The modified cartilage shield tympanoplasty is a good technique for closure of tympanic membrane perforations. Hearing gain is very much similar between thin and thick cartilage groups, except at 4,000 Hz.

Comparison of tympanic membrane grafting medial or lateral to malleus handle

Background:

To compare two methods of tympanic membrane (TM) grafting when graft materials medial or lateral to malleus, this study have been done.

Materials and Methods:

In this clinical trial which was conducted in Alzahra and Kashani hospitals, between June 2010 and February 2012, 56 patients with chronic otitis media and perforated TM entered the study in two groups. The inclusion criteria consisted of patients who were at least 15-years-old without history of smoking, diabetes mellitus or autoimmune disease. Exclusion criteria of the study: No compliance for follow up, post-surgical ear trauma or any infective pathology that directly affects the ear. In Group A patients, the graft material is pierced in near central part of the graft and they lodged so that the malleus handle projects through the graft perforation. Group B had grafting in the lateral side of the malleus. Three month after surgery both groups examined and tested by audiometry. Success of surgery is defined as complete repair of TM, without lateralization, atelectasis, blunting or retraction pocket.

Results:

This study contained 28 patients in Group A and 28 in Group B. Overall success rate was 94.64% that was 96.42% in Group A, and 92.85% in Group B. Differences of air-bone gap in each group before and after surgery was 16.10 (±4.89) in Group A, and 15.78 (±3.40) in Group B. Improvement of hearing level was not significant between two surgical methods (P = 0.442).

Conclusions:

Both techniques (medial and lateral to malleus handle) of TM grafting are effective with success rates 96.42% and 92.85% respectively.

Inferior flap tympanoplasty: a novel technique for anterior perforation closure

Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure. Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support. Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB), compared to 26.5 dB (10 to 55 dB) postoperatively. All perforations were found to be closed but one (92.3% success rate). Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.

Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological results)

The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9 ± 3.7 (5-17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4 kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p < 0.001). However, no significant difference was seen in ABG gain values (p = 0.608), which was 10.1 ± 7.00 dB in cartilage group and 10.8 ± 5.38 dB in fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.

3-flap tympanoplasty - A simple and sure success technique

Objective Three-flap tympanoplasty, a simple method for tympanic membrane repair, is recorded as an alternative method, which probably has advantages over other procedures and its efficacy evaluatedPatients Four hundred and fifty patients with subtotal or large central perforations with either an anterior bony overhang or vers small anterior rim of the perforation who underwent 3-flap tympanoplasty were included in this study Follow up period was 24 months Technique After removing the margin of the tympanic membrane remnant, three flaps (Superior, anterior and posterior) were elevated from the external auditory canal wall The temporalis fascia graft was then placed over the handle of malleus and all the three flaps were repositioned over the graftMain outcome measures The graft take over rate and hearing improvement postoperatively were the main outcome measuresResults Four hundred and twenty-five patients (94 44%) had successful grafts Both subjective and objective hearing improvement with a compliant tympanic membrane was seen in all of these patients postoperatively Mediatisation or lateralisation of the intact tympanic membrane did not occur Twenty-five patients had graft rejection, which was noted about 4 weeks after surgery and was due to infectionsConclusion 3-flap tympanoplasty is a simple technique with a very good success rate It is a useful method for busy practioners and junior otolaryngologists.

Combined approach for experimental Oto-neurosurgical procedures

Background:

Experimental procedures will continue to be a key element while going through the learning curve in the use of the endoscope and minimally invasive procedures. We describe the technical procedure of an experimental approach to middle ear in New Zealand rabbits through external auditory canal and its relevance as an ideal model to study graft materials and serve as a training tool for potential applications in otoneurology.

Methods:

A group of 28 adult New Zealand rabbits were subjected to an experimental myringoplasty, combining the transmeatal and retroauricular approach with endoscopic assistance and microsurgical technique. The different anatomical steps and systematization of the complete experimental procedure are described.

Results:

An experimental approach to middle ear live model and basic anatomic description was successfully used, standardizing the ideal technique. The eardrum could regenerate with no complications and with functional preservation in all the myringoplasty cases. This strategy involves a safe combined approach to the tympanic membrane and others neurosurgical as transcochlear and translaberyntic approaches and is useful as a test of other experimental procedures to evaluate biomaterials to repair the eardrum currently studied. This experimental myringoplasty model also facilitates functional tests such as impedanciometry and the endoscopic follow-up of the whole process.

Conclusions:

The method described to perform an experimental myringoplasty (type I tympanoplasty) in a New Zealand rabbit is an option to be used as a basic model to study the behavior of the graft in the tympanic membrane. Also, basic concepts for the use of combined instrumentation are established in the treatment of eardrum lesions, as a refinement of the technical training application in microsurgery and assisted endoscopy in the transcochlear and translaberintic approaches and otoneurology areas.

A review on the history of tympanoplasty

The history of myringoplasty and tympanoplasty is one of the most interesting in the history of ear surgery. The aims and ambitions of otologists have evolved along with time and experience. The objective of this article is to give an idea about the evolution of tympanoplasty, thus giving inspiration to future surgeons in their quest for a perfect technique which would be as good as a normal ear and its hearing. The history of otology starts from the early Egyptian healers. Hippocrates in his time observed that ear infections may be cause of death especially in young children. Early surgeries were performed mainly for drainage in order to save the life of the child having the ear disease. With time and scientific developments newer methods of treatment started to evolve. The invention of antimicrobials and their usage threw a new light into the treatment of otology infections. Then after the advent of microscope and with better understanding of the anatomy and physiology of ear and its diseases treatment strategies and surgical planning kept on advancing. Surgeons with time have become more interested in returning back the hearing along with curing infection from ear. But the quest is on for the perfect surgical technique which would give best results with minimal maneuvering. History of tympanoplasty nearly sums up the history of evolution of otology as a whole. The quest is still on to devise a way so as to give maximum post-operative hearing using minimal instrumentation.

The zone-based approach for selection of tympanoplasty technique

At the outset of surgery, the extent of a tympanic membrane defect is judged including any additional loss of area that may result from disease extirpation or removal of the mucocutaneous junction. There are, three tiers of complexity when deciding upon which technique should be used for repair. Limited central perforations are defects amenable to a standard underlay technique. The Zone Based Approach is applied for marginal perforations whereby the specific technique is selected based on the zone of the defect. The zones and specific techniques are detailed. There are however, still a significant number of patients who have scarce residual tympanic membrane, or keratin matrix adherently involving the undersurface requiring sacrifice. These situations prove poor for either standard underlay or the zone based techniques. The total tympanic membrane reconstruction (TT MR) technique was developed specifically to avoid these complications as well as facilitate extirpation of the more extensive inflammatory and neoplastic pathologies commonly encountered, yet still amenable to intact canal wall mastoidectomy approaches.

Surgical and hearing results of the circumferential subannular grafting technique in tympanoplasty: a randomized clinical study

PURPOSE

Circumferential elevation of the anullus away from its bony seat and extension of the graft onto the anterior bony canal increase the bed of the graft anteriorly but may be associated with anterior blunting, and so, a significant conductive hearing loss may result. The purpose of this study was to compare the surgical and audiologic success rates of circumferential subannular grafting with the conventional underlay tympanoplasty.

MATERIALS AND METHODS

A randomized clinical study was conducted from September 2007 to December 2010 at a tertiary referral center. Thirty-eight patients underwent circumferential subannular grafting (group A), and 25 patients underwent conventional underlay tympanoplasty with extension of the anterior edge of the graft forward against the lateral wall of the Eustachian tube, and therefore, the anterior sharp tympanomeatal angle remained unbroken (group B). All patients underwent preoperative and postoperative audiogram. Blunting and lateralization of the graft were evaluated 6 months after the surgery.

RESULTS

The surgical success rate was 97% in group A and 100% in group B patients. Improvement of the air conduction thresholds in all frequencies and closure of the mean air-bone gap were significant and similar among the 2 groups. There were no cases of significant blunting and tympanic membrane lateralization in the 2 groups.

CONCLUSION

This study showed underlay tympanoplasty with elevation of the annulus away from the sulcus tympanicus in the anterior sharp tympanomeatal angle and placement of the graft between it and anterior bony canal is not associated with increased risk of blunting and lateralization of the graft, if that sharp angle is adequately restored.

Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal-type chronic otitis media

OBJECTIVES

To assess the efficacy of anterior tagging of graft material with respect to graft uptake and hearing results, in type I tympanoplasty.

STUDY DESIGN

Prospective, randomised, cohort study.

METHODS

Sixty patients with chronic otitis media of the mucosal type, with pars tensa perforations, were included in the study. Patients were randomly allocated to two groups: group one underwent type one tympanoplasty with anterior tagging, while group two underwent type one tympanoplasty without anterior tagging. Follow up included evaluation of graft uptake and hearing improvement.

RESULTS

There were 33 patients in group one and 27 patients in group two. The overall incidence of successful graft uptake was 96.96 per cent in group one and 81.5 per cent in group two. Closure of central and posterior perforations was successful in 100 per cent of both groups. Closure of anterior and subtotal perforations was successful in 95.45 per cent of group one and 54.54 per cent of group two.

CONCLUSION

Type one tympanoplasty with anterior tagging of graft material is a suitable technique for anterior and subtotal perforations.

[Prognostic factors in patients operated on eardrum perforation with intact ossicular chain]

BACKGROUND

Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too.

AIM

This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty.

MATERIAL AND METHODS

Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009.

RESULTS

120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars.

CONCLUSIONS

The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operator's preferences, as well as the availability of given material for transplanting.