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Nicholas Jungbauer W, Jeong S, Nguyen SA, Lambert PR. Comparing Myringoplasty to Type I Tympanoplasty in Tympanic Membrane Repair: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:922-934. [PMID: 36939595 DOI: 10.1002/ohn.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To compare the anatomic success rates of type I tympanoplasty (tympanoplasty) versus myringoplasty. By our definition, tympanoplasty involves entering the middle ear via elevation of a tympanomeatal flap, while myringoplasty involves surgery to the drumhead without middle ear exposure. DATA SOURCES PubMed, Scopus, CINAHL, Cochrane. REVIEW METHODS To be included, studies must have documented surgical technique, tympanic membrane (TM) perforation size (as % of TM), and success rate using tissue or alloplastic grafts. Exclusion criteria included series with more than 10% of patients with cholesteatoma or middle ear pathology. A meta-analysis of weighted summary proportions under the random effects model was performed, and proportion differences (PD) were calculated. A secondary analysis of hearing outcomes was performed. RESULTS Eighty-five studies met inclusion, with a tympanoplasty cohort of n = 7966 and n = 1759 for myringoplasty. For perforations, less than 50% of the TM, the success rate for tympanoplasty and myringoplasty was 90.2% and 91.4%, respectively (PD: 1.2%, p = .19). In perforations greater than 50%, tympanoplasty and myringoplasty success rates were 82.8% and 85.3%, respectively (PD: 2.5%, p = .29). For both procedures, perforations less than 50% of the TM had higher success rates than perforations greater than 50% of the TM (p < .01). Both techniques endorsed significant improvements to air-bone gap (ABG) metrics. CONCLUSION Our analysis suggests that the anatomic success rate is similar for tympanoplasty and myringoplasty, regardless of perforation size, and that smaller perforations experience higher success rates in both techniques. ABG outcomes were also similar between procedure techniques.
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Affiliation(s)
- Walter Nicholas Jungbauer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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General anaesthetic vs local anaesthetic myringoplasties: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 280:2237-2245. [PMID: 36376527 DOI: 10.1007/s00405-022-07734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
AIMS To assess all available data and determine the success rates and tolerability of local anaesthetic myringoplasty in comparison with those undertaken under general anaesthetic myringoplasty. MATERIALS AND METHODS The study was designed following a PRISMA-P protocol and registered with the PROSPERO database. MEDLINE, Cochrane Library (CDSR/Central), EMBASE and CINHAL-were directly searched for studies, which met the inclusion criteria. OBJECTIVES Primary objective was to compare perforation closure rates between patients undergoing myringoplasty under local anaesthetic and those under general anaesthetic from all available published data. Secondary outcomes include complications, such as 'any minor complications', infection rates in the first 6 month post-op, facial nerve weakness, dysgeusia and patient satisfaction. RESULTS 27 studies were included in the final analysis and found that myringoplasty had an overall perforation closure rate of 89%. The pooled proportion of closures after myringoplasty under local anesthesia was 87% and for myringoplasties under general anesthesia was 91%. Analysis of myringoplasty under local anaesthesia focusing on 'in-office' performed procedures only, found a closure rate of 88%. CONCLUSIONS There is no significant difference in the success rate of myringoplasty surgery when performed under local or general anaesthetic as measured by perforation closure rates. However, there are other factors, which can drive choosing local anaesthetic surgery, such as minimising anaesthetic risks, reducing costs and reducing environmental impact.
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Ren Y, Han S, Chen J, Li J, Zhou M, He Z, He Z. Polyethylene glycol derivant crosslink and modify chitosan for tympanic membrane repair. INT J POLYM MATER PO 2022. [DOI: 10.1080/00914037.2022.2090939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Yangjing Ren
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Shuying Han
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Jia Chen
- The Department of Otolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Li
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Mi Zhou
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Zejian He
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Zhen He
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
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Ranguis SC, Leonard CG, James AL. Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty. Otol Neurotol 2021; 42:867-875. [PMID: 34111050 DOI: 10.1097/mao.0000000000003053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare outcomes and complications of endoscopic lateral graft (LGT) and interlay (IT) tympanoplasty. STUDY DESIGN Prospective observational cohort study of totally endoscopic ear surgery (TEES) tympanoplasty. SETTING Pediatric tertiary referral center. PATIENTS One hundred fourteen surgeries for children with tympanic membrane perforation without cholesteatoma. INTERVENTION Porcine-derived collagen graft tympanoplasty using either LGT or IT. MAIN OUTCOME MEASURES Closure rates of perforation, hearing outcomes (four-tone average air conduction [AC] and air bone gap), and complications that required further surgery were assessed 12 months postoperatively. RESULTS Perforation closure rates did not differ between LGT (52/59 (88%)) and IT (45/51 (88%)), (Fisher's exact p = 1.00) (four ears lost to follow-up). AC thresholds (p = 0.32) and air bone gap (p = 0.88) improved similarly after surgery with LGT (median 8.8 dB) and IT (median 7.5 dB). The proportion of ears with serviceably normal hearing (AC ≤ 30 dB HL) postoperatively was similar (LGT 40/49 (82%), IT 36/46 (78%), Fisher's exact p = 0.80). Following IT, three (6%) ears developed inclusion cholesteatoma requiring revision surgery. One (2%) LGT ear developed blunting after myringitis. CONCLUSIONS IT and LGT provide similar perforation closure rates and hearing outcomes. When choosing between these two techniques to repair pediatric tympanic membrane perforations, LGT would seem to be preferable than IT due to the risk of inclusion cholesteatoma after IT. There is a small risk of anterior blunting after LGT.
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Affiliation(s)
- Sebastian C Ranguis
- Department of Otolaryngology, Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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James AL. Totally endoscopic tympanic membrane repair. HNO 2021; 69:791-796. [PMID: 34041565 DOI: 10.1007/s00106-021-01052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transcanal totally endoscopic ear surgery (TEES) has become increasingly popular internationally; however, for surgeons trained with a two-handed microscope-guided approach, the potential challenges of adopting TEES can appear off-putting. OBJECTIVES This article outlines the pros and cons of TEES for tympanic membrane repair and describes aspects of surgical technique relevant to those who might adopt this approach. MATERIALS AND METHODS Data are provided from the author's experience along with a review of relevant literature, including several meta-analyses of tympanoplasty outcome. RESULTS Meta-analyses show that TEES tympanoplasty is as effective at closing tympanic membrane perforations and improving hearing as microscope-guided surgery. Yet patients benefit from avoidance of a skin incision and faster recovery. CONCLUSION Repair of the tympanic membrane with TEES is feasible and effective. This minimally invasive approach is very appealing to patients.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
- Department of Otolaryngology, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada.
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Aleemardani M, Bagher Z, Farhadi M, Chahsetareh H, Najafi R, Eftekhari B, Seifalian A. Can Tissue Engineering Bring Hope to the Development of Human Tympanic Membrane? TISSUE ENGINEERING PART B-REVIEWS 2021; 27:572-589. [PMID: 33164696 DOI: 10.1089/ten.teb.2020.0176] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMPs) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anesthetic risks, and high failure of graft patency. The tissue engineering strategy, which includes the applications of a three-dimensional (3D) scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches, which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, we provide an overview of the in vitro and preclinical studies of emerging products over the past 5 years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.
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Affiliation(s)
- Mina Aleemardani
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Zohreh Bagher
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Chahsetareh
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Roghayeh Najafi
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Behnaz Eftekhari
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London, United Kingdom
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Liu S, Huo Z, Zhang H, Hu Q, Ramalingam M. 3D printing‐assisted
combinatorial approach for designing mechanically‐tunable and vascular supportive nanofibrous membranes to repair perforated eardrum. J Appl Polym Sci 2020. [DOI: 10.1002/app.50132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Suihong Liu
- Rapid Manufacturing Engineering Center Shanghai University Shanghai China
| | - Zirong Huo
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center Shanghai University Shanghai China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics Shanghai University Shanghai China
| | - Qingxi Hu
- Rapid Manufacturing Engineering Center Shanghai University Shanghai China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics Shanghai University Shanghai China
| | - Murugan Ramalingam
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular and Molecular Theranostics, School of Mechanical Engineering Vellore Institute of Technology Vellore India
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Tashjian M, Ruiz A, Dinwiddie J, Greenlee C, Wine T. Cost of closure: Comparing success and spending of fat graft myringoplasties with and without hyaluronic acid. Int J Pediatr Otorhinolaryngol 2020; 135:110104. [PMID: 32502911 DOI: 10.1016/j.ijporl.2020.110104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Myringoplasties are common pediatric procedures used to surgically close a perforated tympanic membrane. While a wide variety of graft materials are available to surgeons, the cost effectiveness of these different techniques is not well studied. OBJECTIVES To compare the cost effectiveness of the fat graft myringoplasty (FGM) with the hyaluronic acid fat graft myringoplasty (HAFGM). METHODS Retrospective chart review of patients ages 31 days to 18 years who had undergone either FGM or HAFGM from 2006 to 2016. RESULTS We identified 85 patients who had undergone FGM and 51 patients who had undergone HAFGM. The two groups were statistically similar in age (CI -0.51, 1.9; p = 0.23), sex (CI 0.3, 1.4; p = 0.27), and history of prior tympanostomy tube placement (CI -0.07, 0.07; p = 0.69). Both groups had a similar number of total comorbidities (40.0% of patients in the FGM group and 27.5% of patients in the HAFGM; CI -0.04, 0.29; p = 0.19). The FGM and the HAFGM procedure did not have statistically significant differences in perforation closure rates, 82.4% and 92.2% respectively (CI 0.81, 7.3; p = 0.13). In comparing the total surgeons' cost of closing a tympanic membrane deficit, the FGM incurred a greater cost per perforation. The cost/tympanic membrane perforation closure for the FGM totaled $3011.88 per deficit, whereas the HAFGM totaled $2742.98. CONCLUSION As financial stewardship becomes more important for medical decision making, it is imperative that providers consider cost and outcomes data together when comparing similar treatment options. The FGM and the HAFGM have statistically similar rates of success in closing tympanic membrane perforations. In this study, the FGM cohort consumed more health care dollars per perforation secondary to the need for revision surgeries. As such, this study offers that the additional use of a hyaluronic disc does not increase overall cost to the healthcare system when performing a fat graft myringoplasty over a large cohort of patients.
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Affiliation(s)
- Margaret Tashjian
- University of Colorado School of Medicine, 13001 East 17th, Place, Aurora, CO, 80045, USA.
| | - Amanda Ruiz
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Jordyn Dinwiddie
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Chris Greenlee
- University of Colorado School of Medicine, 13001 East 17th, Place, Aurora, CO, 80045, USA; Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Todd Wine
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
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What is the Role of Hyaluronic Acid Ester in Myringoplasty? Systematic Review and Meta-Analysis. Otol Neurotol 2020; 40:851-857. [PMID: 31246888 DOI: 10.1097/mao.0000000000002274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To reveal odds of tympanic membrane closure and postoperative hearing outcomes for myringoplasty utilizing hyaluronic acid ester via systematic review and meta-analysis. DATA SOURCES 1) Search of English articles in PubMed/Medline, Embase, and Cochrane databases published between January 1, 1998 and March 31, 2018. STUDY SELECTION Inclusion criteria: 1) English language; 2) clinical studies; 3) reported posttreatment perforation status, hearing outcomes, or complications. EXCLUSION CRITERIA hyaluronic acid used for middle ear packing or topical application of hyaluronic acid solution. DATA EXTRACTION Number of patients, surgical technique, mean age, overall rate of tympanic membrane closure, success rate based on size of perforation, mean air-bone gap improvement, and postoperative speech scores and complications. DATA SYNTHESIS Ten studies encompassing 531 patients met criteria. Reported success rates for closure of chronic perforation ranged from 70.0 to 92.7% (mean, 85.21%). Smaller perforation predicted success in complete closure. Mean air-bone gap closure was 10.6 dB (4-24 dB). There were five complications reported. Meta-analysis was performed on five studies. No difference was noted in the success rates between hyaluronic acid ester myringoplasty and conventional tympanoplasty using fascia or perichondrium, with an overall closure rates of 89.8 and 89.4%, respectively (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.59-1.82, p = 0.896). A higher closure rate was seen in hyaluronic acid ester myringoplasty (87.9%) when compared with fat graft myringoplasty (70.8%), (OR 3.01, 95% CI 1.42-6.35, p = 0.004). CONCLUSIONS Hyaluronic acid (HA) ester myringoplasty appears to be safe and effective at attaining complete closure of tympanic membrane perforation, although there exists significant selection bias and inconsistent reporting among existing papers.
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Abi Zeid Daou C, Bassim M. Hyaluronic acid in otology: Its uses, advantages and drawbacks - A review. Am J Otolaryngol 2020; 41:102375. [PMID: 31862122 DOI: 10.1016/j.amjoto.2019.102375] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Review of the literature for studies involving the use of hyaluronic acid (HA) in otology. METHODS Pubmed and OvidMedline were searched using a combination of the following words in different variations: hyaluronic acid, hyaluronate, otolaryngology, otology, ear, tympanic membrane, perforation, tympanostomy, tympanoplasty, myringoplasty, packing, middle ear, cochlea, gene delivery, gene therapy, cochlear implant, hearing loss, meniere, vertigo, otitis and cholesteatoma. RESULTS The papers relevant for this review were triaged based on abstracts and titles and were then categorized based on topic/disease entity/procedure. The papers were read and summarized in order to use their findings in this review. CONCLUSIONS HA is being recently used as adjuvant therapy for multiple inflammatory conditions and in tissue repair. These immunomodulatory properties and biocompatibility have interested researchers specially in the field of otology for repair, gene delivery, immunomodulation etc. Recent data in the field show optimistic results for the use of HA in several conditions especially tympanic membrane perforations and gene delivery. It also establishes the role of HA as ancillary treatment in many other otologic pathologies. This review presents the most recent findings on the use of HA in otology. The results could be used to guide clinical practice and incite further research based on the presented results of the literature.
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Can Fat-plug Myringoplasty Be a Good Alternative to Formal Myringoplasty? A Systematic Review and Meta-analysis. Otol Neurotol 2019. [PMID: 29533328 DOI: 10.1097/mao.0000000000001732] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study reviewed available literature to evaluate the success rate of fat myringoplasty compared with methods using other graft materials and suggests proper indications for this procedure. DATA SOURCES Studies reporting the success rate of fat myringoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2017. STUDY SELECTION The following terms were used for the literature search: ("Fat" OR "Adipose") and ("Myringoplasty" OR "Tympanoplasty"). DATA EXTRACTION Eight case series reported the data of perforation size and audiologic results. The success rate varied according to the perforation size with a cutoff value of 3 to 5 mm in length or 30% of the total tympanic membrane area. The success rate in anterior perforation was lower than that in other sites, ranging from 76.7 and 85.2% to 84.5 and 91.7%, respectively. The meta-analysis was performed on 10 articles. The overall success rate in fat myringoplasty and paper patch technique was not significantly different, while the success rate of fat myringoplasty was lower than that for the conventional myringoplasty technique using fascia or perichondrium (OR 0.63, 95% CI 0.49-0.80). Hyaluronic acid showed a significantly higher success rate than fat myringoplasty (90.1% versus 69.9%) (OR 0.20, 95% CI 0.09-0.46). CONCLUSIONS The success rate of fat myringoplasty may be associated with the perforation site and size. The success rate of fat myringoplasty was equivalent to that of the paper patch but inferior to a conventional method using perichondrium or fascia.
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Chen SL, Yang SW. Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations. Eur Arch Otorhinolaryngol 2019; 276:3005-3012. [PMID: 31377902 DOI: 10.1007/s00405-019-05583-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. METHODS The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. RESULTS A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51 years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR = 0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). CONCLUSION As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Yang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Shoman NM. Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting. Am J Otolaryngol 2019; 40:482-486. [PMID: 31029401 DOI: 10.1016/j.amjoto.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting. STUDY DESIGN Retrospective case series. SETTING Tertiary care facility. PATIENTS Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection. INTERVENTION In-office modified myringoplasty technique under local anesthesia without sedation. MAIN OUTCOME MEASURES Complete perforation closure rate and audiometric outcomes. RESULTS 250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04). CONCLUSION The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.
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Shoman N. Pilot Study Assessing the Feasibility and Clinical Outcomes of Office-Based Ossiculoplasty. Ann Otol Rhinol Laryngol 2018; 128:50-55. [PMID: 30345805 DOI: 10.1177/0003489418806922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anesthesia in an office setting without sedation. METHODS: Between May 2017 and November 2017, patients who presented with conductive hearing loss and known isolated ossicular discontinuities were offered ossiculoplasty under local anesthesia. Inclusion criteria included age ⩾ 18 years, adequate transcanal access, and the ability to lie supine for up to 45 minutes. Exclusion criteria included associated tympanic membrane perforation and the presence of middleear or mastoid cholesteatoma or infection. RESULTS: Fourteen patients underwent the procedure. The mean age was 48.3 years (range, 19-74 years). Six were primary and 8 revision cases. There were 8 partial and 6 total prosthesis placements. The mean operative time was 34 minutes (range, 26-43 minutes). All patients tolerated the procedure to completion. There were no intraoperative complications. The mean air conduction pure-tone average was 76.6 dB and the mean bone conduction pure-tone average was 27.2 dB, with a preoperative air-bone gap of 49.9 dB. Air conduction pure-tone average significantly improved to 45.2 dB ( P < .0001). Air-bone gap significantly improved to 17.8 dB ( P < .0001). CONCLUSIONS: Ossiculoplasty using partial or total prostheses can be safely performed in the office setting under local anesthesia without sedation in carefully selected patients. This has potentially significant patient and system benefits.
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Affiliation(s)
- Nael Shoman
- 1 Division of Otolaryngology Head & Neck Surgery, Dalhousie University, University Avenue Halifax, Halifax, NS, Canada
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Deng R, Fang Y, Shen J, Ou X, Liuyan W, Wan B, Yuan Y, Cheng X, Shu Y, Chen B. Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media. Acta Otolaryngol 2018; 138:105-109. [PMID: 29073815 DOI: 10.1080/00016489.2017.1384057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM). MATERIALS AND METHODS Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient. RESULTS Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05). CONCLUSIONS Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.
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Affiliation(s)
- Rui Deng
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Yanqing Fang
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Jun Shen
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Laboratory for Molecular Medicine, Partners Personalized Medicine, Cambridge, MA, USA
| | - Xiong Ou
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Wenyi Liuyan
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Bin Wan
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Yasheng Yuan
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Xiaoting Cheng
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Yilai Shu
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
| | - Bing Chen
- Department of Otolaryngology – Head and Neck Surgery, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, National Health and Family Planning Commission, Shanghai, China
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Grotenhuis N, Koopman JP, Kruyt JM, Rothuizen LT, Knevel R, Blom H. Implementation of the hyaluronic acid fat graft myringoplasty technique, pitfalls and lessons learned. Acta Otolaryngol 2017; 137:1035-1038. [PMID: 28554254 DOI: 10.1080/00016489.2017.1330556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Myringoplasty is a common procedure in otorhinolaryngology. Many techniques with different complications and outcomes have been described, one of which is hyaluronic acid fat graft myringoplasty (HAFGM). This technique, as proposed by Saliba, uses fat tissue and hyaluronic acid discs. The technique is relatively fast with a high success rate and low complications. However, what outcomes can be expected when performed by other surgeons? In this paper, we report on the technique's success in our own hands. MATERIALS AND METHODS Based on Saliba's protocol, we performed 86 HAFGMs by a transcanal approach between 2012 and August 2014. However, our 70% success rate was significantly different from Saliba's 92% (p value 2.8e - 05). We visited Saliba's clinic in order to identify critical differences between our approaches. We adapted the differences we found in our protocol and analysed another 50 HAFGMs performed afterwards, between October 2014 and December 2015. RESULTS The success rate increased to 86-89%, this percentage is not different compared to Saliba's results (p value .25 and .54). CONCLUSION HAFGM is a reproducible technique in the hands of other surgeons, but critical following of the surgical protocol is important.
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Affiliation(s)
- Nienke Grotenhuis
- Department of Otorhinolaryngology, HAGA Hospital, The Hague, The Netherlands
- Department of Otorhinolaryngology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan Pieter Koopman
- Department of Otorhinolaryngology, HAGA Hospital, The Hague, The Netherlands
| | - J. M. Kruyt
- Department of Otorhinolaryngology, Reinier de Graaf Gasthuis Hospital, Delft, The Netherlands
| | - L. T. Rothuizen
- Department of Otorhinolaryngology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rachel Knevel
- Medical and Population Genetics Program, Broad Institute, Cambridge, MA, USA
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Henk Blom
- Department of Otorhinolaryngology, HAGA Hospital, The Hague, The Netherlands
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Saliba I. In response to Growth factors expression in hyaluronic acid fat graft myringoplasty. Laryngoscope 2017; 127:E252. [PMID: 28480556 DOI: 10.1002/lary.26630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Issam Saliba
- Division of Otolaryngology-Head and Neck Surgery, Sainte-Justine University Hospital Center (CHU SJ), University of Montreal, Montreal, Quebec, Canada
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Sayin I, Gunes S, Ekizoglu O. Treatment of traumatic tympanic membrane perforations. Eur Arch Otorhinolaryngol 2017; 274:2357-2358. [PMID: 28265746 DOI: 10.1007/s00405-017-4508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ibrahim Sayin
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Sağlam Caddesi, No: 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Selcuk Gunes
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Sağlam Caddesi, No: 11, 34147, Bakırköy, Istanbul, Turkey
| | - Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
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Choi SH, Song HY, Song CI. Fibrinogen-Based Collagen Fleece Graft Myringoplasty for Traumatic Tympanic Membrane Perforation. J Audiol Otol 2016; 20:139-145. [PMID: 27942599 PMCID: PMC5144816 DOI: 10.7874/jao.2016.20.3.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/19/2016] [Accepted: 06/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives The aim of this study was to investigate how fibrinogen-based collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP). Subjects and Methods Between August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty. Results The TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative air-bone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent. Conclusions FCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.
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Affiliation(s)
- Seung Hyo Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Hyoung Yong Song
- Department of Otorhinolaryngology, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Chan Il Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, Jeju, Korea
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Alhabib SF, Saliba I. Hyaluronic Acid Fat Graft Myringoplasty Versus Autologous Platelet Rich Plasma. J Clin Med Res 2016; 9:30-34. [PMID: 27924172 PMCID: PMC5127212 DOI: 10.14740/jocmr2800w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hyaluronic acid fat graft myringoplasty (HAFGM) is an office-based technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aimed to compare HAFGM technique to a recently described topical use of autologous platelet rich plasma myringoplasty (PRPM) in the repair of TMP. We also aimed to assess the hearing level improvement postoperatively. METHODS We conducted a prospective study in an adult tertiary care center between January 2015 and January 2016. Adult patients presenting with simple TMP were operated randomly using either HAFGM or PRPM under local anesthesia in an office-based setting. Perforations were classified into four grades. Success was considered when complete closure is achieved. Audiometric parameters were evaluated pre- and postoperatively. RESULTS We included 27 patients, of whom 16 were operated with HAFGM and 11 were operated with PRPM. Complete closure was achieved in 81.2% and 18.1%, respectively. Postoperatively, no worsening of bone conduction threshold was noted. The study was abandoned due to the low success rate in patients with PRPM. The pure tone audiometry was improved postoperatively in patients with closed tympanic membrane. CONCLUSIONS The study was aborted because of the unsatisfactory obtained results using PRPM. It confirms once again the beneficial effect of hyaluronic acid in the healing process when added to fat graft myringoplasty. Furthermore, it requires no hospitalization.
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Affiliation(s)
- Salman F Alhabib
- Department of Surgery, Division of Otorhinolaryngology, Head & Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC, Canada
| | - Issam Saliba
- Department of Surgery, Division of Otorhinolaryngology, Head & Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC, Canada
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Niazi SA, Hassan ZU, Atif K, Ullah S. Comparison of permeatal medial placement of graft without raising the tympano-meatal flaps to conventional methods of myringoplasty: An experience at tertiary care hospital in Pakistan. Pak J Med Sci 2016; 32:927-30. [PMID: 27648041 PMCID: PMC5017104 DOI: 10.12669/pjms.324.9497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty. Methods: This Quasi-experimental study was carried out in CMH (Combined Military Hospital) Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media (CSOM) with dry central; small, medium and large perforations were selected. They were divided into two groups depending upon the type of approach. In Group-A (n-200); permeatal approach without raising tympano-meatal flap was used; while in Group-B (n-150) end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17. Results: Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A(80%) and Group-B(85%) (p-0.261). Type of approach had a significant impact on duration of surgery(p<0.001) and post-operative recovery time(p<0.001). Conclusion: The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently.
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Affiliation(s)
- Saleem Asif Niazi
- Dr. Saleem Asif Niazi, MBBS, MCPS, FCPS Department of ENT, Combined Military Hospital, Peshawar, Pakistan
| | - Zaheer Ul Hassan
- Dr. Zaheer Ul Hassan, MBBS, FCPS Department of ENT, Combined Military Hospital, Peshawar, Pakistan
| | - Khaula Atif
- Dr. Khaula Atif, MBBS, MCPS(Family-Medicine), DPH, DMA. Department of General Administration, Combined Military Hospital, Peshawar, Pakistan
| | - Saeed Ullah
- Dr. Saeed Ullah, MBBS, FCPS Department of ENT, Combined Military Hospital, Quetta, Baluchistan, Pakistan
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Zhengcai-Lou, Xiangming-Wang. In Reference to Growth factors expression in hyaluronic acid fat graft myringoplasty. Laryngoscope 2016; 127:E251. [PMID: 27114053 DOI: 10.1002/lary.26021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Zhengcai-Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiangming-Wang
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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A trans-well-based cellular model for the rapid pre-evaluation of tympanic membrane repair materials. Eur Arch Otorhinolaryngol 2015; 273:2027-34. [DOI: 10.1007/s00405-015-3768-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
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Villar-Fernandez MA, Lopez-Escamez JA. Outlook for Tissue Engineering of the Tympanic Membrane. Audiol Res 2015; 5:117. [PMID: 26557361 PMCID: PMC4627121 DOI: 10.4081/audiores.2015.117] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 01/02/2023] Open
Abstract
Tympanic membrane perforation is a common problem leading to hearing loss. Despite the autoregenerative activity of the eardrum, chronic perforations require surgery using different materials, from autologous tissue - fascia, cartilage, fat or perichondrium - to paper patch. However, both, surgical procedures (myringoplasty or tympanoplasty) and the materials employed, have a number of limitations. Therefore, the advances in this field are incorporating the principles of tissue engineering, which includes the use of scaffolds, biomolecules and cells. This discipline allows the development of new biocompatible materials that reproduce the structure and mechanical properties of the native tympanic membrane, while it seeks to implement new therapeutic approaches that can be performed in an outpatient setting. Moreover, the creation of an artificial tympanic membrane commercially available would reduce the duration of the surgery and costs. The present review analyzes the current treatment of tympanic perforations and examines the techniques of tissue engineering, either to develop bioartificial constructs, or for tympanic regeneration by using different scaffold materials, bioactive molecules and cells. Finally, it considers the aspects regarding the design of scaffolds, release of biomolecules and use of cells that must be taken into account in the tissue engineering of the eardrum. The possibility of developing new biomaterials, as well as constructs commercially available, makes tissue engineering a discipline with great potential, capable of overcoming the drawbacks of current surgical procedures.
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Affiliation(s)
| | - Jose A. Lopez-Escamez
- Otology & Neurotology Croup CTS495, Centre for Genomics and Oncological Research (CENYO) - Pfizer, University of Granada, Andalusian Regional Government, Granada, Spain
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Comparison of temporal muscle fascia and cartilage grafts in pediatric tympanoplasties. Am J Otolaryngol 2014; 35:796-9. [PMID: 25115537 DOI: 10.1016/j.amjoto.2014.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare anatomic and functional outcomes of the different graft materials used in pediatric tympanoplasty. MATERIALS AND METHODS The patients younger than 18 years of age and who had tympanoplasty between 2010 and 2012 were included in the study. Temporal muscle fascia or cartilage was used as the graft material. The age, gender, the side of the operated ear, the operation technique, pre- and postoperative audiological results, and the status of the graft were noted. An intact graft and an air-bone gap (ABG) ≤ 20 were regarded as surgical success in the postoperative period. Audiograms obtained before surgery and 1 year after surgery were used for the comparison. RESULTS Sixty pediatric cases were included in the study. Fascia graft was used as the graft material in 35 of them, and cartilage was used in 25 patients. The graft success rate was 82.9% in the fascia group while it was 92% in the cartilage group. In the fascia group preoperative ABG was 28.2 ± 10.1 dB, postoperative ABG was 15.1 ± 10.2dB, and postoperative gain was 13.1 ± 9.6 dB. In the cartilage group, preoperative ABG was 28.9 ± 10.2dB, and postoperative ABG was 16.8 ± 10.3 dB with a postoperative gain of 12.1 ± 6.8 dB. The differences between the fascia and the cartilage groups were not statistically significant either for hearing gain or graft success rate. CONCLUSION Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in pediatric tympanoplasty.
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Habesoglu M, Oysu C, Sahin S, Sahin-Yilmaz A, Korkmaz D, Tosun A, Karaaslan A. Platelet-Rich Fibrin Plays a Role on Healing of Acute-Traumatic Ear Drum Perforation. J Craniofac Surg 2014; 25:2056-8. [DOI: 10.1097/scs.0000000000001140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Saliba I, Alzahrani M, Zhu T, Chemtob S. Growth factors expression in hyaluronic acid fat graft myringoplasty. Laryngoscope 2014; 124:E224-30. [DOI: 10.1002/lary.24468] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/23/2013] [Accepted: 10/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Issam Saliba
- Division of Otolaryngology-Head and Neck Surgery; Sainte-Justine University Hospital Center; University of Montreal; Montreal Quebec Canada
| | - Musaed Alzahrani
- Division of Otolaryngology-Head and Neck Surgery; Sainte-Justine University Hospital Center; University of Montreal; Montreal Quebec Canada
| | - Tang Zhu
- Department of Pediatrics; Sainte-Justine University Hospital Center; University of Montreal; Montreal Quebec Canada
| | - Sylvain Chemtob
- Department of Pediatrics; Sainte-Justine University Hospital Center; University of Montreal; Montreal Quebec Canada
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Hyaluronic acid fat graft myringoplasty vs fat patch fat graft myringoplasty. Eur Arch Otorhinolaryngol 2014; 272:1873-7. [DOI: 10.1007/s00405-014-2982-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/22/2014] [Indexed: 11/25/2022]
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Redleaf MI. Air space reduction tympanomastoidectomy repairs difficult perforations more reliably than tympanoplasty. Laryngoscope 2013; 124 Suppl 3:S1-13. [PMID: 23553170 DOI: 10.1002/lary.23599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/11/2012] [Accepted: 06/25/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Air space reduction tympanomastoidectomy improves outcomes over tympanoplasty in repairing tympanic membrane perforations in the presence of unfavorable risk factors. STUDY DESIGN Retrospective review of 67 subjects' 87 operations. METHODS Interventions were tympanoplasty versus air space reduction tympanomastoidectomy. Risk factors were contracted mastoid air cells, previous failed operations, descent from the indigenous peoples of the Americas, and middle/ear mastoid volumes l<3 CC. Favorable outcomes were closure of the perforation, no decline in hearing, and creation of a self-cleaning mastoid bowl. RESULTS Five out of 46 air space reduction tympanomastoidectomies failed to close their perforations (11%). Pure-tone threshold (PTA) worsened in 13/46 ears (28%). Four of 46 required mastoid bowl cleaning (9%). In contrast, 21 of 41 tympanoplasties failed to close (51%). PTA worsened in 9/34 ears (26%). All four tympanoplasty failures treated with an air space reduction tympanomastoidectomy closed. Three of the seven tympanoplasty failures treated with a second tympanoplasty did not close. Statistical analysis found two risk factors more prevalent among the air space reduction tympanomastoidectomies: contracted mastoids (P = .019) and middle ear volumes <3 CC (P = .0001). Increased closure of perforations occurring after the air space reduction tympanomastoidectomy was also statistically significant (P = .0002). Descendants of indigenous peoples of the Americas trended toward better PTAs after their air space reduction tympanomastoidectomies than their tympanoplasties and showed statistically significant increases in closure of perforation (P = .0046). CONCLUSIONS Air space reduction tympanomastoidectomy is an effective and safe method for closing tympanic membrane perforations.
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Affiliation(s)
- Miriam I Redleaf
- Department of Otology/Neurotology, University of Illinois-Chicago, Chicago, Illinois, U.S.A
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A prospective controlled trial comparing spontaneous closure and Epifilm® patching in traumatic tympanic membrane perforations. Eur Arch Otorhinolaryngol 2013; 270:2857-63. [DOI: 10.1007/s00405-012-2331-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Teh BM, Marano RJ, Shen Y, Friedland PL, Dilley RJ, Atlas MD. Tissue engineering of the tympanic membrane. TISSUE ENGINEERING PART B-REVIEWS 2012; 19:116-32. [PMID: 23031158 DOI: 10.1089/ten.teb.2012.0389] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tympanic membrane (TM) perforations are common, with current treatments for chronic perforations involving surgery, using various graft materials, from autologous cartilage or fascia through to paper patch. Recent research developments in this field have begun applying the principles of tissue engineering, with appropriate scaffolds, cells, and bioactive molecules (BMs). This has revolutionized the therapeutic approach due to the availability of a wide range of materials with appropriate compatibility and mechanical properties to regenerate the membrane acoustics and may also represent a paradigm shift in the management of TM perforations in an outpatient setting without surgery. However, many factors need to be considered in the fabrication of a bioengineered TM. This review discusses the issues associated with current treatment and examines TM wound healing relevant to the construction of a bioengineered TM. It also describes the tissue-engineering approach to TM regeneration by summarizing currently used scaffolds, BMs, and cells in TM wound healing. Finally, it considers the design of scaffolds, delivery of BMs, and cell engraftment toward potential clinical application.
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Affiliation(s)
- Bing Mei Teh
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
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Abstract
Tympanoplasty in children poses some different challenges from the same procedure in adults. The aim of the current article is to review 10 important considerations in pediatric tympanoplasty that focus on these differences and help to optimize the chance of successful outcome.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Koc S, Akyuz S, Gurbuzler L, Aksakal C. Fat graft myringoplasty with the newly developed surgical technique for chronic tympanic membrane perforation. Eur Arch Otorhinolaryngol 2012; 270:1629-33. [DOI: 10.1007/s00405-012-2040-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 04/24/2012] [Indexed: 11/28/2022]
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Knapik M, Saliba I. Myringoplasty in children with cleft palate and craniofacial anomaly. Int J Pediatr Otorhinolaryngol 2012; 76:278-83. [PMID: 22172220 DOI: 10.1016/j.ijporl.2011.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/20/2011] [Accepted: 11/21/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Analyze the anatomical and audiological success rates of myringoplasty in children with craniofacial anomaly, cleft palate and compare them to a control group. METHODS Retrospective review of medical records for all children who underwent myringoplasty between 1997 and 2007. The following data was recorded: sex, age, perforation side, size, location and etiology, surgical approach, type of myringoplasty, graft material, season of surgery, preoperative status of the operated and contralateral ear, history of previous otologic surgery, and adenoidectomy or tonsillectomy. RESULTS Myringoplasty outcomes of 22 craniofacial anomaly patients (15/22 were cleft palate patients) were compared to 144 controls. Children in the craniofacial anomaly group demonstrated a tendency towards surgery at an older age. Children in the craniofacial anomaly and cleft palate groups had a significant positive history of previous otologic procedures to both operated and contralateral ears. Peroperative subannular ventilation T-tubes were more frequently recorded in patients with craniofacial anomaly than patients in the control group. The craniofacial anomaly, cleft palate and control group had comparable mean preoperative and postoperative ABG and their ABG improvement was statistically significant. Children with craniofacial anomaly, cleft palate and control group shared similar anatomical and audiological success rates (ABG<20 dB) at 6, 12 and 24 months. CONCLUSIONS Although children in the craniofacial anomaly and cleft palate groups are predisposed to middle ear disease, their disease responds well to surgical intervention. Their audiological and anatomical success rates were equivalent to the ones observed in the control group. In light of our results, we recommend that myringoplasty in children with craniofacial anomaly and cleft palate be performed after the age of 12.
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Affiliation(s)
- Monika Knapik
- CHU Sainte-Justine, 3175, Côte Sainte-Catherine, Service ORL, Montréal (Qc) H3T 1C5, Canada
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Teh BM, Shen Y, Friedland PL, Atlas MD, Marano RJ. A review on the use of hyaluronic acid in tympanic membrane wound healing. Expert Opin Biol Ther 2011; 12:23-36. [DOI: 10.1517/14712598.2012.634792] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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