Comparison of Endoscopic Modified and Typical Myringoplasty: A Randomized Controlled Trial

Endoscopic Cartilage Myringoplasty with Anterior Margin Preservation for Repairing Large Anterior Perforations

Objective: This study compared the graft outcomes and complications of endoscopic cartilage inlay myringoplasty with preservation of anterior margins (IPAM) and the cartilage underlay technique with raising the tympanomeatal flap (CUTF) for repairing large anterior perforations. Materials and Methods: In total, 55 patients with large anterior perforations were recruited and allocated to the IPAM (n = 28) or the CUTF (n = 27) group. The graft success rate, hearing gain, operation time, and postoperative complications were compared between the groups at 12 months. Results: The mean operation times were 29.3 ± 2.7 minutes and 46.4 ± 3.9 minutes in the IPAM and CUTF groups, respectively (P < .001). The residual perforation rate was 0.0% in the IPAM group and 11.1% in the CUTF group (P = .222). All patients completed the 12-month follow-up. The overall graft success rate was 96.4% in the IPAM group and 88.9% in the CUTF group (P = .577). No significant differences were observed between the groups in terms of postoperative pure-tone averages for air conduction and bone conduction, air-bone gaps (ABGs), or ABG changes. In the CUTF group, 22.2% of the patients reported altered taste perception, 3.7% experienced bony external auditory canal (EAC) stenosis, and 3.7% developed EAC cholesteatoma. By contrast, the IPAM group did not have any cases of altered taste perception, EAC stenosis, or cholesteatoma. Conclusions: Endoscopic cartilage myringoplasty with IPAM and anterior perichondrium folding is a simple, effective, and minimally invasive technique for repairing large anterior perforations. It offers a high graft success rate and better hearing improvement compared to CUTF.

Preliminary investigation of endoscopic surgery for tympanic membrane perforation: Regenerative treatment compared with conventional surgery

PURPOSE

To compare surgical outcomes of regenerative treatment (RT) including basic fibroblast growth factor (bFGF) (Group-R) with the conventional method (Group-C) for patients with tympanic membrane perforation (TMP), both of whom underwent transcanal endoscopic ear surgery.

METHODS

The study population of Group-R included 61 ears of 59 patients treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the TMP. Fibrin glue was then dripped over the sponge. Group-C consisted of 13 patients who underwent conventional surgery before adopting the RT-TMP. Patients' characteristics and outcomes including TMP closure rates, and change in hearing level were evaluated three or more weeks after the surgery.

RESULTS

The baseline characteristics including size of TMP were not significantly different between the two groups. Although Group-R had significantly shorter operating time than Group-C, the complete TMP closure rates were 69 % (9/13) and 85 % (52/61), respectively. Air-conduction hearing thresholds showed significant improvements, and analysis of variance showed that Group-R achieved significant interactions other than at 8 kHz, implying better improvement in cases with TMP closure. The air-bone gaps also improved at all frequencies in both groups. Specifically, at 4 kHz, there was a trend showing better improvement in Group-R.

CONCLUSION

RT-TMP had a high TMP closure rate and good hearing improvement, with no significant differences compared with those of conventional surgery. This new therapy is simple and safe, and requires less operating time, and it could help improve the quality of life of patients with TMP.

Comparative study of endoscopic underlay myringoplasty with or without tucking of the attached perichondrium graft when repairing large central dry perforations

OBJECTIVE

To compare the graft success rates and hearing outcomes of underlay myringoplasty with or without perichondrium tucking of the attached perichondrium, graft perforation margins when repairing chronic large central dry perforations.

STUDY DESIGN

Randomized controlled trial.

MATERIAL AND METHODS

Chronic large central dry perforations were prospectively randomized to tucking perichondrium graft underlay (TPGU) and no-tucking perichondrium graft underlay (NTPG) groups. The graft outcomes and complications were compared between the two groups at 12 months postoperatively.

RESULTS

In total, 61 patients with large central dry perforations were included. All patients completed 12-month follow-ups. Residual perforations occurred in 0.0 % of the TPGU group and in 12.9 % of the NTPG group (P = 0.129), and re-perforations occurred within 6 months in 0.0 % and 3.2 % of the two groups, respectively (P = 0.987). The graft success rates were 100.0 % (30/30) and 83.9 % (26/31) (P = 0.067). No significant between-group differences were observed in terms of preoperative (P = 0.547) or postoperative (P = 0.612) air bone gaps (ABGs) or mean ABG gains (P = 0.597). No graft-related complications were observed in either group during follow-up. No patients exhibited significant graft blunting or medialization; graft lateralization was noted in one patient of the NTPG group.

CONCLUSIONS

Endoscopic cartilage with tucking of the attached perichondrium perforation margins during underlay myringoplasty may improve the graft success rate compared to that of the cartilage push-through technique when repairing large central dry perforations; however, the hearing improvements were comparable in the two groups.

Effects of no perforation margin trimming and EAC packing in cartilage underlay myringoplasty for chronic large perforations in children

OBJECTIVE

Trimming of perforation margins and external auditory canal (EAC) packing are basic procedures in underlay myringoplasty for repairing chronic perforations. The objective of this study was to compare the operation time, graft outcome, hearing improvement, and complications of endoscopic cartilage underlay myringoplasty with and without trimming of perforation margins and EAC packing in children.

STUDY DESIGN

Prospective, randomized study.

SETTING

Tertiary referral center.

MATERIAL AND METHODS

Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups: myringoplasty with trimming of perforation margin and EAC packing (TPME) group or no trimming of perforation margin and EAC packing (NTPME) group. The operation time, graft success rate, hearing improvement, and complications were compared between the two groups.

RESULTS

Fifty-two patients were ultimately included in the study. The mean operation time was 31.4 ± 4.2 min in the TPME group and 23.6 ± 1.7 min in the NTPME group; the difference was significant (P < 0.01). The rate of aural fullness significantly differed between the TPME and NTPME groups (P = 0.000). All participants were followed up for 12 months; the graft success rate did not significantly differ between the groups (88.5% vs. 96.2%; P = 0.603). No patients developed adhesive otitis media. Between the preoperative and postoperative measurements, the mean air-bone gap improved by 10.2 ± 2.8 dB in the TPME group and 11.6 ± 0.7 dB in the NTPME group; this was significant (P < 0.001) in both groups.

CONCLUSIONS

Endoscopic cartilage underlay myringoplasty NTPME shorted the operation time and avoided aural fullness and EAC discomfort compared with the TPME technique; however, graft success and hearing improvement were comparable between the two techniques for repairing large perforations in children.

Additional cartilage reinforcement of the annulus in myringoplasty for subtotal perforation

OBJECTIVE

In this study, graft success, hearing outcome, and complications were compared following the repair of subtotal perforation using a cartilage reinforcement underlay technique (CRUT) versus the traditional cartilage underlay technique (TCUT).

STUDY DESIGN

Randomized controlled trial.

MATERIALS AND METHODS

Seventy-six patients with subtotal perforations were prospectively randomized to the CRUT (n = 38) or TCUT (n = 38) group. The graft success rate, hearing outcome, and complications were compared at 12 months.

RESULTS

The mean operation time was 32.9 ± 4.2 (range: 26-47) min in the CRUT group and 51.8 ± 6.3 (range: 48-73) min in the TCUT group (P < 0.001). At 12 months postoperatively, no residual perforation was seen in either group. The graft success rate was 94.7 % (36/38) in the CRUT group and 92.1 % (35/38) in the TCUT group; the difference was not significant (P = 0.643). The postoperative air bone gap (ABG) was significantly improved compared to the preoperative value in both groups, without significant between-group differences in either the preoperative (P = 0.741) or postoperative (P = 0.865) ABG or the mean ABG gain (P = 0.812). Additionally, there were no significant between-group differences in the preoperative (P = 0.887) or postoperative (P = 0.753) mean bone-conduction pure tone average. In the TCUT group, seven (18.4 %) patients developed temporary hypogeusia and two (5.3 %) had external auditory canal scarring. Graft cholesteatoma was not observed in either group.

CONCLUSION

In the treatment of subtotal perforations, lateral reinforcement of the annulus with additional cartilage is simpler than traditional cartilage underlay for achieving graft and hearing success. The technique also does not involve raising the tympanomeatal flap or removing perforation margins.

Graft Healing Process Following Cartilage Myringoplasty Without Trimming of the Perforation Margin

Objective: The objective of this study was to endoscopically evaluate the graft healing process and graft success rate following cartilage myringoplasty, without trimming of the perforation margin or external ear canal (EAC) packing. Material and Methods: Patients with chronic tympanic membrane (TM) perforation underwent endoscope cartilage underlay myringoplasty, without trimming perforation margin or EAC packing. The healing process of the cartilage graft and the graft success rate were evaluated at 6 months postoperatively. Results: Fifty-eight ears were included in this study. At 1 week postoperatively, clinical inosculation and neovascularization of the graft were observed in small- and medium-sized perforations, but not in large or subtotal perforations. At 2 weeks postoperatively, graft clinical inosculation and neovascularization were completed in the small- and medium-sized perforations; however, neovascularization of the graft had only just begun in the large perforations. At 3 weeks postoperatively, completion of the graft clinical inosculation was achieved in 57 of the 58 ears. At 4 weeks postoperatively, complete neovascularization was achieved in all perforations. Of the 58 ears, postoperative infection resulted in residual perforation in 1 ear, and an insufficient graft resulted in residual perforation in a large perforation without infection. Overall, the graft success rate was 96.6% (56/58). There was no correlation between the graft success rate and graft neovascularization score. Conclusions: The graft healing process experienced the dilation of the blood vessels of the remnant TM, graft clinical inosculation, and neovascularization following cartilage myringoplasty without trimming of the perforation margin and EAC packing; however, the graft success rate was not related to the endoscopic graft neovascularization scores.

Comparison of two endoscopic perichondrium-cartilage graft underlay myringoplasty for large perforations: a randomized controlled trial

OBJECTIVE

The objective of this study was to compare the graft outcomes and complications of two endoscopic perichondrium-cartilage graft techniques for repairing large perforations.

STUDY DESIGN

Single center blinded randomized controlled trial.

MATERIALS AND METHODS

61 large perforations more than 50% of TM area were prospectively randomized to undergo the free perichondrium and free cartilage graft group (FPFC, n = 31) or perichondrium partial attachment the cartilage graft group (PPAC, n = 30). The primary outcome measures were the operation time; secondary outcome measures were the graft success rate and hearing gain at 12 months postoperatively and postoperative complications.

RESULTS

All patients completed follow-up of 12 months. The mean operation time was 38.2 ± 2.3 min in the FPFC group and 37.4 ± 5.6 min in the PPAC group (P = 0.658). At postoperative 3 months, the graft success rates were 96.7% in the FPFC group and 93.3% in the PPAC group (P = 0.976). At postoperative 12 months, the graft success rates were 96.7% in the FPFC group and 83.3% in the PPAC group (P = 0.182). However, the residual and re-perforation rate with no infection was 0.0% (0/31) in the FPFC group and 16.7% (5/30) in the PPAC group (P = 0.056). No significant between-group differences were observed pre- (P = 0.842) or post- (P = 0.759) operative air bone gap (ABG) values or mean ABG gain (P = 0.886). However, granular myringitis has been noted in 6.5% in the FPFC group and in 3.3% in the PPAC group.

CONCLUSIONS

This study suggested that 12-month graft success and hearing gain were comparable between the perichondrium free and partial attachment the cartilage graft techniques, nevertheless, partial attachment technique could increase residual and re-perforations.

Cartilage-Perichondrium Myringoplasty for Managing Intratympanic Membrane Cholesteatomas With Chronic Otitis Media in Adults

Objective: This study evaluated the surgical outcomes and complications of the endoscopic cartilage-perichondrium graft technique for treating intratympanic membrane cholesteatomas (ITMCs) with tympanic membrane (TM) perforation or an atrophic TM in adults. Methods and Materials: Clinical data on 11 adult ITMCs were analyzed retrospectively. The graft success and cholesteatoma recurrence were evaluated 12 months postoperatively. Results: Of the 11 patients with ITMC, TM perforation had occurred in 2 (18.2%) and an atrophic TM or TM scar healing occurred in 9 (81.8%). In endoscopy, keratin debris accumulation was seen at the superior edge of the perforation or atrophic TM. Computed tomography revealed that the cholesteatoma was confined to the TM. Intraoperatively, the epithelial invasion of the cholesteatoma was limited to the fibrous layer within the TM. Cartilage-perichondrium grafting was performed after removing the cholesteatoma. All the grafts were successful, and the perforations achieved complete closure by the final 12 month follow-up. Endoscopy revealed no recurrent cholesteatoma. Of the 9 patients with preoperative tinnitus, the tinnitus disappeared in 3 (33.3%), was relieved in 4 (44.4%), and was unchanged in 2 (22.2%). Of the 7 patients with an ear fullness preoperatively, the ear fullness disappeared in 6 (85.7%) and was relieved in 1 (14.3%). The mean air-bone gap improved from 28.6 dB preoperatively to 16.2 dB postoperatively. Conclusions: Endoscopic complete excision of an ITMC and cartilage-perichondrium graft without raising a tympanomeatal flap can lead to successful graft intake and improve the symptoms for the patients with ITMC combined with perforation or atrophic TM.

Effect of Packing Versus No Packing in Transperforation Myringoplasty for Chronic Tympanic Membrane Perforations

OBJECTIVE

To compare the operation times, graft survival and success rates, audiometric outcomes, and complications of patients who underwent transperforation myringoplasty with and without packing but without perforation rimming.

STUDY DESIGN

A prospective, randomized controlled trial.

SETTING

A university-affiliated teaching hospital.

METHODS

We conducted a randomized controlled trial that enrolled patients who underwent underlay myringoplasty. No patient underwent perforation rimming. Patients underwent myringoplasty with or without graft lateral packing. The operation times, graft survival and success rates, audiometric outcomes, and complications were compared between the 2 groups.

RESULTS

Sixty patients with unilateral perforations were included. The mean neovascularization score at postoperative week 2 was significantly higher in the no-packing group than in the packing group (p < .01) but did not differ significantly at postoperative weeks 3 and 4, or postoperative month 3. Neither the graft healing rate (p = .313) nor the perforation closure rate (p = .640) significantly differed between the 2 groups. The mean air-bone gap improved by 8.91 ± 5.45 dB in the packing group and 8.17 ± 1.19 dB in the no-packing group (p = .758).

CONCLUSION

The long-term graft success and hearing improvements in transperforation myringoplasty with no rimming of the perforation and no-graft lateral packing were comparable to those in the graft lateral packing group with no rimming of the perforation, with a low incidence of complications. These results may change the traditional practice of packing the external auditory canal and rimming the perforation in underlay myringoplasty, even for all myringoplasty surgery.