Failures in myringoplasty

Surgical results and factors affecting outcome in patients with fat-graft myringoplasty

Objectives: We evaluated the closure rate after fat-graft myringoplasty (FGM) of perforations differing in size and location. We explored whether patient's factors and the FGM surgical technique influenced surgical outcomes. Methods: We retrospectively studied patients with tympanic membrane perforations who underwent FGM from March 2015 to March 2019. All procedures were performed by a single senior surgeon at our tertiary hospital. The patients who followed-up for at least 6 months after surgery were enrolled. We recorded hypertension and diabetes status, age, any prior ear surgery, any calcific plaques adjacent to the perforation, and perforation size and location. Results: A total of 150 patients were enrolled. Our success rate of FGM was 90%. Hypertension, diabetes, prior ear surgery history, and eardrum calcific plaques did not affect the surgical outcomes. There was no statistical difference in the surgical success rate according to the size (< 50%) or location of perforation. The closure rate was 97.2% in patients aged 1660 and 87.5% in patients aged > 60, respectively. However, FGM was successful in only two of six children (33.3%) aged ≤ 15 years, thus significantly less than in the other groups. Conclusion: FGM is a fast, safe, and efficient method for repairing tympanic membrane perforation. The surgical outcome is not significantly affected by underlying disease, perforation size or location, or by the condition of the tympanic membrane or older age. However, it may be poor in children with dysfunctional Eustachian tube.

Recurrent tympanic perforation after myringoplasty: a narrative literature review and personal experience

The aim of the work is to review the current literature concerning recidivism of tympanic perforation after myringoplasty and to give some tips to improve the chance of success and manage the possible scenario of failure. An analysis of the existing literature is presented and, based on it and on our experience, an algorithm of management of tympanic perforation recidivism is proposed.

Comparative Study of Inlay and Overlay Cartilage Perichondrium Composite Graft Myringoplasty

To compare results of inlay and overlay cartilage-perichondrium composite graft myringoplasty. The present study was conducted in the department of otorhinolaryngology, Pt. B. D. Sharma PGIMS, Rohtak. The study was conducted on 40 patients of either sex in age group of 15-50 years having unilateral or bilateral inactive (mucosal) chronic otitis media with dry ear over a period of at least 4 weeks without use of topical or systemic antibiotics after obtaining their informed and written consent. Mean age in group I was 25.25 ± 7.27 years and in group II was 25.95 ± 9.06 years. Maximum number of patients in both groups were in the age group 15-24 years. Out of the total patients, 60% were males and 40% were females. At 6 months post operatively, 95% cases in group I had successful graft take-up compared to 85% cases in group II. However, at long term follow up for 24 months, graft success rate was statistically significant in group I. In group I, 100% graft uptake was seen in large size perforation of 4 and 5 mm along with 2 mm as compared to group II, with 100% graft uptake for only small size perforation of 2 mm. The mean hearing threshold gain was 16.50 ± 5.52 dB in group I as compared to 13.03 ± 6.44 dB in group II. Mean postoperative improvement in air bone (AB) gap of 16.50 ± 5.52 dB was seen in group I as compared to 13.07 ± 6.44 dB seen in group II. The graft take up rate was found to be better in long term with inlay cartilage- perichondrium composite graft myringoplasty technique compared to over lay technique with both the groups showing significant hearing improvement post-operatively. This high success rate for graft uptake and ease to perform under local anaesthesia makes in-lay cartilage perichondrium composite graft myringoplasty technique relatively optimal to use for office based myringoplasty.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03487-w.

Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study

Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.

Current outcomes of myringoplasty in a European referral children's hospital

OBJECTIVES

Myringoplasty is a frequently performed procedure in children, with a heterogeneous failure rate. Our study aimed to evaluate the outcome of myringoplasty in a pediatric hospital and to identify which are risk factors for reperforation or poor hearing improvement after surgery.

METHODS

Preoperative and intraoperative variables between pediatric patients who had undergone myringoplasty with an intact tympanic membrane at follow-up and the cases with reperforation were compared. The same factors were investigated as potential predictors of audiological success. Pre and postoperative PTA and ABG were compared in the whole population, in structural success and failure groups and closure of ABG was calculated and used to compare the audiological outcomes between the two groups.

RESULTS

Parameters that affected the postoperative integrity of TM were age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure. Early perforations occurred mostly after surgeries performed by trainees, while late perforations were more frequently in autumn. Myringoplasty, regardless of the structural outcome, can improve the ABG and PTA. No preoperative and intraoperative parameters affected the audiological outcome.

CONCLUSION

Pediatric myringoplasty is a safe and successful procedure that can improve hearing, regardless of the structural outcome. In light of our results, parameters to consider before surgery are age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure.

Comparative Study of Outcome of Type 1 Tympanoplasty in Dry and Wet Ear in Tertiary Care Hospital

Chronic suppurative otitis media is very common otological disease in general population. Persistent wet ear produces dilemma for ENT surgeons whether to go ahead with tympanoplasty or not. Present study compare outcome of type 1 tympanoplasty in both wet and dry ear. Present study is randomized, prospective, Interventional type of study carried in ENT department of tertiary care hospital over period of 18 months. Total 62 cases fulfilling study criteria were included in the study, which were equally divided in dry and wet group. All cases underwent type 1 tympanoplasty. Temporalis fascia was used as graft material in all cases. Most of the patients in both dry and wet group belonged to the age group between 21 to 30 (40.32%). 26 (41.94%) were males and 36 (58.06%) were females. Male: Female ratio was 1:1.38. After 12 weeks 27 (87.10%) cases of dry group and 20 (64.52%) cases of wet group had significant hearing improvement and in dry group 28 (90.32%) cases had intact graft while in wet group 23 (74.19%) cases had intact graft. According to the statistical analysis, in current study, there is no significant differences between the success rates of wet and dry ears, either in terms of graft uptake or the hearing improvement, thus it can be concluded that the presence of minimal ear discharge at the time of surgery does not affect the success rate of type 1 tympanoplasty.

Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty

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.

Is It Wise to Wait for Ear to Become Dry in Indian Scenario?

Tympanoplasty is the standard and well-established procedure for closure of tympanic membrane perforations. Tympanoplasty in wet ear is still a topic of debate among ENT surgeons. This study discusses the balance between wait and watch policy and early intervention in wet ear. It also compares the rate of graft uptake and hearing improvement in Type I tympanoplasty in dry and wet ears. This is a hospital based, observational, descriptive and comparative study. Total 246 patients enrolled in the study. Two groups were created with 123 patients in each group. One included dry ears and another included wet ears. All patients had mucosal type of chronic otitis media. They all underwent Type I tympanoplasty. Graft uptake rate and hearing was compared between both groups. The overall success rate (graft uptake) was 91.06% (224). The success rate in dry ear group was 93.50% (115) and in wet ear group it was 88.62% (109). This study concluded that there is no added advantage of drying the ear rather the delay in treatment increases morbidity and drop outs in Indian scenario.

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

OBJECTIVE

This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications.

METHOD

This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained.

RESULTS

Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring.

CONCLUSION

Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

Type I Tympanoplasty: surgical success and prognostic factors

OBJECTIVES

To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake.

MATERIAL AND METHODS

Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined.

RESULTS

The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79).

CONCLUSION

Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.

Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty

Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures. Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty. Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success. Results: Mean follow up time was 20.69 ± 5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69 ± 2.83 dB HL in group 1 and 7.98 ± 3.08 dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups (p>.05). Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.

Effectiveness of Type I Tympanoplasty in Wet and Dry Ear in Safe Chronic Suppurative Otitis Media

The aims and objectives of the study were to compare the rate of graft uptake after type 1 tympanoplasty in wet and dry ears and also to compare the postoperative hearing improvement in wet and dry ears. It was a Non Randomized Experimental Study. This study was done in ENT OPD at Tertiary Health Care Institute of Central India. It was conducted from November 2012 to October 2014 on 86 patients having Safe Chronic Suppurative Otitis Media. The patients were divided into two groups as Dry ear group and Wet ear group. Dry ear group included patients whose ear was dry for at least 6 weeks prior to the surgery. Wet ear group included patients who had minimal mucoid discharge in the middle ear which on culture and sensitivity showed no microorganisms. Type 1 Tympanoplasty was done in all patients. Results were analyzed statistically. Complete graft uptake was seen in 86.95% cases of Dry ear group and 80% of Wet ear group and the difference was statistically insignificant. Hearing improvement was achieved in 80% cases in dry group and 67.5% cases in wet group. The difference in hearing improvement in both groups was also statistically insignificant. So conclusion was drawn that, presence of minimal mucoid ear discharge at the time of surgery does not affect the success rate of Type 1 Tympanoplasty.

Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis

OBJECTIVE

To determine which independent variables influence the efficacy of type I tympanoplasty in adult and pediatric populations.

DATA SOURCES

A search of the PubMed database and Cochrane Database of Systematic Reviews using the key words "tympanoplasty OR myringoplasty" from January 1966 to July 2014 was performed.

STUDY SELECTION

Studies reporting outcomes of myringoplasty or Type I tympanoplasty in primary non-cholesteatomatous chronic tympanic membrane (TM) perforation were included.

DATA EXTRACTION

Of 4,698 abstracts reviewed, 214 studies involving 26,097 patients met our inclusion criteria and contributed to meta-analysis.

DATA SYNTHESIS

The primary outcome of success was defined as closure rate at 12 months. The independent variables analyzed were age, follow-up period, approach, graft material, perforation cause, size, location, ear dryness, and surgical technique. Only those studies providing data on a given parameter of interest could be included when comparing each variable.

CONCLUSION

The weighted average success rate of tympanic closure was 86.6%. Based on this meta-analysis, pediatric surgery has a 5.8% higher failure rate than adults and there is no correlation between follow-up period and success. Other variables associated with improved closure rates include perforation with a size less than 50% of total area (improved by 6.1%) and the use of cartilage as a graft (improved by 2.8% compared with fascia), while ears that were operated on while still discharging, those in different locations of the pars tensa, or using different surgical approaches or techniques did not have significantly different outcomes.

A moist edge environment aids the regeneration of traumatic tympanic membrane perforations

OBJECTIVE

To review the history of moist therapy used to regenerate traumatic tympanic membrane perforations.

STUDY DESIGN

Literature review.

METHODS

The literature on topical agents used to treat traumatic tympanic membrane perforations was reviewed, and the advantages and disadvantages of moist therapy were analysed.

RESULTS

A total of 76 studies were included in the analysis. Topical applications of certain agents (e.g. growth factors, Ofloxacin Otic Solution, and insulin solutions) to the moist edges of traumatic tympanic membrane perforations shortened closure times and improved closure rates.

CONCLUSION

Dry tympanic membrane perforation edges may be associated with crust formation and centrifugal migration, delaying perforation closure. On the contrary, moist edges inhibit necrosis at the perforation margins, stimulate proliferation of granulation tissue and aid eardrum healing. Thus, moist perforation margins upon topical application of solutions of appropriate agents aid the regeneration of traumatic tympanic membrane perforations.

Study of Myringoplasty in Wet and Dry Ears in Mucosal Type of Chronic Otitis Media

INTRODUCTION

Chronic otitis media is the most common cause of hearing impairment in the developing countries. Hearing loss can have serious effects on day to day life. Ear discharge in chronic otitis media may continue for months to years with increasing hearing impairment and also life threatening infective complications, which is more common in active and also in inactive disease form as well. Myringoplasty is an operative procedure to close the perforation in tympanic membrane.

AIM

To compare the success rate of graft uptake in dry and wet ears and to compare the postoperative hearing improvement in dry and wet ear following myringoplasty.

MATERIALS AND METHODS

The comparative study was carried out on total 30 patients with chronic otitis media with central perforation. Of these 15 patients belong to dry ear group and 15 patients with wet ear group. These selected patients on simple random basis were subjected to clinical, audiological, radiological and laboratory investigations and one day before operation, patients were admitted to the hospital and written informed consent was taken in all cases. All patients underwent underlay technique myringoplasty. Postoperatively all patients were evaluated for graft uptake and hearing improvement by pure tone audiometry at 3rd month follow-up.

RESULTS

In our study, the successful graft uptake was seen in 80% in dry ear and 73.3% in wet ear, statistically p-value (χ2=1.24) is (p>0.05) which is insignificant. Postoperatively hearing gain was (0-5 dB) in 3 patients (20%) with dry ear and 2 patients (13.5%) with wet ear; (6-10 dB), in 4 patients (26.6%) with dry ear and 6 patients (40%) with wet ear; more than 10 dB in 5 patients (33.3%) with dry ear and 3 patients (20%) with wet ear, statistically p-value is χ2=1.24 (p >0.05) which is not significant.

CONCLUSION

In this study the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ear by using underlay technique of myringoplasty, also found statistically insignificant.

Effect of anti-adhesion barrier solution containing ciprofloxacin-hydrocortisone on abraded mucosa with otitis media

OBJECTIVE

No study to date has assessed the anti-adhesive effect of new middle ear (ME) packing agents in. This study compared the anti-inflammatory and anti-adhesive effect of antibiotic-steroid containing packing agents in abraded mucosa of the ME inflammation.

MATERIALS AND METHODS

Transbullar injection of a saline suspension of Pseudomonas aeruginosa lipopolysaccharide (LPS) induced otitis media. ME mucosa of guinea pigs was abraded using a pick 30 min after LPS inoculation. The animals were divided into four groups of 10 guinea pigs each. In group A, ME cavity was preserved without any packing. In group B, ME cavity was packed with soluble hyaluronic acid-carboxymethyl cellulose (HA-CMC). In group C, the ME cavity was packed with soluble HA-CMC. In group D, the ME cavity was packed with antibiotic-steroid containing soluble HA-CMC. Otoendoscopic examination, auditory brainstem responses (ABRs), and radiographic examination using computerized tomography (CT) were performed at 2 weeks post-surgery. Histopathological evaluation for ME mucosa was performed by light microscopy (LM) and scanning electron microscopy (SEM).

RESULTS

Otoendoscopic findings and CT findings revealed that group D showed the best recovery of aeration in the ME compared to other groups. Recovery of ABRs threshold was significantly attenuated in group D. In LM and SEM findings, group D showed normalized mucosal thickening compared to other groups.

CONCLUSION

ME packing by antibiotic-steroid containing soluble HA-CMC may be useful in the abraded mucosa of the ME inflammation.

Hearing Results Post Tympanoplasty: Our Experience with Adults at the KKR ENT Hospital, India

Chronic suppurative otitis media is often associated with some degree of hearing loss. Tympanomastoid surgery is considered effective in controlling infection and preventing recurrence. However, opinions differ with regards the post-operative hearing results. This study aims to assess the hearing results, and also ascertain the effects of some variables on hearing in adult patients with chronic suppurative otitis media after primary tympanoplasty. This was a retrospective review of the clinical records of adult patients with chronic suppurative otitis media, who had primary tympanoplasty at the KKR ENT Hospital and Research Institute in Chennai (India), between 1st June and 30th September, 2011. A total of 26 adult patients with a mean age of 35.85 years (SD 14.775) were studied. There were 16 males (61.54 %) and 10 females (38.46 %). The commonest presenting symptoms were ear discharge (80.8 %) and hearing loss (76.9 %); and the mean duration of symptom was 8.52 years (SD 8.599). The overall mean pre-operative pure tone average was 49.58 dB (SD 18.608), while the overall mean post-operative pure tone average was 37.38 dB (SD 17.837). The difference between the overall mean pre- and post-operative pure tone average (hearing gain) was 12.192 dB (SD 12.924); and this was found to be statistically significant (p < 0.05). Multiple linear regression model showed that only increasing age was significantly associated with increasing mean post-operative pure tone average. This study found primary tympanoplasty effective in improving hearing results in adults with chronic suppurative otitis media even in those with advanced ossicular lesions.

Clinical efficacy of fat-graft myringoplasty for perforations of different sizes and locations

CONCLUSION

Fat-graft myringoplasty (FGM) has a reliable tympanic closure rate for small to large perforations, but yields poor hearing improvement in the latter case. A topographic evaluation of FGM showed that the procedure resulted in a reliable perforation closure rate and audiologic outcome, regardless of perforation location.

OBJECTIVES

This study assessed the utility of FGM in treating perforations of different sizes and locations.

METHODS

This retrospective study involved 45 patients (46 ears) who underwent FGM at St Mary's Hospital (Seoul, Korea) between August 2007 and February 2010.

RESULTS

The total perforation closure rate after FGM was 87% (40 cases), with no statistical difference among perforation size groups, even though the mean closure rates of the 10-20% and >30% perforation groups were lower than other groups. The difference in the closure rates of patients with anteriorly located perforations and those with perforations in other sites was not significant. The mean postoperative air-bone gap (ABG) was 14.3 (±7.5) dB. Mean postoperative ABG improved significantly after FGM; however, on a per-group basis, the >30% perforation group had the poorest results and the difference was statistically significant. The difference in mean postoperative ABGs of the two groups depending on the location of the perforation (anterior and other) was not significant.

Canal Wall—Down Tympanoplasty with Soft-Wall Reconstruction Using the Pedicled Temporoparietal Fascial Flap: Technique and Preliminary Results

Objectives:

We compared the use of the pedicled temporoparietal fascial flap (TPFF) with the use of free deep temporal fascia (DTF) in soft-wall reconstruction after canal wall–down tympanoplasty.

Methods:

In the TPFF group (6 ears), the pedicled TPFF that includes the superficial temporal artery and vein was raised ipsilaterally and rotated into the eradicated mastoid cavity. The tympanic membrane and external auditory canal (EAC) were reconstructed by gluing one side of the TPFF to the mucosal layer of the tympanic membrane and the reverse side of the posterior EAC skin. In the DTF group (21 ears), reconstruction was performed similarly with free DTF. The postoperative period for epithelialization of the tympanic membrane and EAC skin, postoperative complications, and reaeration in the middle ear revealed by computed tomography were reviewed in both groups.

Results:

In the TPFF group, the mean (±SD) period to epithelialization was 25.5 ± 2.8 days versus 38.4 ± 12.0 days in the DTF group; the two groups differed statistically (Welch's t-test, p = 0.0002). No postoperative complications occurred in the TPFF group, whereas 2 patients in the DTF group underwent graft necrosis with infection. Three of the 6 patients in the TPFF group showed reaeration not only in the tympanic cavity, but also in the mastoid cavity. However, no statistical differences between the two groups were observed in terms of postoperative complications or reaeration of the mastoid cavity.

Conclusions:

Our preliminary findings suggest that the pedicled TPFF has positive effects on quick epithelialization. Further prospective studies are needed to reveal the superiority of the pedicled TPFF over free DTF with regard to postoperative infection and recovery of mastoid aeration.

Adipose graft: an original option in myringoplasty

OBJECTIVE

To describe the fat graft as a reconstructive material in myringoplasty.

METHOD

In a review of 45 patients conducted between 1993 and 1999, the authors analyzed their patients' outcomes after having myringoplasties with fat graft. Median follow-up was 2.5 years (range, 6 mo-6 yr).

RESULTS

We achieved a success rate of 91.1%. Different features of the patient and the tympanic perforation were studied to demonstrate their role in the quality of the surgical closing. A review of the literature was done to compare our results with the results of other series using this type of graft as well as with studies of the temporalis fascia as a graft material.

CONCLUSION

The high reliability of the fat graft and the technical simplicity of this procedure in anterior perforations, especially with the use of intraoperative endoscopy, make it an attractive technique.

Myringoplasty with temporalis fascia : Analysis of 200 cases

Two hundred cases of chronic suppurative otitis media with dry ear were taken up for myringoplasty operation by underlay technique through transcanal route. Autologous temporalis fascia was used as the graft material in all cases. Surgery was done during the period from April 1987 to November 1992. The patients were reviewed 5 years after the surgery [1997] and analysed.

Revision myringoplasty

This retrospective study was undertaken to review the short- and long-term results of 70 revision and 16 re-revision myringoplasty operations. Of the former, 43 cases (61.4 per cent) had initial success, six weeks following surgery. The leading causes of immediate failure (27 cases) were associated with a complete no-take of the graft, infection with graft necrosis and poor anterior adaptation of the graft in decreasing order. Six out of the 43 patients developed late re-perforations during the follow-up period, thus reducing the success rate of revision myringoplasty to 52.8 per cent. Late re-perforations were attributed to insidious atrophy of the tympanic membrane or episodes of acute otitis media. Sixteen patients underwent re-revision myringoplasty and their success rate was 62.5 per cent. The overall success rate of revision and re-revision myringoplasty was 54.7 per cent. It has been concluded that results of revision myringoplasty were independent of patients' age, location and size of perforation and the seniority of the surgeon.

Toynbee Memorial Lecture 1992: facts and fantasies in modern otology: the ear doctor's dilemma

Until it is accepted that many of the recommendations for surgical treatment of middle ear disease, based on impressions formed twenty years ago, are misleading, attempts to rationalize the use of hospital resources will be little more than cosmesis. Responsibility for the initiation of cost-effective reform is primarily that of surgeons and requires urgent self-audit and the provision of realistic advice to patients (and administrators) as to what benefits microsurgery of the ear can offer.

Long-term results of tympanic membrane repair

Long-term results of tympanic membrane repair were analyzed in 605 patients operated upon from 1970 to 1975. By survival life table analysis, 81% closure of perforations was found at 11 years, and only 74% of patients had normally healed tympanic membranes. Children less than 10 years of age and with anterior perforations healed more poorly. A second group of patients--all with anterior perforations operated upon from 1982 to 1984-showed autologous temporalis fascia to be superior to homograft dura as the graft material. Analysis of results also showed a 60% chance of perforation closure at revision operation. These results are believed to represent an accurate and realistic assessment of tympanic membrane repair by use of survival life table analysis.