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Al-Arman AM, Moneir W, Amer HE, Ebada HA. Platelet rich fibrin augmented tympanoplasty versus cartilage tympanoplasty: a randomized clinical trial. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08819-2. [PMID: 39042174 DOI: 10.1007/s00405-024-08819-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. METHODS This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. RESULTS Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. CONCLUSION Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts.
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Affiliation(s)
| | - Waleed Moneir
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Hazem Emam Amer
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
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Singh Nagi R, Singh M, Singh SP. To Study the Outcome of Cartilage Tympanoplasty Type I in Patients with Medium and Large Perforations Using 0.5 mm Sliced Conchal Cartilage Reinforced with Temporalis Fascia Grafts with 5 Years Follow-up. Indian J Otolaryngol Head Neck Surg 2024; 76:2326-2330. [PMID: 38883539 PMCID: PMC11169099 DOI: 10.1007/s12070-024-04474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/31/2023] [Indexed: 06/18/2024] Open
Abstract
Aims To study the outcome of cartilage tympanoplasty type I in patients with medium and large perforations using 0.5 mm sliced conchal cartilage reinforced with temporalis fascia grafts with 5 years follow-up. Study Design Retrospective clinical study. Patients and Method 120 patients with dry tympanic membrane perforation medium and large size and intact ossicular chain, and with no history of previous ear surgery were selected. An underlay type one tympanoplasty, using 0.5 mm sliced conchal cartilage reinforced with temporalis fascia, was performed during 2018-19. A successful anatomical outcome was considered to comprise full, intact healing of the graft without perforation these patients were evaluated for at least 5 years post-operatively till 2023. Results In this study graft uptake rate was 95.33% for medium size and 93.66% for large perforations at 3 months and after 5 years of follow-up 92.77% medium size and large size perforations were 89.67.66% (P < 0.001). Residual perforations were there in about 7.29% in medium and 10.33% in large size perfrations. Conclusion Sliced conchal cartilage reinforced with temporalis fascia is a reliable technique for tympanoplasty, with improved graft uptake results in medium and large perforations in the long-term, also the residual perforations is significantly lower.
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Affiliation(s)
| | - Manjit Singh
- Dept. of ENT & Head Neck Surgery, GMC, Amritsar, Punjab India
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Lou Z, Lou Z, Yu D, Wang J, Lv T, Chen Z. Comparison of two endoscopic perichondrium-cartilage graft underlay myringoplasty for large perforations: a randomized controlled trial. Eur Arch Otorhinolaryngol 2024; 281:1773-1780. [PMID: 37934275 DOI: 10.1007/s00405-023-08295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
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.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Province, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Dongzhen Yu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Tian Lv
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Province, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China.
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
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Wang L, Han H, Wang J, Zhu Y, Liu Z, Sun Y, Wang L, Xiang S, Shi H, Ding Q. Finite element analysis of repairing tympanic membrane perforation using autologous graft material and biodegradable bionic cobweb scaffold. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107868. [PMID: 37891016 DOI: 10.1016/j.cmpb.2023.107868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVE As for repairing the perforated tympanic membranes (TM), temporalis fascia and tragal cartilage are popular in clinics as autologous graft materials. However, there is a significant hearing loss after repairing the TM with autologous graft materials, which needs to be addressed in biomechanical engineering. METHODS The finite element model of normal middle ear is improved from two aspects: the repair method of tympanic fibrous layer and the bionic spider web tympanic scaffold. By creating the solid-shell coupling condition and strong coupling boundary condition to simulate the repair, TM umbo and stapes footplate displacement-frequency response are explored in 200-8000 Hz. RESULTS The tympanic membrane perforation (TMP) causes a significant conductive hearing loss in high frequency region, which is positively correlated with perforation area. Both temporalis fascia and tragal cartilage still perform a certain degree of high-frequency hearing loss after repairing TMP. The TM attachment the magnesium alloy scaffold (MAS) prevents appropriately the high frequency hearing loss after autologous graft repair and makes the sound transmission closer to the normal condition. Significantly, the density of graft material has a negative effect on high-frequency sound transmission without the MAS. The modal-motion of TM repaired with temporalis fascia and tragal cartilage is improved significantly after attaching the MAS. In addition, the MAS restores effectively the configuration and vibration frequency of the repaired TM, which is similar to that of the native TM. CONCLUSION The area size of TMP is studied through the finite element method, which includes autologous graft materials, the MAS, parameter sensitivity analysis, modal analysis of graft material and the MAS in biological form on the effect of middle ear sound transmission. Relevant conclusions provide some references for clinical trial protocol and the follow-up repair ideas of TM of tympanoplasty.
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Affiliation(s)
- Liang Wang
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| | - Hongge Han
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| | - Jie Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China; Beijing Engineering Research Center of Audiological Technology, Beijing 100730, China
| | - Yueting Zhu
- Department of Otolaryngology, Head and Neck Surgery, Tianjin Children's Hospital, Tianjin University, Tianjin 300400, China
| | - Zhanli Liu
- School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Yongtao Sun
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China; National Key Laboratory of Strength and Structural Integrity, Xian, Shaanxi 710065, China.
| | - Lele Wang
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| | - Shuyi Xiang
- School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Huibin Shi
- School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Qian Ding
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
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Lou Z, Lou Z, Lv T, Chen Z. Comparison of temporalis fascia and cartilage graft over-under myringoplasty for repairing large perforations. Am J Otolaryngol 2024; 45:104101. [PMID: 37948821 DOI: 10.1016/j.amjoto.2023.104101] [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] [Received: 07/28/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The objective of this study was to compare the operation time, graft success, audiometric outcomes and complications of over-under technique using a temporalis fascia (TMF) and cartilage grafts for the repair of large perforations. STUDY DESIGN Randomized controlled trial. MATERIALS AND METHODS 80 large perforations >2 quadrants of eardrum were prospectively randomized to undergo TMF over-under technique group (TFON, n = 40) or cartilage-perichondrium over-under technique group (CPON, n = 40). The graft success rate, audiometric outcomes, and complications were compared among two groups at 12 months. RESULTS The mean operation time was 56.8 ± 4.2 (range:52-71) min in the TFON group and 37.9 ± 2.8 (range: 31-47) min in the CPON group (P < 0.001). The lost follow-up rate was 3 (7.5 %) patients in the TFON group and 2 (5.0 %) patient in the CPON group (P = 0.644). Finally, 37 patients in the TFON group and 38 patients in the CPON group were included in this study. The graft infection rate was 2 (5.4 %) patients in the TFON group and 2 (5.3 %) patient in the CPON group (P = 0.626), all the graft infection resulted in the residual perforation. The remaining residual perforation was 2 (5.4 %) patients in the TFON group and 1 (2.6 %) patient in the CPON group; the re-perforation was 3 (8.1 %) patients in the TFON group and 0 (0.0 %) patient in the CPON group. The graft success rate was 81.1 % (30/37) patients in the TFON group and 92.1 % (35/38) patient in the CPON group. The mean preoperative and 12-month postoperative ABGs were significantly different in any group (P < 0.01). However, there were no significant difference among two groups regardless of pre-or post-ABGs or ABG closure. No lateralization of the graft or blunting was noted in any group. Four (10.8 %)patients developed atelectasis and one (2.7 %) developed the EAC scarring in the TFON group. Graft cholesteatomas was found in 2 (5.4 %) patients in the TFON group and in 5 (13.2 %) patients in the CPON group (P = 0.449). Three (8.1 %) patients had temporary hypogeusia in the TFON group. CONCLUSION Although temporalis fascia graft over-under technique obtained similar graft success rates and hearing outcomes for large chronic perforations to the cartilage-perichondrium over-under technique, temporalis fascia graft technique prolonged the operation time and increased the re-perforation and graft atelectasis. Nevertheless, the graft cholesteatomas were comparable among two techniques.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou medical university affiliated Yiwu Hospital, 699 jiangdong road, Yiwu city 322000, Zhejiang province, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology, Wenzhou medical university affiliated Yiwu Hospital, 699 jiangdong road, Yiwu city 322000, Zhejiang province, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Haci C, Bayram O, Gurbuz G, Barcan Y, Acikalin RM, Yasar H. Investigation of factors affecting pediatric type 1 endoscopic tympanoplasty results and success rates of surgery. Auris Nasus Larynx 2023; 50:848-853. [PMID: 37005113 DOI: 10.1016/j.anl.2023.03.001] [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] [Received: 10/25/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE There are many factors that affect the results of tympanoplasty in children. Recurrent ear infections, hearing loss, and more serious complications due to cholesteatoma may be observed. This study examined factors affecting the success of type 1 endoscopic tympanoplasty surgery in pediatric patients and investigated recommended procedures to increase the success of the operation. METHODS Our study included pediatric patients who underwent type 1 endoscopic tympanoplasty operation for chronic otitis media. Patient files were analyzed retrospectively. Hearing results before and after the operations were recorded.. Patients were divided into groups according to gender, age (<12 age group, ≥12 age group), and perforation type. Hearing results and physical examination findings were compared for each group. RESULTS A total of 204 pediatric patients were included in our study: 114 were male and 90 were female. Patients' hearing results were compared according to the size and location of their tympanic membrane perforations. Hearing loss was found to increase as the size of the tympanic membrane perforation increased. In addition, it was observed that perforations in the posterior quadrant caused more severe hearing loss than in the other quadrants. The postoperative results of the two groups <12 years old, and ≥12 years old were evaluated according to age. Postoperative improvement was higher in the ≥12 age group compared to the <12 age group. CONCLUSION According to the results of this study, tympanoplasty surgeries performed on patients younger than 12 have a decreased success rate. Among the many factors that affect the success of an operation, age is one of the most important. There are many factors that affect the results of the operation, perforation size and localization is one of them. There are many factors that affect the success of surgery such as pediatric patients and adult patients. It is useful to make a personal evaluation and to plan the surgery by evaluating the obstacles such as eustachian tube maturation and difficulty in postoperative care in pediatric patients.
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Affiliation(s)
- Cemal Haci
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey; Istanbul Rumeli Univercity, Vocational School of Health Services, Dep.of Audiometry, Istanbul, Turkey.
| | - Ozlem Bayram
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Gokhan Gurbuz
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Yagmur Barcan
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Resit Murat Acikalin
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Husamettin Yasar
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
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Lajdam GB, Alahmadi RA, Alhakami M, Ghaddaf AA, Abdulhamid AS, Alahmadi A, Abdelsamad Y, Hagr A. Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 2023; 280:5153-5165. [PMID: 37540270 DOI: 10.1007/s00405-023-08170-y] [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] [Received: 04/27/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. METHODS Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air-bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6 weeks to 24 months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12 months (OR = 2.24, 95% CI 1.33-3.78) and 24 months (OR = 2.96, 95% CI 1.18-7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6 weeks to 12 months). CONCLUSIONS Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.
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Affiliation(s)
- Ghassan Bin Lajdam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Rana A Alahmadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed Alhakami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S Abdulhamid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | | | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
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Stefan I, Stefanescu CD, Vlad AM, Zainea V, Hainarosie R. Postoperative Outcomes of Endoscopic versus Microscopic Myringoplasty in Patients with Chronic Otitis Media-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1074. [PMID: 37374278 DOI: 10.3390/medicina59061074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope's advantages. The aim of this review is to compare the surgical outcomes of a totally endoscopic transcanal approach with a conventional microscopic approach for type 1 tympanoplasty in patients with chronic otitis media (COM) in order to establish if endoscopic myringoplasty (EM) could be a better alternative to microscopic myringoplasty (MM). A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. The selected articles were identified by searching PubMed Central, PubMed, MEDLINE and Embase databases for the relevant publications. Only studies where the same surgeon in the department performed both endoscopic and microscopic myringoplasty have been included in the review. The results suggest that with an endoscopic approach, minimally invasive myringoplasty can be achieved with a similar graft success rate and postoperative air-bone gap (ABG) improvement, a shorter operative time and less postoperative complications compared to a microscopic approach.
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Affiliation(s)
- Iemima Stefan
- Medical Center of Special Telecommunications Service, 060044 Bucharest, Romania
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Cristian Dragos Stefanescu
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Ana Maria Vlad
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Viorel Zainea
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Răzvan Hainarosie
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
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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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Ferlito S, Fadda G, Lechien JR, Cammaroto G, Bartel R, Borello A, Cavallo G, Piccinini F, La Mantia I, Cocuzza S, Merlino F, Achena A, Brucale C, Mat Q, Gargula S, Fakhry N, Maniaci A. Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study. J Clin Med 2022; 11:jcm11237000. [PMID: 36498572 PMCID: PMC9740685 DOI: 10.3390/jcm11237000] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Gianluca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Ambroise Paré Hospital (APHP), Paris Saclay University, 75016 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1000 Brussels, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75016 Paris, France
| | - Giovanni Cammaroto
- Department of Otolaryngology-Head and Neck Surgery, Morgagni Pierantoni Hospital, 47121 Forli, Italy
| | - Ricardo Bartel
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitario Mutua Terrasa, 8080 Barcelona, Spain
| | - Andrea Borello
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Francesca Piccinini
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Andrea Achena
- U.O.C. di Otorinolaringoiatria ASST Grande Ospedale Metropolitano Niguarda, 20100 Milano, Italy
| | - Cristina Brucale
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Quentin Mat
- Department of Medicine, Neurology, CHU de Charleroi, 15022 Charleroi, Belgium
| | - Stéphane Gargula
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, 75016 Paris, France
| | - Nicolas Fakhry
- Service d’Otorhinolaryngologie et de Chirurgie Cervico-Faciale, Université Aix-Marseille, Hôpital de La Conception, 147, Boulevard Baille, 13005 Marseille, France
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-3204154576
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Chen K, Zhao R. Comparison of cartilage and temporalis fascia grafts in type 1 tympanoplasty: A meta-analysis. EAR, NOSE & THROAT JOURNAL 2022:1455613221137122. [PMID: 36300279 DOI: 10.1177/01455613221137122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE To systematically review the results of type 1 tympanoplasties with temporalis fascia (TF) vs cartilage grafts in patients with chronic otitis media. METHODS Eligible studies were identified from PubMed, Ovid, and EMBASE databases prior to November 2021. We analyzed the pure tone audiometry (PTA) and air-bone gap (ABG) data as continuous variables, and the success rate was analyzed as a dichotomous variable. RESULTS Forty-four studies, including 4582 patients, were eligible. The cartilage graft overall morphologic success rate was higher than that of the TF grafts (P < .001). In the palisade (P < .004) and island grafts (P < .001) subgroups, the analysis was significantly different. However, there was no significant difference in the inlay butterfly grafts subgroup. For hearing outcomes, the analysis revealed that TF grafts had a smaller mean post-operative ABG (P = .009). However, the subgroup analysis showed no significant difference in the mean post-operative ABG. For PTA, there was no significant difference in hearing improvement. However, the palisade cartilage graft subgroup resulted in a better hearing outcome than the TF graft subgroup in terms of the mean post-operative PTA (P = .007). There was no significant difference in the functional success rate or mean ABG gain. CONCLUSION Cartilage grafts have a better success rate than TF grafts in tympanoplasty. Both cartilage and TF tympanoplasty provided similar improvements in hearing outcome, while TF grafts generated a better outcome in post-operative ABG and palisade cartilage grafts in post-operative PTA. This may be related to the biological characteristics of the grafts. Further thorough studies need to be conducted.
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Affiliation(s)
- Kai Chen
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Zhao
- Otorhinolaryngology-Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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12
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Hu YQ, Zou MZ, Sun H, Ma M, An J, Chen R, Cheng LJ, Liu B. Tragus Perichondrium-Cartilage Island and Temporalis Muscle Fascia for Repairing Tympanic Membrane Perforation Under the Otoendoscope: A Randomized Controlled Trial. EAR, NOSE & THROAT JOURNAL 2022:1455613221130884. [PMID: 36222002 DOI: 10.1177/01455613221130884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the clinical effects of repairing tympanic membrane perforation (TMP) with the tragus perichondrium-cartilage island and temporalis muscle fascia (TMF) under the otoendoscope. METHODS The clinical data of 84 patients (total 84 ears) with TMP repaired by otoendoscopy from March 2019 to April 2021 were analyzed. The patients were randomly divided into the control group (n = 42, TMF repair) and the experimental group (n = 42, perichondrium-cartilage island repair). The intraoperative blood loss, operation time, length of hospital stay, success rate of the TMP repair, mean air-conducted sound, and air-bone gap before and after surgery were compared between the two groups. RESULTS The mean air-bone gap and mean air-conducted hearing threshold in the experimental group were significantly lower after surgery at all frequencies than those of the control group (all P < .05). The reduction of the mean air-conducted hearing threshold in the experimental group was significantly higher than that of the control group (P < .001). The surgery time of the experimental group was significantly shorter than the control group (78.04 ± 2.23 vs. 84.27 ± 1.67 minutes, P < .001). The success rate of the TMP repair was 95.24% (40/42) in the experimental group and 92.86% (39/42) in the control group, indicating that there was no significant difference in the success rate of TMP repair between the two materials (risk ratio = 1.75; 95% confidence interval: .31-12.04; P = .71). CONCLUSION Repairs with the tragus perichondrium-cartilage island have a short operation time, high healing rate, and more significant postoperative hearing improvement, which makes it a more effective method of TMP repair.
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Affiliation(s)
- Yu-Qiang Hu
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Ming-Zhen Zou
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Hai Sun
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Mei Ma
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Jun An
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Ran Chen
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Liang-Jun Cheng
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Bing Liu
- Department of Otolaryngology-Head and Neck Surgery, Xuzhou Central Hospital, Xuzhou, China
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
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13
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Costa JR, Sousa F, Costa S, Soares T, Meireles L. Role of mastoid pneumatization in predicting tympanoplasty results: Will it have the same importance in different age groups? Am J Otolaryngol 2022; 44:103680. [DOI: 10.1016/j.amjoto.2022.103680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
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abdel aziz AAR, Youssef AM, Mostafa MM, talaat M, Abdelzaher KM, Sadeq AA. Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation. J Otol 2022; 17:226-231. [PMID: 36249921 PMCID: PMC9547107 DOI: 10.1016/j.joto.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To compare cartilage tympanoplasty (CT) combined with eustachian tube balloon dilatation (ETBD) and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media (AdOM) in terms of graft healing, audiological outcomes, and impact on life style, using Chronic Otitis Media Outcome Test 15 (COMOT-15). Methods 50 patients with AdOM were randomly classified into 2 groups: 25 patients for cartilage tympanoplasty only (CT group) and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation (CT + ETBD group). Clinical outcomes in both groups were compared at 3 and 6 months of follow up. Results There was no significant difference in graft healing between the two groups. Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up (P < 0.05). Hearing improvement was achieved, as the mean preoperative ABG was 26.5 ± 5.4 and 27.1 ± 4.6 dB, and the mean postoperative ABG at 6 months was 19.4 ± 4.4 and 14.6 ± 3.9 dB in the CT and the CT + ETBD groups, respectively. The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up (P < 0.05) in favour of the CT + ETBD group. Conclusion ETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.
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Lubianca Neto JF, Koerig Schuster A, Neves Lubianca JP, Eavey RD. Comparison of Inlay Cartilage Butterfly and Underlay Temporal Fascia Tympanoplasty. OTO Open 2022; 6:2473974X221108935. [PMID: 35836497 PMCID: PMC9274429 DOI: 10.1177/2473974x221108935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To systematically review the results of inlay cartilage butterfly
tympanoplasty and standard underlay temporal fascia tympanoplasty for
anatomic and functional end points. Data Sources PubMed, Embase, MEDLINE, and Virtual Health Library (VHL/Lilacs) databases
were searched from inception through April 2, 2021. No restrictions on
language, publication year, or publication status were applied. Review Methods The meta-analysis included data from articles that met inclusion criteria and
were extracted by 2 authors independently. The PRISMA statement was
followed. Risk of Bias 2.0 and Newcastle-Ottawa Scale were used to assess
risk of bias. The primary outcome was tympanic membrane closure rate. The
secondary outcome was improvement of the air-bone gap. Results Ten studies were included, 9 cohort studies and 1 randomized clinical trial,
with 577 patients. The graft take rate was 82.8% in the butterfly cartilage
inlay tympanoplasty group and 85.2% in the temporal fascia underlay
tympanoplasty group (relative risk, 1.01; 95% CI, 0.93-1.11;
I2 = 42%, P = .08). The
air-bone gap reduction ranged from 6.1 to 11.28 in the butterfly cartilage
inlay group and from 5.2 to 12.66 in the temporal fascia underlay group,
with a mean difference between groups of −2.08 (95% CI, −3.23 to −0.94;
I2 = 58%, P = .04),
favoring temporal fascia underlay. Conclusion The 2 tympanoplasty techniques analyzed here produced similar results in
terms of successful reconstruction of the tympanic membrane and reduction in
the air-bone gap. Neither age nor follow-up length of time influenced
outcomes.
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Affiliation(s)
- José Faibes Lubianca Neto
- Medical School of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Pediatrics of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Otorhinolaryngology Service of Santa Casa de Misericórdia Hospital of Porto Alegre, Porto Alegre, Brazil
- Pediatric Otolaryngology Service of Santo Antonio Children’s Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Artur Koerig Schuster
- Medical School of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Otorhinolaryngology Service of Santa Casa de Misericórdia Hospital of Porto Alegre, Porto Alegre, Brazil
- Pediatric Otolaryngology Service of Santo Antonio Children’s Hospital of Porto Alegre, Porto Alegre, Brazil
| | | | - Roland Douglas Eavey
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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16
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Coelho SB, Lopes WDS, Bezerra GDAM, Araújo DFD, Meira ASF, Caldas Neto SDS. Use of nasal mucosa graft in tympanoplasty. Braz J Otorhinolaryngol 2022; 88:345-350. [PMID: 32771433 PMCID: PMC9422603 DOI: 10.1016/j.bjorl.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/01/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tympanoplasty techniques with different types of graft have been used to close tympanic perforations since the 19th century. Tragal cartilage and temporalis fascia are the most frequently used types of graft. They lead to similar functional and morphological results in most cases. Although little published evidence is present, nasal mucosa has also been shown to be a good alternative graft. OBJECTIVE Surgical and audiological outcomes at the six-month follow-up in type I tympanoplasty using nasal mucosa and temporalis fascia grafts were analyzed. METHODS A total of 40 candidates for type I tympanoplasty were randomly selected and divided into the nasal mucosa and temporalis fascia graft groups with 20 in each group. The assessed parameters included surgical success; the rate of complete closure of tympanic perforation and hearing results; the difference between post- and pre-operative mean quadritonal airway-bone gap, six months after surgery. RESULTS Complete closure of the tympanic perforation was achieved in 17 of 20 patients in both groups. The mean quadritonal airway-bone gap closures were11.9 and 11.1 dB for the nasal mucosa and temporalis fascia groups, respectively. There was no statistically significant difference between the groups. CONCLUSION The nasal mucosa graft can be considered similar to the temporal fascia when considering the surgical success rate of graft acceptance and ultimate audiological gain.
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Affiliation(s)
- Sandro Barros Coelho
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídeo, Fortaleza, CE, Brazil.
| | | | | | - Davi Farias de Araújo
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídeo, Fortaleza, CE, Brazil
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Benecke L, Chen Z, Zeidler-Rentzsch I, von Witzleben M, Bornitz M, Zahnert T, Neudert M, Cherif C, Aibibu D. Development of electrospun, biomimetic tympanic membrane implants with tunable mechanical and oscillatory properties for myringoplasty. Biomater Sci 2022; 10:2287-2301. [PMID: 35363238 DOI: 10.1039/d1bm01815a] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Most commonly, autologous grafts are used in tympanic membrane (TM) reconstruction. However, apart from the limited availability and the increased surgical risk, they cannot replicate the full functionality of the human TM properly. Hence, biomimetic synthetic TM implants have been developed in our project to overcome these drawbacks. These innovative TM implants are made from synthetic biopolymer polycaprolactone (PCL) and silk fibroin (SF) by electrospinning technology. Static and dynamic experiments have shown that the mechanical and oscillatory behavior of the TM implants can be tuned by adjusting the solution concentration, the SF and PCL mixing ratio and the electrospinning parameters. In addition, candidates for TM implants could have comparable acousto-mechanical properties to human TMs. Finally, these candidates were further validated in in vitro experiments by performing TM reconstruction in human cadaver temporal bones. The reconstructed TM with SF-PCL blend membranes fully recovered the acoustic vibration when the perforation was smaller than 50%. Furthermore, the handling, medium adhesion and transparency of the developed TM implants were similar to those of human TMs.
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Affiliation(s)
- Lukas Benecke
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, Breitscheidstraße 78, 01237 Dresden, Germany.
| | - Zhaoyu Chen
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ines Zeidler-Rentzsch
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Max von Witzleben
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Center for Translational Bone, Joint and Soft Tissue Research, Fetscherstraße 74, 01307 Dresden, Germany
| | - Matthias Bornitz
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Thomas Zahnert
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Marcus Neudert
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Chokri Cherif
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, Breitscheidstraße 78, 01237 Dresden, Germany.
| | - Dilbar Aibibu
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, Breitscheidstraße 78, 01237 Dresden, Germany.
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Lou Z, Jin K, Sun J. Endoscopic inlay cartilage and perichondrium myringoplasty for repairing large perforations in teenagers. Int J Pediatr Otorhinolaryngol 2021; 151:110915. [PMID: 34507235 DOI: 10.1016/j.ijporl.2021.110915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study compared the long-term graft success rates and hearing outcomes of overlay-underlay and underly cartilage myringoplasty for repairing large perforations in Teenagers. STUDY DESIGN prospective, randomized study. SETTING Tertiary referral center. METHODS Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups:intervention group (n = 39) and control group (n = 41). The graft success rate, hearing improvement, and complications were compared between the two groups. RESULTS A total of 80 patients were included in this study. The graft success rate was 100% in the intervention group and 95.1% in the control group at postoperative 3 months, the difference wasn't significant (P = 0.496). Also, the graft success rate was not significantly different between the two groups at 12 months postoperatively (100.0% vs 87.8%, p = 0.073). However, the difference of graft success rate was significant between the two groups at 24 months postoperatively (97.4% vs 75.6%, p = 0.012). CT examination revealed well-pneumatized middle ears 24 months after surgery in both group. However, epithelial pearls near the umbo were seen at 31 months postoperatively in one patient in the observation group. CONCLUSIONS Compared to the endoscopic cartilage with perichondrium composite graft underlay technique, endoscopic perichondrial graft overlay and cartilage underlay had a better long-term graft success rate and lower rate of long-term re-perforation in teenagers. However, the graft technique had no effect on hearing outcome.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China.
| | - Kangfeng Jin
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China
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19
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Eberhard KE, Masud SF, Knudson IM, Kirubalingam K, Khalid H, Remenschneider AK, Nakajima HH. Mechanics of Total Drum Replacement Tympanoplasty Studied With Wideband Acoustic Immittance. Otolaryngol Head Neck Surg 2021; 166:738-745. [PMID: 34281437 DOI: 10.1177/01945998211029541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Poor hearing outcomes often persist following total drum replacement tympanoplasty. To understand the mechanics of the reconstructed eardrum, we measured wideband acoustic immittance and compared the mechanical characteristics of fascia-grafted ears with the normal tympanic membrane. STUDY DESIGN Prospective comparison study. SETTING Tertiary care center. METHODS Patients who underwent uncomplicated total drum replacement with temporalis fascia grafts were identified. Ears with healed grafts, an aerated middle ear, and no other conductive abnormalities were included. All patients underwent pre- and postoperative audiometry. Wideband acoustic immittance was measured with absorbance and impedance computed. Fascia-grafted ears were compared with normal unoperated ears. RESULTS Eleven fascia-grafted ears without complications were included. Postoperatively, the median air-bone gap was 15 dB (250-4000 Hz), with variation across frequency and between ears. Fifty-six control ears were included. Absorbance of fascia-grafted ears was significantly lower than that of normal ears at 1 to 4 kHz (P < .05) but similar below 1 kHz. Impedance magnitude demonstrated deeper and sharper resonant notches in fascia-grafted ears than normal ears (P < .05), suggesting lower mechanical resistance of the fascia graft. CONCLUSION The mechanics of fascia-grafted ears differ from the normal tympanic membrane by having lower absorbance at mid- to high frequencies and thus poor sound transmission. The lower resistance in fascia-grafted ears may be due to poor coupling of the graft to the malleus. To improve sound transmission, grafts for tympanic membrane reconstructions would benefit from refined mechanical properties.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Copenhagen University Hospital-Righospitalet, Copenhagen, Denmark
| | - Salwa Fatima Masud
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - Keshinisuthan Kirubalingam
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,School of Medicine, Queen's University, Kingston, Canada
| | - Hamza Khalid
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, University Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Kaya İ, Şahin FF, Tanrıverdi O H, Kirazlı T. The new "cubism" graft technique in tympanoplasty: A randomized controlled trial. Laryngoscope Investig Otolaryngol 2021; 6:503-511. [PMID: 34195372 PMCID: PMC8223469 DOI: 10.1002/lio2.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this prospective, randomized-controlled study is to analyze the outcomes of a new graft technique in tympanoplasty and compare its outcomes with cartilage island graft plus extra perichondrium. METHODS A total of 44 patients with noncomplicated chronic otitis media were included in this prospective randomized-controlled clinical trial. Patients were randomly divided into 2 double-layer graft groups: The cartilage island graft + cubism graft (study group) and the cartilage island graft + extra perichondrium (control group). The main outcome measures of the study were the air-bone gap (ABG), ABG gain, and graft status. RESULTS Graft success rate was 100% and 95.5% in the study group and the control group, respectively. There were statistically significant differences in the postoperative first month ABG and ABG gain between study and control groups (P < .05). ABG and ABG gain showed no significant differences in the postoperative sixth month between groups (P > .05). CONCLUSION This study revealed that both graft techniques have satisfactory functional and morphological results compared to preoperative findings. The use of cubism graft with cartilage island graft has significantly better auditory outcomes in short-term and similar results in long-term compared to double-layered cartilage island graft with extra perichondrium. Cubism graft is a highly promising graft technique with its many advantages. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- İsa Kaya
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
| | - Fetih Furkan Şahin
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
| | - Hasan Tanrıverdi O
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
| | - Tayfun Kirazlı
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
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Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Çetin YS, Erdem MZ. Endaural Over-Underlay Cartilage Tympanoplasty for Repair of Dry Subtotal Perforations. Ann Otol Rhinol Laryngol 2021; 130:1345-1350. [PMID: 33825491 DOI: 10.1177/00034894211007218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We explored the auditory and anatomical success of grafting when the cartilage perichondrium (CP) was prepared using two different methods. METHODS Patients with subtotal or total perforation underwent tympanoplasty with a CP graft. A V-shaped groove for the handle of the malleus was prepared for CP grafts in patients in group 1. Patients in group 2 did not have a groove on the graft. The anatomical success of the graft was evaluated as success, partial success, or failure. Results of auditory evaluations were compared between the two groups. RESULTS A total of 195 patients were included in the study. The total CP graft integration rate was 96% for both groups. Significant changes were detected in all hearing criteria evaluated 12 months after surgery compared to the preoperative period (P < .05). There were no significant differences between the groups in terms of the relationship between graft technique and postoperative hearing results. However, rates of partial success were significantly higher for group 1 than group 2 (P = .033). CONCLUSION Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. Partial failures are rare, but when they occur, they most often involved anterior graft medialization. When a piece of cartilage is removed at the malleus interface there may be a higher rate of partial failure.
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Affiliation(s)
- Yaser Said Çetin
- Department of Otorhinolaryngology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Mehmet Zeki Erdem
- Department of Otorhinolaryngology, Van SBU Training and Research Hospital, Van, Turkey
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Success rate of type 1 tympanoplasty: a comparative study. The Journal of Laryngology & Otology 2021; 135:315-319. [PMID: 33691826 DOI: 10.1017/s0022215121000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to compare graft take rate after tympanoplasty between adults and paediatric patients, cartilage and fascia grafts, and overlay and underlay techniques. METHODS Data were analysed in groups according to the technique (underlay vs overlay), age (paediatric patients vs adults) and graft (cartilage vs temporalis fascia). The main outcome measures were full graft take and the incidence of complications. RESULTS A total of 198 patients (208 ears) were included. Overall, full graft take was achieved in 200 ears (96 per cent). The success rate was higher in adults compared with paediatric patients (97.5 per cent vs 92.25, respectively) but the difference was insignificant. Similarly, higher but insignificant graft take rate was found in the cartilage group compared with fascia group (98.6 per cent vs 94.9 per cent, respectively). CONCLUSION All cases of overlay tympanoplasty had full graft take (success rate 100 per cent). In the underlay group, successful graft take was achieved in 154 cases (95 per cent). This difference was statistically insignificant.
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Hussain Z, Pei R. Necessities, opportunities, and challenges for tympanic membrane perforation scaffolding-based bioengineering. Biomed Mater 2021; 16. [PMID: 33260166 DOI: 10.1088/1748-605x/abcf5d] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
Tympanic membrane (TM) perforation is a global clinical dilemma. It occurs as a consequence of object penetration, blast trauma, barotrauma, and middle ear diseases. TM perforation may lead to otitis media, retraction pockets, cholesteatoma, and conductive deafness. Molecular therapies may not be suitable to treat perforation because there is no underlying tissue matrix to support epithelium bridging. Chronic perforations are usually reconstructed with autologous grafts via surgical myringoplasty. Surgical treatment is uncomfortable for the patients. The grafting materials are not perfect because they produce an opaque membrane, fail in up to 20% of cases, and are suboptimal to restore acoustic function. Millions of patients from developing parts of the world have not got access to surgical grafting due to operational complexities, lack of surgical resources, and high cost. These shortcomings emphasize bioengineering to improve placement options, healing rate, hearing outcomes, and minimize surgical procedures. This review highlights cellular, structural, pathophysiological, and perforation specific determinants that affect healing, acoustic and surgical outcomes; and integrates necessities relevant to bioengineered scaffolds. This study further summarizes scaffolding components, progress in scaffolding strategies and design, and engenders limitations and challenges for optimal bioengineering of chronic perforation.
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Affiliation(s)
- Zahid Hussain
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei 230026, People's Republic of China
- CAS Key Laboratory for Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou 215123, People's Republic of China
| | - Renjun Pei
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei 230026, People's Republic of China
- CAS Key Laboratory for Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou 215123, People's Republic of China
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Lou Z. Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty in adhesive perforation: retrospective case series. Acta Otolaryngol 2021; 141:14-18. [PMID: 32921208 DOI: 10.1080/00016489.2020.1814406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation. OBJECTIVES To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation. MATERIALS AND METHODS In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months. RESULTS The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4-6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up. CONCLUSIONS Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, Zhejiang Province, China
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Lou Z. Full-thickness cartilage graft myringoplasty combined with topical application of bFGF for repair of perforations with extensive epithelialization. Auris Nasus Larynx 2020; 48:601-608. [PMID: 33257105 DOI: 10.1016/j.anl.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/16/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the long term outcome of endoscope full-thickness cartilage graft myringoplasty combined with topical application of basic fibroblast growth factor (bFGF) for repair of perforations with extensive epithelialization. MATERIALS AND METHODS In total, 65 perforations with extensive epithelialization of edges were divided into the endoscope full-thickness cartilage graft myringoplasty with (bFGF treatment group) and without topical application of bFGF (control group) groups. The outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months post-surgery. RESULTS All patients were followed up at 24 months. Graft success rate was 97.2% in postoperative 12th month and 97.2% in postoperative 24th month in the bFGF group, whereas graft success rate was 100.0% in postoperative 12th month and 86.2% in postoperative 24th month in the control group. The re-perforation wasn't evident in any patients in the bFGF group while re-perforation in 4 (13.8%) patients in the control group, with statistical significance (P = 0.023).Comparing the two groups, there was no difference regardless of in preoperative or postoperative 12 months mean ABG or ABG closure. CT images revealed the well pneumatized middle ear and mastoid cells at postoperative 24th months in both groups, no middle ear cholesteatoma and keratin pearls were found during the period of follow up. CONCLUSIONS The cartilage-perichondrium double graft combined with bFGF are a feasible and effective method for providing the long-term graft success rate of the perforations with extensive epithelialization.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), 699 Jiangdong Road, Yiwu 322000, Zhejiang, China.
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Lou Z. Endoscopic myringoplasty in pediatric patients: a comparison of cartilage graft push-through and underlay fascia graft techniques. Acta Otolaryngol 2020; 140:893-898. [PMID: 32650682 DOI: 10.1080/00016489.2020.1787510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although myringoplasty is performed in pediatric patients, there is still no consensus on the graft material and surgerical procedure. OBJECTIVE To compare the short-and long- term graft take rates of the cartilage push-through and fascia graft techniques employed during pediatric myringoplasty. MATERIALS AND METHODS 93 pediatric patients with perforation who underwent myringoplasty were randomized into the cartilage push-through and underlay fascia graft group. The outcomes evaluated were hearing gains, and graft success rates at 12 and 24 months. RESULTS The graft success rate was similar between two groups (95.7% vs 91.3%, p = .653) at postoperative 12th months, however, the graft success rate was significantly higher 91.5% for the cartilage graft group compared with 73.9% for the fascia group at postoperative 24th months. No significant between-group differences were observed pre- (p = .694) or post- (p = .812) operative ABG values or mean ABG gain (p = .745).The re-perforation rate in fascia group was significantly higher than that in push through group (19.05 vs. 4.44%). No middle ear cholesteatoma formation was found in either group. CONCLUSION Endoscopic cartilage push-through and underlay fascia graft myringoplasty afforded comparable hearing results in pediatric patients; however, the push-through technique without the elevation of a tympanomeatal flap exhibited better long-term graft success rate compared to underlay fascia graft.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, China
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Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:182-189. [PMID: 32862972 DOI: 10.1016/j.otorri.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/11/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Pedro Salvador
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
| | - Patrícia Gomes
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Francisco Silva
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Rui Fonseca
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
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Ghanad I, Polanik MD, Trakimas DR, Knoll RM, Castillo-Bustamante M, Black NL, Kozin ED, Remenschneider AK. A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty. Laryngoscope 2020; 131:392-400. [PMID: 33176008 DOI: 10.1002/lary.28914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans. METHODS A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed. RESULTS The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small-intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air-bone gap of 5.6 dB was found in the 23% of studies reporting this metric. CONCLUSIONS The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392-400, 2021.
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Affiliation(s)
- Iman Ghanad
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Marc D Polanik
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, University of Massachusetts Medical School, Worcester, Massachusetts, U.S.A.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, U.S.A
| | - Danielle R Trakimas
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Renata M Knoll
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | | | - Nicole L Black
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Elliott D Kozin
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Aaron K Remenschneider
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, University of Massachusetts Medical School, Worcester, Massachusetts, U.S.A.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, U.S.A
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Endoscopic transtympanic myringoplasty should be cautious for repairing large perforation. Eur Arch Otorhinolaryngol 2020; 277:3533-3534. [DOI: 10.1007/s00405-020-06217-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
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Lou ZC. Endoscopic myringoplasty: comparison of double layer cartilage-perichondrium graft and single fascia grafting. J Otolaryngol Head Neck Surg 2020; 49:40. [PMID: 32571414 PMCID: PMC7310158 DOI: 10.1186/s40463-020-00440-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To compare surgical results of endoscopic myringoplasty using double layer cartilage-perichondrium grafts versus single fascia grafts. Study design Prospective, randomized, controlled. Setting University-affiliated teaching hospital. Subjects and methods In total,134 patients who underwent endoscopic myringoplasty were included in this study. Patients in group A received a double layer tragal cartilage-perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air-bone gap (ABG) and the graft success rate. Results The graft success rate was 98.5% (66/67) in the Group A and 94.0% (63/67) in the Group B at 6 months, the difference wasn’t statistically significant (p = 0.362). However, the graft success rate was 97.0% (65/67) in the Group A and 85.1% (57/67) in the Group B at 12 months, the difference was statistically significant (p = 0.034). In addition, only one patient (1.49%) had small keratin pearls in the Group A, no patients developed cholesteatoma of middle ear in either group. Conclusions The endoscopic double layer perichondrium-cartilage graft technique is feasible for repairing medium or larger perforations, it has a better long-term graft success rate and less operative time compared with the single layer fascia graft technique. However, long-term hearing outcomes were the same for the single and double layer closure techniques.
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Affiliation(s)
- Zheng Cai Lou
- Department of Otorhinolaryngology, the affiliated Yiwu hospital of Wenzhou medical university (Yiwu central Hospital), 699 jiangdong road, Yiwu city, 322000, Zhejiang provice, China.
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Lou Z. The Elevation of Tympanomeatal Skin Flap Could Not be Necessary for Endoscopic Cartilage Myringoplasty. EAR, NOSE & THROAT JOURNAL 2020; 100:781S-782S. [PMID: 32126816 DOI: 10.1177/0145561320910671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endoscope provide the excellent view and observe the entire perforation edges, endoscopic cartilage myringoplasty doesn't require the lateral circumferential incision and the elevation of tympanomeatal skin flap in most cases. The cartilage graft may be pushed through the perforation and place medial to the remnant tympanic membrane and annulus.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, Zhejiang Province, China
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A Comparative Study of Type-I Underlay Tympanoplasty with Temporalis Fascia Graft Alone and with Conchal Cartilage. Indian J Otolaryngol Head Neck Surg 2019; 71:1320-1326. [PMID: 31750172 DOI: 10.1007/s12070-018-1397-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022] Open
Abstract
Tympanoplasty which is the repair of the tympanic membrane using temporalis fascia, has been done worldwide and has stood the test of time. However in cases of reperforation or large/subtotal perforations, we are often left in need of some sturdy material for grafting. To compare the graft uptake and hearing improvement in patients undergoing type I tympanoplasty using temporalis fascia alone and temporalis fascia along with conchal cartilage. The current research is a prospective study of 60 patients with chronic suppurative otitis media (Tubo tympanic type), undergoing type I tympanoplasty, using temporalis fascia alone and temporalis fascia along with conchal cartilage. The graft uptake and hearing improvement was much better using temporalis fascia along with conchal cartilage graft as compared to cartilage alone. The use of temporalis fascia along with conchal cartilage graft is beneficial for patients with chronic suppurative otitis media (tubotympanic type) undergoing type I tympanoplasty than using temporalis fascia alone.
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Pontes-Madruga TDC, Nogueira Neto FB, Suzuki FADB, Testa JRG, Onishi ET. Endoscopic tympanoplasty with inlay cartilage graft in an university hospital. Braz J Otorhinolaryngol 2019; 87:434-439. [PMID: 31874832 PMCID: PMC9422507 DOI: 10.1016/j.bjorl.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/26/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.
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Affiliation(s)
| | | | | | - José Ricardo Gurgel Testa
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Otorrinolaringologia, São Paulo, SP, Brazil
| | - Ektor Tsuneo Onishi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Otorrinolaringologia, São Paulo, SP, Brazil
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Genç S, Özel HE, Altıparmak E, Başer S, Eyisaraç Ş, Bayakır F, Özdoğan F. Rates of success in hearing and grafting in the perichondrium-preserved palisade island graft technique. Braz J Otorhinolaryngol 2019; 87:305-309. [PMID: 31753779 PMCID: PMC9422520 DOI: 10.1016/j.bjorl.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/09/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Various graft materials have been used in the tympanoplasty technique. Cartilage grafts are being used increasingly in recent years. OBJECTIVE The aim of this study was to present the comparative outcomes of the perichondrium-preserved palisade island graft technique previously defined by ourselves. METHODS We retrospectively compared the hearing and graft success rates in 108 patients with chronic otitis media, who had undergone cartilage tympanoplasty, where both island and perichondrium-preserved palisade graft techniques were used. RESULTS The success rates among the study and the control groups with regard to graft take were 97% and 93%, respectively. No significant difference was observed between the groups with regard to the postoperative mean pure tone values, improvement in air-bone gaps and reduction in air-bone gaps to under 20dB. However, better results were observed in the study group. CONCLUSION The perichondrium-preserved palisade island graft technique is an easy method with high graft success rates and hearing outcomes.
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Affiliation(s)
- Selahattin Genç
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey.
| | - Halil Erdem Özel
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Erdem Altıparmak
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Serdar Başer
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Şaban Eyisaraç
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Ferit Bayakır
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Fatih Özdoğan
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
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Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results. J Craniofac Surg 2019; 30:e297-e300. [PMID: 30839461 DOI: 10.1097/scs.0000000000005278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ± 6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.
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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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Si Y, Chen Y, Xu G, Chen X, He W, Zhang Z. Cartilage tympanoplasty combined with eustachian tube balloon dilatation in the treatment of adhesive otitis media. Laryngoscope 2018; 129:1462-1467. [PMID: 30485447 DOI: 10.1002/lary.27603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Yu Si
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
| | - Yubin Chen
- Department of Otolaryngology–Head and Neck SurgeryThird Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Guo Xu
- Department of Otolaryngology–Head and Neck SurgeryShenzhen Children's Hospital Shenzhen China
| | - Ximing Chen
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
| | - Wuhui He
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
| | - Zhigang Zhang
- Department of Otolaryngology–Head and Neck Surgery , Sun Yat‐Sen Memorial Hospital, and Institute of Hearing and Speech‐Language ScienceSun Yat‐sen University Guangzhou China
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Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair. The Journal of Laryngology & Otology 2018; 132:1007-1009. [DOI: 10.1017/s0022215118001937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveAnteriorly located tympanic membrane perforations can negatively affect surgical success rates. This study aimed to present, using our case series results, endoscopic triple-C (composite chondroperichondrial clip) tympanoplasty as an alternative method in the repair of tympanic membrane anterior quadrant perforations.MethodsThis study included patients with a perforation sized greater than 3 mm, who had an anterior quadrant dominant perforation where the anterior portion could not be seen during microscopic examination; all underwent endoscopic triple-C tympanoplasty.ResultsOperating time was 30–79 minutes (mean, 46.6 minutes). The post-operative graft success rate at six months was 92 per cent (23 out of 25). Mean post-operative follow-up duration was 21.5 ± 7.3 months (range, 11–40 months), and no intratympanic cholesteatoma was observed.ConclusionEndoscopic triple-C tympanoplasty is a comfortable, minimally invasive alternative method to repair anterior tympanic membrane perforations. The graft success rate and the degree of recovery from hearing loss were in accordance with the literature. However, more reliable results may be obtained in a larger series with longer follow-up times.
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The wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia for type 1 tympanoplasty: a prospective, randomized study. Eur Arch Otorhinolaryngol 2018; 275:2975-2981. [DOI: 10.1007/s00405-018-5171-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/10/2018] [Indexed: 11/27/2022]
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Cruz Toro P, Callejo Castillo Á, Moya Martínez R, Domenech Juan I. Inlay Butterfly Miringoplasty. Our Experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramadan MO, Abd-Algaleel AAA, Ahmad RA. Formaldehyde-treated temporofascial graft versus cartilage graft in repairing failed tympanic membrane grafting. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2017; 33:626-630. [DOI: 10.4103/ejo.ejo_29_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/07/2017] [Indexed: 09/02/2023]
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Jiang Z, Lou Z. Comparing the outcome of tympanoplasties using bovine pericardium underlay xenografts versus butterfly inlay autografts. Eur Arch Otorhinolaryngol 2017; 274:3535-3537. [DOI: 10.1007/s00405-016-4374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 11/04/2016] [Indexed: 11/28/2022]
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Lou Z. Commentary on: comparison of endoscopic and microscopic tympanoplasty. Eur Arch Otorhinolaryngol 2017; 274:4273-4274. [PMID: 28819734 DOI: 10.1007/s00405-017-4704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/05/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
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Cruz Toro P, Callejo Castillo Á, Moya Martínez R, Juan ID. Inlay butterfly miringoplasty. Our experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:30-34. [PMID: 28807323 DOI: 10.1016/j.otorri.2017.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/23/2017] [Accepted: 04/02/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Multiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference. METHODS We performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results. RESULTS Surgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17dB preoperatively to 7dB after the intervention. CONCLUSIONS The modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children.
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Affiliation(s)
- Paula Cruz Toro
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España.
| | - Ángela Callejo Castillo
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España
| | - Rafael Moya Martínez
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España
| | - Iván Domenech Juan
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lou Z, Lou ZH. It is prudent to consider use of endoscopic tympanoplasty to treat complicated middle-ear disease. Eur Arch Otorhinolaryngol 2017; 274:4063-4065. [PMID: 28608240 DOI: 10.1007/s00405-017-4624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
| | - Zi-Han Lou
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang, 453003, Henan, China
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Minimally invasive endoscopic transcanal cartilage myringoplasty is the treatment of choice for repair of anterosuperior perforations. Eur Arch Otorhinolaryngol 2017; 275:639-641. [PMID: 28401299 DOI: 10.1007/s00405-017-4552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
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Response to Letter to The Editor: "The Inclusion Criteria and Follow-Up Duration are Important When Evaluating the Outcomes of Inlay Butterfly Cartilage Tympanoplasty". Otol Neurotol 2017; 38:782-783. [PMID: 28333774 DOI: 10.1097/mao.0000000000001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lou Z. Inclusion Criteria and Follow-Up Duration Are Important When Evaluating the Outcomes of Inlay Butterfly Cartilage Tympanoplasty. Otol Neurotol 2017; 38:780-782. [PMID: 28333773 DOI: 10.1097/mao.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, China
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