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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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Yang Z, Chen X, Ye F, Huang Y, Wu X, Wu C. Comparison of endoscopic type I tympanoplasty with and without assistance of customized 3D-printed guiding template for tympanic membrane. Am J Otolaryngol 2021; 42:103042. [PMID: 33910103 DOI: 10.1016/j.amjoto.2021.103042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the anatomical and audiological outcomes of endoscopic type I tympanoplasty using cartilage-perichondrium, with or without a customized 3D-printed guiding template. MATERIALS AND METHODS A total of 60 patients with tympanic membrane perforation receiving endoscopic type I tympanoplasty were divided into the non-template group (group 1, n = 30) and template group (group 2, n = 30). Closure rate, hearing outcomes and operating time were compared between the two groups. RESULTS Group1 had a significant higher operation time compared with group2 (77.73 ± 10.63 min vs. 66.23 ± 14.92 min, p = 0.001). The overall closure rate of group1 was lower than that of group2 (83.33% vs. 100%, p = 0.052). The postoperative air-bone gaps (ABGs) were significantly lower than preoperative ones in each group (p < 0.001, respectively). CONCLUSIONS Improvements in hearing outcomes were comparable for the two groups. The applying of customized 3D-printed guiding template resulted in a higher closure rate and a shorter operation time. Our results suggest that the customized 3D-printed guiding template can be recommended as a useful aid for endoscopic type I tympanoplasty.
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Shakya D, KC A, Tamang N, Nepal A. Endoscopic versus microscopic type-I cartilage tympanoplasty for anterior perforation - a comparative study. Acta Otolaryngol 2021; 141:135-140. [PMID: 33118838 DOI: 10.1080/00016489.2020.1834616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic otitis media with anterior perforation is a challenging condition to treat with a microscope especially if the canal is narrow or has overhang. The endoscope provides the advantage of wide-angle view and transcanal access avoiding postauricular approach and canaloplasty. OBJECTIVE To compare the anatomical, functional outcomes, and surgical duration between endoscopic and microscopic type-I tympanoplasty performed for anterior perforation. MATERIALS AND METHODS A comparative study was conducted. The two groups, the microscopic (MT) and the endoscopic (ET) were created with 50 cases each and underwent type-I tympanoplasty. Results were evaluated at a minimum follow-up of 12 months. RESULTS The graft uptake rate in MT and ET was 81.8% and 91.3% respectively and was not statistically significant. The mean operative time for MT and ET was 68.68 ± 18.79 min and 61.24 ± 11.18 min respectively which was significant (p-.003). Endoscopic tympanoplasty significantly saved time. The difference in hearing outcomes was highly significant within the groups but not between the groups. CONCLUSION AND SIGNIFICANCE The endoscopic tympanoplasty offered superior visualization avoiding postauricular incision and canaloplasty, with morphological and functional outcomes comparable to microscopic tympanoplasty. It offers significantly faster completion of procedure and provides minimally invasive surgery.
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Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, Civil Service Hospital, Kathmandu, Nepal
| | - Arun KC
- Department of Otorhinolaryngology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Nirmala Tamang
- Department of Otorhinolaryngology, Civil Service Hospital, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, Patan Academy of Health Sciences, School of Medicine, Lagankhel, Nepal
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Thotambailu A, Ganesh P, Pillai V, Dey D. Cartilage Interposition Ossiculoplasty in Mucosal Type of Chronic Otitis Media: A Prospective Analysis in a Tertiary Care Hospital. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 134:1-7. [PMID: 33019948 DOI: 10.1017/s0022215120001978] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
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Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
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Shakya D, Nepal A. Total Endoscopic Perichondrium Reinforced Cartilage Myringoplasty for Anterior Perforation. EAR, NOSE & THROAT JOURNAL 2020; 101:158-164. [PMID: 32776835 DOI: 10.1177/0145561320946908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the outcomes of graft uptake and hearing results in the repair of anterior perforation via a total endoscopic transcanal approach using a single or double perichondrium reinforced cartilage underlay technique. STUDY DESIGN Retrospective study. SETTING Tertiary referral hospital. MATERIALS AND METHODS We analyzed 65 patients who underwent surgery for anterior perforation. All surgeries were done via an endoscopic transcanal approach using tragal cartilage as graft, underlay technique reinforced with single or double perichondrium. Two groups were created in which group A had single perichondrium reinforcement and group B had double perichondrium. Graft uptake and hearing outcomes were evaluated between the two groups. RESULTS During the study period, 65 patients were included, of which 3 were lost to follow-up, and thus, only 62 patients were assessed. As for the surgical outcome, graft uptake was observed in 95.2% (n = 59) of patients, 6 months after the intervention. Graft uptake was not statistically significantly different between groups A and B and was 95% in both. There was a statistically significant improvement in hearing across the series overall, with no significant differences seen between group A and group B. CONCLUSIONS The endoscopic approach for myringoplasty offers superior visualization, especially for anterior perforation avoiding postaural approach and canaloplasty. Endoscopic single or double perichondrium reinforced cartilage underlay technique is a reliable method for repair of anterior perforation. There is no difference in using single or double perichondrium reinforcement. Thus, we recommend using single or double perichondrium reinforcement depending on the need during the surgery.
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Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, Patan Academy of Health Sciences, School of Medicine, Lagankhel, Lalitpur, Nepal
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Dursun E, Terzi S, Demir E, Özgür A, Çelebi Erdivanlı Ö, Özergin Coşkun Z, Çeliker M. The evaluation of prognostic factors in endoscopic cartilage tympanoplasty. Eur Arch Otorhinolaryngol 2020; 277:2687-2691. [PMID: 32338297 DOI: 10.1007/s00405-020-05992-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the prognostic factors that may affect the success in endoscopic cartilage tympanoplasty and determine the outcomes of endoscopic cartilage tympanoplasty. METHODS This study included 312 patients who underwent transcanal endoscopic type I cartilage tympanoplasty. The effects of sex, the affected side, the size of the perforation, the location of the perforation, the absence of myringosclerosis, external ear canal protrusion, the condition of the contralateral ear, and surgical experience on the rate of graft success and hearing improvement were investigated. RESULTS The affected side, sex, location of the perforation, myringosclerosis, the condition of contralateral ear, and surgical experience did not significantly affect the surgical success (p > 0.05). However, the size of perforation and ear canal wall protrusion were significantly related to both functional and anatomical success (p < 0.05). CONCLUSION Endoscopic transcanal type I cartilage tympanoplasty can be performed with a high anatomical and functional success rate. However, surgeons should be more careful and design a case-specific operation strategy in patients with external ear canal anterior wall protrusion and large perforations.
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Affiliation(s)
- Engin Dursun
- Department of Otorhinolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, Şehitler caddesi, No:74, 53020, Rize, Turkey
| | - Suat Terzi
- Department of Otorhinolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, Şehitler caddesi, No:74, 53020, Rize, Turkey.
| | - Emine Demir
- Department of Otorhinolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, Şehitler caddesi, No:74, 53020, Rize, Turkey
| | - Abdulkadir Özgür
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Samsun Health Practices and Research Centre, Samsun, Turkey
| | - Özlem Çelebi Erdivanlı
- Department of Otorhinolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, Şehitler caddesi, No:74, 53020, Rize, Turkey
| | - Zerrin Özergin Coşkun
- Department of Otorhinolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, Şehitler caddesi, No:74, 53020, Rize, Turkey
| | - Metin Çeliker
- Department of Otorhinolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, Şehitler caddesi, No:74, 53020, Rize, Turkey
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Lou Z. Endoscopic modified cartilage tympanoplasty. Eur Arch Otorhinolaryngol 2020; 277:1559-1561. [PMID: 32036408 DOI: 10.1007/s00405-020-05835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang, China.
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