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Faramarzi M, Faramarzi A, Roosta S, Abbasi N, Monabati A. Comparison of subcutaneous soft tissue versus temporalis fascia as a tympanoplasty graft material: a retrospective cohort study. J Laryngol Otol 2024; 138:153-161. [PMID: 37218630 DOI: 10.1017/s0022215123000956] [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] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. METHODS A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. RESULTS Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air-bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). CONCLUSION Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nadia Abbasi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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Current variations and practice patterns in tympanic membrane perforation repair. J Laryngol Otol 2023; 137:249-258. [PMID: 35307041 DOI: 10.1017/s0022215122000779] [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: 11/07/2022]
Abstract
OBJECTIVE Management of tympanic membrane perforations is varied. This study aimed to better understand current practice patterns in myringoplasty and type 1 tympanoplasty. METHODS An electronic questionnaire was distributed to American Academy of Otolaryngology - Head and Neck Surgery members. Practice patterns were compared in terms of fellowship training, practice length, practice setting, paediatric case frequency and total cases per year. RESULTS Of the 321 respondents, most were comprehensive otolaryngologists (60.4 per cent), in private practice (60.8 per cent), with a primarily adult practice (59.8 per cent). Fellowship training was the factor most associated with significant variations in management, including pre-operative antibiotic usage (p = 0.019), contraindications (p < 0.001), approach to traumatic perforations (p < 0.001), use of local anaesthesia (p < 0.001), graft material (p < 0.001), tympanoplasty technique (p = 0.003), endoscopic assistance (p < 0.001) and timing of post-operative audiology evaluation (p = 0.003). CONCLUSION Subspecialty training appears to be the main variable associated with significant differences in peri-operative decision-making for surgical repair of tympanic membrane perforations.
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Hu H, Chen J, Li S, Xu T, Li Y. 3D printing technology and applied materials in eardrum regeneration. JOURNAL OF BIOMATERIALS SCIENCE, POLYMER EDITION 2022; 34:950-985. [PMID: 36373498 DOI: 10.1080/09205063.2022.2147350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tympanic membrane perforation is a common condition in clinical otolaryngology. Although some eardrum patients can self-heal, a long period of non-healing perforation leads to persistent otitis media, conductive deafness, and poor quality of life. Tympanic membrane repair with autologous materials requires a second incision, and the sampling site may get infected. It is challenging to repair tympanic membranes while maintaining high functionality, safety, affordability, and aesthetics. 3D bioprinting can be used to fabricate tissue patches with materials, factors, and cells in a design manner. This paper reviews 3D printing technology that is being used widely in recent years to construct eardrum stents and the utilized applied materials for tympanic membrane repair. The paper begins with an introduction of the physiological structure of the tympanic membrane, briefly reviews the current clinical method thereafter, highlights the recent 3D printing-related strategies in tympanic membrane repair, describes the materials and cells that might play an important role in 3D printing, and finally provides a perspective of this field.
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Affiliation(s)
- Haolei Hu
- Department of Otolaryngology, the 988th Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Zhengzhou City 450042, Henan Province, China
| | - Jianwei Chen
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, People’s Republic of China
| | - Shuo Li
- Xinxiang Medical College, Xinxiang,453003, Henan Province, China
| | - Tao Xu
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, People’s Republic of China
| | - Yi Li
- Department of Otolaryngology, the 988th Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Zhengzhou City 450042, Henan Province, China
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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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Venkatesan D, Umamaheswaran P, Vellikkannu R, Kannan S, Sivaraman A, Ramamurthy S. A Comparative Study of Temporalis Fascia Graft and Full Thickness Tragal Island Cartilage Graft in Type 1 Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:619-623. [PMID: 36032890 PMCID: PMC9411460 DOI: 10.1007/s12070-021-02459-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/08/2021] [Indexed: 12/01/2022] Open
Abstract
We aim to compare the functional and anatomical outcomes of temporalis muscle fascia graft with that of full thickness composite tragal island cartilage graft in patients who are undergoing Type 1 Tympanoplasty. This is a prospective study conducted on 60 patients. Patients who underwent type 1 tympanoplasty were included in the study. Patients were divided into Group A (temporalis fascia graft) and Group B (tragal island cartilage) with 30 patients in each. Out of the 60 patients, 18 females and 12 males belonged to Group A, 20 females and 10 males belonged to Group B. The mean age group was between 31 and 40 yrs in both the groups. The mean hearing gain and ABG closure for Group A was 13.83 ± 8.11 and 13.39 ± 7.44 and in Group B it was 11.17 ± 4.06 and 11.5 ± 5. The graft uptake rate of Group A was 90% and Group B was 96.67%. The wound healing rate of Group A was 93.33% and Group B was 100%. The mean duration of surgery in Group A was 97.5 ± 17.16 and in Group B was 81.33 ± 11.14. Both the groups had significant post-operative improvement in hearing. No significant results found between both the groups in terms of hearing gain, air-bone gap closure, wound healing and graft uptake rate except lesser duration of surgery in group B. We conclude that tragal island cartilage graft is a better choice in Type 1 Tympanoplasty.
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Liu Y, Ding Y, Li Y, Xin Y, Li D, Lin Y. Endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations. Am J Otolaryngol 2022; 43:103231. [PMID: 34537512 DOI: 10.1016/j.amjoto.2021.103231] [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: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this study was evaluate the short-and long-term graft outcome and complications of endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations. STUDY DESIGN Prospective case series. MATERIALS AND METHODS 135 patients with chronic subtotal and total perforations who underwent endoscopic modified perichondrium-cartilage sandwich graft technique. The graft success rate, hearing outcome, and complications were evaluated at postoperative 6 and 24 months. RESULTS 124 patients were finally included in this study. The graft success rate was 96.3% in subtotal perforation and 97.7% in total perforation (P = 0.874), with an overall success rate of 96.8% at postoperative 6 months. The graft success rate was 95.8% (68/71) in subtotal perforation and 94.9% (37/39) in total perforation (P = 0.795), with an overall success rate of 95.5% (105/110) at postoperative 24 months. The mean ABG improved from 28.0 ± 5.3 dB preoperatively to 14.9 ± 4.8 dB postoperatively 12 months (P < 0.05) for subtotal perforations; from 33.4 ± 7.4 dB preoperatively to 16.1 ± 2.4 dB postoperatively 12 months (P < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. Of the 110 patients, temporal bone CT revealed well pneumatization of the middle ear and mastoid region. However, graft keratin pearl was noticed in 1.8% (2/110) patients. CONCLUSIONS Endoscopic modified perichondrium-cartilage sandwich graft for repairing subtotal and total perforations had excellent short and long-term graft success rate with less time-consuming and minimal complications.
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Shrestha BL, Dhakal A, Pradhan A, Pokharel M, Rajbhandari P, KC AK, Shrestha KS. Long Term Versus Short Term Hearing Results in Endoscopic Sandwich Myringoplasty. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:291-299. [PMID: 34692576 PMCID: PMC8507947 DOI: 10.22038/ijorl.2021.54372.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/17/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The use of the endoscope in otological surgeries has both diagnostic and therapeutic values. It provides an excellent view in difficult nooks and corners. The use of endoscopic sandwich myringoplasty using cartilage and perichondrium has its benefit in hearing outcome and graft uptake in long-term follow-up. The main objective was to compare the long-term with short- term hearing outcomes in those who have undergone endoscopic sandwich myringoplasty with Dhulikhel hospital (D‑HOS) technique. MATERIALS AND METHODS Forty-two patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage perichondrium were enrolled in the study. The hearing outcome was analyzed by comparing the pre-operative findings with post-operative findings and amongst post-operative patients, long-term with short-term air bone gap (ABG) and ABG closure in speech frequencies (0.5kHz, 1kHz, 2kHz, 4kHz) were compared. RESULTS Amongst forty-two patients, 40 (95.2%) had graft uptake in both short-term (6.08 months) and in long-term (20 months) follow-up. The mean pre-operative ABG was 28.1±9.3dB whereas the mean short-term post-operative ABG was 14.5±7.2dB, it showed statistical significance (P=0.001). Likewise, while comparing pre-operative with long-term post-operative ABG (13.4±4.8 dB), it showed statistical significance of P=0.000. While comparing short-term with long-term post-operative ABG, it did not show any statistical significance (P=0.065).The mean closure in ABG in both short-term and long-term hearing assessment was not statistically significant (P=0.077). CONCLUSION Endoscopic sandwich myringoplasty with D-HOS technique is a reliable procedure with good hearing outcome and graft uptake in both short and long-term follow-up.
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Affiliation(s)
- Bikash Lal Shrestha
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
| | - Ashish Dhakal
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
| | - Akash Pradhan
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
| | - Monika Pokharel
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
| | - Pradeep Rajbhandari
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
| | - Abha Kiran KC
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
| | - Krishna Sunadar Shrestha
- Department of Otorhinolaryngology,Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.
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Lou Z. Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults? BMC Surg 2021; 21:287. [PMID: 34103039 PMCID: PMC8186039 DOI: 10.1186/s12893-021-01283-3] [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: 11/16/2020] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background The objective of this study was to evaluate the graft success and hearing outcomes of concurrent adenoidectomy or tonsillectomy and myringoplasty. Methods Medical case notes were reviewed for all adult patients with dry perforations who had undergone myringoplasty, with or without concurrent throat surgery, from December 2015 to February 2018. The study population was divided into concurrent myringoplasty and throat surgery (Group A) and single myringoplasty (Group B) groups. The air–bone gap (ABG) and graft success rate were evaluated in both groups. Results A total of 131 ears of 131 patients were included in this study. In total, 33 ears of 33 patients were assigned to Group A and 98 to Group B. Of the 33 patients in Group A, adenoid residue was detected in 3, chronic tonsillitis in 21, and tonsil hypertrophy in 9. The graft success rate was 96.9 % in Group A and 96.9 % in Group B at 6 months postoperatively (p = 0.993). In addition, the graft success rate was 87.9 % in Group A and 92.8 % in Group B at 24 months postoperatively (p = 0.372). Reperforation occurred in three patients in Group A and four in Group B; the difference was not significant. No significant group differences were observed in preoperative (p = 0.654) or postoperative (p = 0.791) ABG values or mean ABG gain (p = 0.439). No patient in either group developed cholesteatoma of the middle ear. Conclusions Simultaneous adenoidectomy or tonsillectomy and myringoplasty is feasible but does not improve the graft success rate or hearing outcome.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
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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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Intraoperative tragal and conchal cartilage thickness: Comparative study for cartilage tympanoplasty. Am J Otolaryngol 2020; 41:102690. [PMID: 32866848 DOI: 10.1016/j.amjoto.2020.102690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In conditions like recurrent perforations, atelectatic tympanic membrane and poor eustachian tube function, temporalis fascia graft fails to give the desired result. In such cases cartilage is used for tympanoplasty. It was demonstrated that if the thickness of cartilage is reduced to around 0.5 mm, the sound conduction is comparable to that of normal tympanic membrane with excellent mechanical stability. AIM To intra-operatively measure the mean thickness of tragal and conchal cartilage and compare it for age and sex variations. MATERIAL & METHODS A total of 114 tragal and conchal cartilage samples of 86 patients were included in the study. Thickness of cartilages was measured intra-operatively after removing the perichondrium from both sides. RESULTS Out of 58 tragal cartilages, 32 were from males and 26 from females. Mean thickness was 1.18 ± 0.11 mm among males and 1.12 ± 0.14 mm among females. Out of 56 conchal cartilage taken, 29 were from males and 27 females. Mean thickness among males were 1.38 ± 0.13 mm and 1.35 ± 0.08 mm in females. In 28 patients both tragal and conchal cartilage was taken. Mean thickness of both tragal (1.22 mm) and conchal cartilage (1.36 mm) increased with increase in age. Among 16 males in whom both cartilages were taken, mean thickness of tragal cartilage was 1.25 ± 0.11 mm and conchal cartilage was 1.41 ± 0.12 mm. Similarly among 12 females where both cartilages were taken, mean thickness of tragal cartilage was 1.20 ± 0.13 mm and conchal cartilage was 1.35 ± 0.07 mm. CONCLUSION Sliced cartilage tympanoplasty is a relatively better technique. When using cartilage splitter to get sliced cartilage, ideally thickness of every graft should be known. As it is difficult to measure the exact thickness in every case, so knowing the mean for age and sex for cartilage thickness is important to have an idea of which plates to use for a successful outcome of slicing. We concluded that thickness of tragal cartilage is significantly less than the thickness of conchal cartilage. Also there is significant age related difference between mean thickness of cartilages, both for tragal and conchal cartilage. Surprisingly the difference between thickness in male and female is not statistically different.
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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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Khoza-Shangase K, Ramdin N. Audiological function in a group of adults following myringoplasty: an exploratory study in South Africa. Pan Afr Med J 2019; 34:57. [PMID: 31803343 PMCID: PMC6876893 DOI: 10.11604/pamj.2019.34.57.11714] [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: 01/20/2017] [Accepted: 08/01/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Chronic suppurative otitis media is a global middle ear disease with quality of life as economic implications, which are worse felt in low and middle income (LAMI) countries; thus the need for myringoplasty. This study aimed to explore audiological function in a group of adults following myringoplasty in South Africa, with an exploration of the possible influence of factors such as HIV/AIDS and type of surgical technique on hearing outcomes. Methods Within a retrospective chart review research design, 41 participant files for a six-year period from two academic hospitals in Johannesburg, South Africa, were reviewed. Data were analysed using both descriptive and inferential statistics. Results Participant files comprised of 16 males and 25 females between 18-63 years. Findings revealed that clinically, overall hearing improved post-operatively, as indicated by improved tympanometry findings, pure tone air-conduction and speech reception thresholds. Descriptively, the predictors of improved hearing outcomes post-operatively appeared to be HIV negative status and butterfly cartilage inlay surgery as a surgical technique adopted. Although clinically, hearing outcomes improved post-operatively at all air-conduction frequencies tested; these clinical improvements were only statistically significant at specific frequencies. Conclusion Current findings provide useful initial evidence on the benefits of myringoplasty from the South African context; particularly because of the HIV/AIDS prevalence and its potential influence on middle ear disease and its management. Prospective efficacy studies with bigger sample sizes are recommended, with early identification strategies for middle ear disease to reduce the need for myringoplasty seriously considered bearing in mind the resource constraints.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Namita Ramdin
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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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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Sen A, Özdamar K. Which graft should be used for the pediatric transcanal endoscopic type 1 tympanoplasty? A comparative clinical study. Int J Pediatr Otorhinolaryngol 2019; 121:76-80. [PMID: 30877979 DOI: 10.1016/j.ijporl.2019.02.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare the functional and anatomical success rates of the fascial versus perichondrial grafts in pediatric endoscopic type 1 tympanoplasties. METHODS This retrospective clinical study was conducted on 40 pediatric patients (23 females and 17 males; mean age: 10.0 ± 1.7 years; the age range: 6-13) who were operated with a transcanal endoscopic type 1 tympanoplasty. The study participants were assigned to two groups by graft types. The patients were assigned to either the tragal cartilage perichondrium group (Group A) or the fascia of the temporal muscle (Group B). The groups were compared according to the pre- and postoperative air-bone gaps and to the status of the tympanic membrane. RESULTS There were not any statistically significant differences between the groups in terms of the distribution of age, gender, the operation sites, the duration of the operation, MERI scores or the size of the perforation (all p values > 0.05). The graft retention success rates were 94.7% and 90.5% in Group A and Group B, respectively. There were no statistically significant differences between the two groups in terms of the graft retention success rates (p = 0.609). The functional (audiological) success rate was statistically higher in Group B compared to Group A (p = 0.044). CONCLUSION Perichondrium and fascia grafts were found out to be acceptable for use in pediatric endoscopic tympanoplasties. The functional success rates were higher in the fascia group. We also recommended the fascia as a graft in pediatric transcanal endoscopic type 1 tympanoplasties.
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Affiliation(s)
- Alper Sen
- Harran University, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Şanlıurfa, Turkey.
| | - Kadir Özdamar
- Private Sanmed Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Şanlıurfa, Turkey.
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Gilberto N, Santos R, Sousa P, O'Neill A, Escada P, Pais D. Pars tensa and tympanicomalleal joint: proposal for a new anatomic classification. Eur Arch Otorhinolaryngol 2019; 276:2141-2148. [PMID: 31004197 DOI: 10.1007/s00405-019-05434-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/15/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The tympanic membrane (TM) belongs to the ear. Despite its place in the ear anatomy, can we give it also a different anatomic classification? The main objective is to clarify the nature of TM, tympanic bone and malleus to propose a new anatomic classification. METHODS This cadaveric study was performed in two human heads and six fresh temporal bones. A study of the temporomandibular joint, external acoustic meatus (EAM), TM and middle ear structures was conducted. A medical literature review englobing anatomy, embryology, histology and phylogeny of the ear was performed and the results were compared with the results of the dissection. RESULTS The external ear is constituted by the auricle and the EAM. This last segment is made by a cartilaginous and an osseous portion. The osseous portion of the EAM is constituted mainly by tympanic bone. The external ear is separated from the middle ear by the TM. Inside the middle ear, there are three ossicles: malleus, incus and stapes, which allow the conduction of sound to the cochlea. Based on the anatomic dissection and medical literature review of the tympanic bone, malleus and TM, we propose that these structures are interconnected like a joint, and named it "Tympanicomalleal joint". CONCLUSIONS It seems that the TM can be part of a joint that evolved to improve sound transmission and middle ear protection. Thinking TM has part of a joint may help in the development of more efficient reconstructive surgical techniques.
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Affiliation(s)
- Nelson Gilberto
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE, Nova Medical School, Egas Moniz Hospital, New University of Lisbon, Rua da Junqueira, 126, 1349-019, Lisbon, Portugal.
- Department of Anatomy, Nova Medical School, New University of Lisbon, Lisbon, Portugal.
- Emergency Department, Hospital das Forças Armadas, Lisbon, Portugal.
| | - Ricardo Santos
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE, Nova Medical School, Egas Moniz Hospital, New University of Lisbon, Rua da Junqueira, 126, 1349-019, Lisbon, Portugal
| | - Pedro Sousa
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE, Nova Medical School, Egas Moniz Hospital, New University of Lisbon, Rua da Junqueira, 126, 1349-019, Lisbon, Portugal
| | - Assunção O'Neill
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE, Nova Medical School, Egas Moniz Hospital, New University of Lisbon, Rua da Junqueira, 126, 1349-019, Lisbon, Portugal
- Department of Anatomy, Nova Medical School, New University of Lisbon, Lisbon, Portugal
| | - Pedro Escada
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE, Nova Medical School, Egas Moniz Hospital, New University of Lisbon, Rua da Junqueira, 126, 1349-019, Lisbon, Portugal
| | - Diogo Pais
- Department of Anatomy, Nova Medical School, New University of Lisbon, Lisbon, Portugal
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16
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Jain A, Samdani S, Sharma MP, Meena V. Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:311-317. [DOI: 10.1016/j.otorri.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 10/17/2022]
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17
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Jain A, Samdani S, Sharma MP, Meena V. Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Trakimas DR, Ishai R, Ghanad I, Black NL, Kozin ED, Cheng JT, Remenschneider AK. Otopathologic evaluation of temporalis fascia grafts following successful tympanoplasty in humans. Laryngoscope 2018; 128:E351-E358. [PMID: 29756238 DOI: 10.1002/lary.27239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/28/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Temporalis fascia is a commonly used graft material in tympanoplasty; however, little is known about how the histological structure of fascia remodels postimplantation. Herein, we aim to quantify the pre- and postoperative microstructure of temporalis fascia and compare histological findings to the native tympanic membrane (TM). METHODS Temporal bone specimens having undergone successful subtotal or total drum replacement using temporalis fascia were identified (n = 3). Surgically prepared preimplantation temporalis fascia (PreTF, n = 4) and normal TMs (n = 5) were used as controls. Multiple measurements of thickness of PreTF and of normal and fascia reconstructed TMs at the mesotympanum and hypotympanum were obtained. Collagen fiber patterns of normal and reconstructed TMs were histologically described. RESULTS In cases of fascia tympanoplasty, the mean time of surgery to death was 16 years (range 8-28 years). All cases contained an aerated middle ear without residual perforation. There was no significant difference between the thickness of PreTF and fascia of reconstructed TMs (234.9 ± 144.9 μm vs. 162.9 ± 71.9 μm, P = 0.1). The lamina propria and total thicknesses of controls (59.8 ± 39.3 μm and 83.7 ± 42.4 μm, respectively) were thinner than the PreTF and fascia-reconstructed TMs, respectively, in all cases (P ≤ 0.001, P ≤ 0.001). Reconstructed TMs contained a thick, longitudinal fiber structure that was qualitatively similar to PreTF. CONCLUSION Based on human temporal bone specimens, temporalis fascia does not significantly remodel, change thickness, or change fibrous structure following successful tympanoplasty. Results have implications for selection and surgical preparation of graft materials in TM reconstruction. LEVEL OF EVIDENCE 4. Laryngoscope, 128:E351-E358, 2018.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester
| | - Reuven Ishai
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | - Iman Ghanad
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
| | - Nicole L Black
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, U.S.A
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston
| | - Jeffrey Tao Cheng
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otology and Laryngology, Harvard Medical School, Boston.,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester
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Malhotra M, Varshney S, Malhotra R, Joshi P. Indian Perspectives on Graft Materials Used for Repair of Tympanic Membrane. J Clin Diagn Res 2017; 11:ME01-ME06. [PMID: 28892946 DOI: 10.7860/jcdr/2017/26289.10199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/30/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Repair of Tympanic Membrane (TM) is one of the most common surgeries performed by the otologists. Literature reveals that Indian surgeons have contributed substantially in the research on techniques and graft materials used for the repair of tympanic membrane, though no review has been written so far highlighting their contributions. AIM To summarize and analyse the contributions of Indian authors who have used different graft materials for repair of TM and their studies listed in Medline search. MATERIALS AND METHODS A literature review was conducted using a Medline search using keywords of 'myringoplasty' and 'tympanoplasty' with 'India' on 30th June 2016. A total of 243 articles were found listed onwards from year 1998. Out of these 50 articles in which type 1 tympanoplasty or myringoplasty was performed using different graft materials were selected. The content of each abstract was studied in order to identify studies related to topic. RESULTS Authors have experimented with a variety of tissues as graft materials. Temporalis Fascia (TF) has been most widely used in 58.6% studies as graft material. The next popular graft is tragal perichondrium. The graft take up rates varied from 68.5% to 100%, while method of reporting of hearing gain in most studies was inconsistent amongst studies, though most studies have reported achievement of serviceable hearing of < 25 dB in most patients. CONCLUSION TF was the most prefered material due to anatomic proximity, light material and strength. It was followed in popularity by tragal perichondrium and tragal cartilage. All graft materials have given satisfactory hearing results.
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Affiliation(s)
- Manu Malhotra
- Associate Professor, Department of Otolaryngology, AIIMS, Rishikesh, Uttarakhand, India
| | - Saurabh Varshney
- Professor, Department of Otolaryngology, AIIMS, Rishikesh, Uttarakhand, India
| | - Rashmi Malhotra
- Assistant Professor, Department of Anatomy, AIIMS, Rishikesh, Uttarakhand, India
| | - Poonam Joshi
- Assistant Professor, Department of Otolaryngology, AIIMS, Rishikesh, Uttarakhand, India
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Ensari N, Gür ÖE, Öztürk MT, Süren D, Selçuk ÖT, Osma Ü. The effect of platelet-rich fibrin membrane on the repair of perforated tympanic membrane: an experimental study. Acta Otolaryngol 2017; 137:695-699. [PMID: 28498077 DOI: 10.1080/00016489.2017.1282169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION Platelet-rich fibrin (PRF) membrane could be used successfully in the repair of tympanic membrane perforation and wound healing. OBJECTIVES To evaluate the effect of platelet-rich fibrin membrane in the repair of perforated tympanic membrane. METHODS After otoscopic examination, a 3-mm perforation was made in the posterior quadrant of both tympanic membranes of 50 adult male Sprague-Dawley rats. Venous blood was withdrawn from the rats, then centrifuged. PRF was obtained in membrane form. The membrane was placed on the right tympanic membrane perforation. The perforations on the left side were left to spontaneously heal and, thus, formed the control group. Daily examinations were made of 20 rats and the time to healing of the tympanic membrane was recorded. The remaining 30 rats were separated into five groups of six, and histopathological examination was made. Evaluation was made in respect of the presence of oedema in the lamina propria, neovascularization, fibroblastic reaction, and inflammatory cells. RESULTS The healing time of the tympanic membrane perforation was determined as mean 10.3 ± 2.18 days in the study group applied with PRF and 17 ± 2.40 days in the control group. Higher values in respect of fibrosis and neovascularization were obtained in the study group.
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Affiliation(s)
- Nuray Ensari
- Department of ENT, Antalya Education and Research Hospital, Antalya, Turkey
| | - Özer Erdem Gür
- Department of ENT, Antalya Education and Research Hospital, Antalya, Turkey
| | | | - Dinç Süren
- Department of Pathology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ömer Tarık Selçuk
- Department of ENT, Antalya Education and Research Hospital, Antalya, Turkey
| | - Üstün Osma
- Department of ENT, Antalya Education and Research Hospital, Antalya, Turkey
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Abstract
Purpose To evaluate the use of cartilage as a potential graft material toward osteo-odontal tissue replacement in keratoprosthesis surgery. Methods We describe a modification of the osteo-odonto-keratoprosthesis surgery that involves the use of autologous auricular conchal cartilage graft (ACCG). In stage 1a, a full-thickness cheek mucosa graft was performed over the ocular surface. In stage 1b, ACCG was harvested via a retroauricular approach. An optical polymethyl-methacrylate cylinder was embedded into a double-layered fragment of cartilage and secured by cyanoacrylate glue. The graft is then placed in a infraorbital pocket. Stage 2, performed after 3 months, involved retrieval of the complex and implantation after reflection of the mucosal flap, corneal trephination, iris and lens removal and anterior vitrectomy. Results We report two cases of chondro-keratoprosthesis (CKPRO) who underwent surgery with up to 15 months of follow-up. Preoperatively, vision was limited to light perception (LP) in both cases. On patient 1, CKPRO was performed in the right eye and the postoperative visual acuity stay limited to LP related to preoperative retinal lesions. On patient 2, CKPRO was performed in the left eye and the vision was improved to 20/100 J6. No postoperative complications such as extrusion, epithelial downgrowth, retrocorneal membrane or endophtalmia were observed. Conclusions ACCG could be an interesting alternative to replace osteo-odontal graft in keratoprosthesis surgery. However, further comprehensive studies with larger sample size and longer follow-up are required. However longer follow-up and a higher number of patient are required to report postoperative complications incidence, survival and functional outcomes.
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Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies. Laryngoscope 2016; 127:2139-2148. [PMID: 27933630 DOI: 10.1002/lary.26451] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement. DATA SOURCES The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar. REVIEW METHODS A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I2 statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated. RESULTS A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P < 0.001). Although there was no significant difference in the air-bone gap (ABG) closure of < 10 dB between the two groups, the subanalysis of prospective studies showed that patients in the TF group had less mean postoperative ABG (P = 0.02). Subgroup analysis of palisade grafts compared with that of TF graft revealed a significant difference in the graft integration rate favoring cartilage tympanoplasty (P = 0.01). CONCLUSION Cartilage grafting seemed to show a higher graft integration rate compared with TF grafting. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2139-2148, 2017.
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Affiliation(s)
- Mir Mohammad Jalali
- Nose and Sinus Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Motasaddi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kouhi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Soleimani
- Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Heo KW. Outcomes of type I tympanoplasty using a cartilage shield graft in patients with poor prognostic factors. Auris Nasus Larynx 2016; 44:517-521. [PMID: 27955869 DOI: 10.1016/j.anl.2016.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/18/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although fascia is widely used as the grafting material in tympanoplasty (TP), unsatisfactory outcomes can result in patients with poor prognostic factors. Recently, cartilage has emerged as a graft material in TP. This study examined the operative outcomes of type I TP using a cartilage shield graft (CSG) in patients with poor prognostic factors. METHODS This study reviewed the medical records of patients who underwent type I TP using CSG performed by the same surgeon, with over 24 months of follow-up. RESULTS There were 94 patients (mean age 46 years). Preoperatively, 39 patients had near-total perforation, 29 had a previous TP or myringoplasty, 14 had adhesive otitis media, and 12 had a marginal perforation covering ≥50% of the tympanic membrane area. The mean postoperative air-bone gap was significantly (p<0.0001) reduced compared to preoperative measurements. Postoperatively, tympanic membrane perforation occurred in 2.1% and otorrhea in 6.4%. There were no cases of retraction, adhesion, or lateralization. One subject complained of autophonia and ear fullness. CONCLUSION Type I TP using CSG has excellent surgical results and minimal complications, even in patients with poor prognostic factors, and should thus be considered in those patients.
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Affiliation(s)
- Kyung Wook Heo
- Department of Otorhinolaryngology-Head & Neck Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea.
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Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol 2016; 82:695-701. [PMID: 27068884 PMCID: PMC9444745 DOI: 10.1016/j.bjorl.2015.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. Objective To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. Methods In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7–18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant. Results The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females. Conclusions Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.
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Affiliation(s)
- Yakup Yegin
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Mustafa Çelik
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
| | - Arzu Karaman Koç
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Levent Küfeciler
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Mustafa Suphi Elbistanlı
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Fatma Tülin Kayhan
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
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Dundar R, Kulduk E, Soy FK, Aslan M, Yükkaldiran A, Çiftçi MA. Boomerang-Shaped Chondro-Perichondral Graft Versus Temporalis Muscle Fascia Graft: Which One is to be Trusted? Indian J Otolaryngol Head Neck Surg 2016; 68:339-44. [PMID: 27508137 PMCID: PMC4961630 DOI: 10.1007/s12070-015-0825-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to compare anatomical and audiological results of boomerang-shaped chondroperichondrial graft (BSCPG) with temporal muscle fascia in type 1 tympanoplasties. Sixty-eight patients in BSCPG group and 54 patients in fascia group were evaluated. Otomicroscopic examination was done periodically till 24 months as for graft perforation, lateralization and retraction and mean air conduction threshold and airbone gap values were measured. At long term controls, in BSCPG group, rates of neomembrane, perforation, retraction and lateralization were 91.17 % (n = 62), 8.82 % (n = 6), 4.41 % (n = 3) and 0 % (n = 0), respectively. In fascia group, the corresponding rates were 79.62 % (n = 43), 20.37 % (n = 11), 12.96 % (n = 7) and 3.7 % (n = 2), respectively. In both groups, mean postoperative PTA and ABG values were significantly better while postoperative same values were significantly different between groups (p = 0.044 and 0.032, respectively). Compared to fascia, BSCPG is an ideal grafting technique in the repair of tympanic membrane perforations.
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Affiliation(s)
- Riza Dundar
- Department of Otorhinolaryngology, Harran University, Şanliurfa, Turkey
| | - Erkan Kulduk
- Department of Otorhinolaryngology, Mardin State Hospital, Mardin, Turkey
| | - Fatih Kemal Soy
- Department of Otorhinolaryngology, Mardin State Hospital, Mardin, Turkey
| | - Mehmet Aslan
- Department of Otorhinolaryngology, Mardin State Hospital, Mardin, Turkey
| | - Ahmet Yükkaldiran
- Department of Otorhinolaryngology, Harran University, Şanliurfa, Turkey
| | - Mehmet Ali Çiftçi
- Department of Otorhinolaryngology, Harran University, Şanliurfa, Turkey
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Vadiya S, Parikh V, Shah S, Pandya P, Kansara A. Comparison of Modified Cartilage Shield Tympanoplasty with Tympanoplasty Using Temporalis Fascia Only: Retrospective Analysis of 142 Cases. SCIENTIFICA 2016; 2016:8092328. [PMID: 27559489 PMCID: PMC4983392 DOI: 10.1155/2016/8092328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
The current study compares outcomes of modified cartilage shield tympanoplasty (CST) with temporalis fascia tympanoplasty in type I procedures in Indian patients. Graft uptake rates are better with the CST technique and hearing results are almost equivalent with both techniques except at 8000 Hz where improvement in hearing was found better with the use of temporalis fascia alone. The CST technique used in the study is unique.
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Affiliation(s)
- Sohil Vadiya
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Vibhuti Parikh
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Saumya Shah
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Parita Pandya
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Anuj Kansara
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
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Allardyce BJ, Rajkhowa R, Dilley RJ, Xie Z, Campbell L, Keating A, Atlas MD, von Unge M, Wang X. Comparative acoustic performance and mechanical properties of silk membranes for the repair of chronic tympanic membrane perforations. J Mech Behav Biomed Mater 2016; 64:65-74. [PMID: 27479895 DOI: 10.1016/j.jmbbm.2016.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022]
Abstract
The acoustic and mechanical properties of silk membranes of different thicknesses were tested to determine their suitability as a repair material for tympanic membrane perforations. Membranes of different thickness (10-100μm) were tested to determine their frequency response and their resistance to pressure loads in a simulated ear canal model. Their mechanical rigidity to pressure loads was confirmed by tensile testing. These membranes were tested alongside animal cartilage, currently the strongest available myringoplasty graft as well as paper, which is commonly used for simpler procedures. Silk membranes showed resonant frequencies within the human hearing range and a higher vibrational amplitude than cartilage, suggesting that silk may offer good acoustic energy transfer characteristics. Silk membranes were also highly resistant to simulated pressure changes in the middle ear, suggesting they can resist retraction, a common cause of graft failure resulting from chronic negative pressures in the middle ear. Part of this strength can be explained by the substantially higher modulus of silk films compared with cartilage. This allows for the production of films that are much thinner than cartilage, with superior acoustic properties, but that still provide the same level of mechanical support as thicker cartilage. Together, these in vitro results suggest that silk membranes may provide good hearing outcomes while offering similar levels of mechanical support to the reconstructed middle ear.
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Affiliation(s)
| | - Rangam Rajkhowa
- Deakin University, Institute for Frontier Materials, Geelong, Australia
| | - Rodney J Dilley
- Ear Science Institute Australia and Ear Sciences Centre, School of Surgery, University of Western Australia, Australia
| | - Zhigang Xie
- Deakin University, Institute for Frontier Materials, Geelong, Australia
| | - Luke Campbell
- Department of Otolaryngology, University of Melbourne, Australia
| | - Adrian Keating
- School of Mechanical and Chemical Engineering, The University of Western Australia, Australia
| | - Marcus D Atlas
- Ear Science Institute Australia and Ear Sciences Centre, School of Surgery, University of Western Australia, Australia
| | - Magnus von Unge
- Dept. ENT, Akershus University Hospital and the University of Oslo, Oslo, Norway; Center for Clinical Research, Västerås, University of Uppsala, Sweden
| | - Xungai Wang
- Deakin University, Institute for Frontier Materials, Geelong, Australia.
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Lyons SA, Su T, Vissers LET, Peters JPM, Smit AL, Grolman W. Fascia compared to one-piece composite cartilage-perichondrium grafting for tympanoplasty. Laryngoscope 2015; 126:1662-70. [PMID: 26542167 DOI: 10.1002/lary.25772] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of type 1 tympanoplasty with one-piece composite cartilage-perichondrium (CCP) grafts compared to temporalis fascia (TF) grafts for tympanic membrane (TM) closure and hearing improvement in adult patients with a subtotal TM perforation and chronic otitis media (COM). DATA SOURCES PubMed, Embase, Cochrane Library. REVIEW METHODS A systematic search was conducted. Relevance and validity of selected articles were assessed. Studies that scored moderate or high on relevance were included, and relevant data for both outcomes were extracted. For the outcome of TM closure, absolute risk differences (RD), relative risks, and number needed to treat with their respective 95% confidence intervals were calculated when possible. RESULTS We retrieved 3,783 unique studies. Ten studies satisfied the eligibility criteria. Four studies of moderate validity showed RD ranging from 0.08 to 0.13 in favor of the CCP graft compared to the TF graft for TM closure 1 year or more postoperatively, but this was not statistically significant. Five studies of moderate to high validity showed no clinically relevant difference in hearing improvement between both intervention groups at a minimum follow-up of 3 months. The relative air-bone gap closure ranged from 5.7 to 11.5 dB in the TF group and from 8.9 to 12.7 dB in the CCP group. CONCLUSIONS There is no evidence of superiority of one-piece CCP grafting over TF grafting in type 1 tympanoplasty regarding complete closure of a subtotal perforated TM 1 year or more postoperatively or hearing improvement at a minimum of 3 months follow-up. Laryngoscope, 126:1662-1670, 2016.
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Affiliation(s)
- Sarah A Lyons
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tanly Su
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linda E T Vissers
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen P M Peters
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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Salviz M, Bayram O, Bayram AA, Balikci HH, Chatzi T, Paltura C, Ozkul MH. Prognostic factors in type I tympanoplasty. Auris Nasus Larynx 2015; 42:20-3. [DOI: 10.1016/j.anl.2014.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
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