Circumferential Subannular Tympanoplasty: Panacea for revision tympanoplasty

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

OBJECTIVE

To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology.

METHODS

A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out.

RESULTS

Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls.

CONCLUSION

Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success.

LEVEL OF EVIDENCE

3B.

Circumferential subannular tympanoplasty: surgical and hearing outcome in 224 ears with subtotal perforation

BACKGROUND

Subannular tympanoplasty is a newer technique with limited research articles in the literature. These articles have limitation in terms of sample data. We reviewed outcome of subannular tympanoplasty performed during last five years in our center.

OBJECTIVE

To determine the surgical and hearing outcome of circumferential subannular tympanoplasty.

METHODS

A retrospective observational study was performed in a tertiary care academic center involving 224 subjects with mucosal chronic otitis media who underwent circumferential subannular type 1 tympanoplasty.

RESULTS

Complete neo-tympanum was found in 213 cases (95.1%) at the end final follow period of 12 months after surgery. Eleven tympanic membranes did not take up the graft and considered failure at the end of 6 months after surgery. All of them were subjected for revision surgery and showed intact neo-tympanum after 12 months of surgery. The hearing outcome showed significant improvement in air conduction thresholds from 42.54 ± 13.04 dB to 30.48 ± 10.61 dB at the end of one year. No surgical complication was observed in the study group.

CONCLUSION

The circumferential subannular tympanoplasty carries good surgical success and should be preferred in large and subtotal perforations. Randomized controlled trials are warranted to overcome the limitations in the present study.

SIGNIFICANCE

This is the first study showing outcome of subannular tympanoplasty in large sample size of more than 200.

Excising or preserving perforation margins in endoscopic transtympanic cartilage myringoplasty does not affect surgical success

OBJECTIVE

To compare the outcome of endoscopic transtympanic cartilage myringoplasty with and without removal of perforation edges for repairing chronic perforations with mucosal chronic otitis media (COM).

STUDY DESIGN

Quasi-randomised clinical trial.

SETTING

Tertiary referral centre.

MATERIALS AND METHODS

Patients with chronic perforations and mucosal COM undergoing endoscopic transtympanic cartilage myringoplasty were allocated to a control group for whom the perforation edges were preserved (n = 40) and an intervention group for whom the edges were removed (n = 39). Mean operation time, graft success rate, mean scores of graft neovascularisation and epithelialisation, and hearing were compared between the groups at 4 weeks and/or 6 months postoperatively.

RESULTS

Graft success rate was 95% (38/40) in the control group and 97% (38/39) in the intervention group at 6 months postoperatively; the difference was not significant. Mean graft neovascularisation scores 4 weeks postoperatively were 2.52 ± 0.59 in the control group and 2.58 ± 0.55 in the intervention group; the difference was not significant. Mean graft epithelisation scores 4 weeks postoperatively were 1.48 ± 0.57 in the control group and 1.68 ± 0.51 in the intervention group; the difference was not significant and remained nonsignificant 6 months postoperatively (2.5 ± 0.55 vs. 2.76 ± 0.36). Audiological outcomes at 6 months did not differ between the groups.

CONCLUSION

Endoscopic, transtympanic cartilage underlay myringoplasty with preservation of the perforation margins did not affect graft neovascularisation, epithelialisation or success. Longer-term outcomes and risk of cholesteatoma require further study.