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Haci C, Bayram O, Gurbuz G, Barcan Y, Acikalin RM, Yasar H. Investigation of factors affecting pediatric type 1 endoscopic tympanoplasty results and success rates of surgery. Auris Nasus Larynx 2023; 50:848-853. [PMID: 37005113 DOI: 10.1016/j.anl.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE There are many factors that affect the results of tympanoplasty in children. Recurrent ear infections, hearing loss, and more serious complications due to cholesteatoma may be observed. This study examined factors affecting the success of type 1 endoscopic tympanoplasty surgery in pediatric patients and investigated recommended procedures to increase the success of the operation. METHODS Our study included pediatric patients who underwent type 1 endoscopic tympanoplasty operation for chronic otitis media. Patient files were analyzed retrospectively. Hearing results before and after the operations were recorded.. Patients were divided into groups according to gender, age (<12 age group, ≥12 age group), and perforation type. Hearing results and physical examination findings were compared for each group. RESULTS A total of 204 pediatric patients were included in our study: 114 were male and 90 were female. Patients' hearing results were compared according to the size and location of their tympanic membrane perforations. Hearing loss was found to increase as the size of the tympanic membrane perforation increased. In addition, it was observed that perforations in the posterior quadrant caused more severe hearing loss than in the other quadrants. The postoperative results of the two groups <12 years old, and ≥12 years old were evaluated according to age. Postoperative improvement was higher in the ≥12 age group compared to the <12 age group. CONCLUSION According to the results of this study, tympanoplasty surgeries performed on patients younger than 12 have a decreased success rate. Among the many factors that affect the success of an operation, age is one of the most important. There are many factors that affect the results of the operation, perforation size and localization is one of them. There are many factors that affect the success of surgery such as pediatric patients and adult patients. It is useful to make a personal evaluation and to plan the surgery by evaluating the obstacles such as eustachian tube maturation and difficulty in postoperative care in pediatric patients.
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Affiliation(s)
- Cemal Haci
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey; Istanbul Rumeli Univercity, Vocational School of Health Services, Dep.of Audiometry, Istanbul, Turkey.
| | - Ozlem Bayram
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Gokhan Gurbuz
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Yagmur Barcan
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Resit Murat Acikalin
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
| | - Husamettin Yasar
- Haseki Training and Research Hospital, Dept. of Otorhinolaryngology Fatih, Istanbul, Turkey
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Gutierrez JA, Cabrera CI, Stout A, Mowry SE. Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:1453-1466. [PMID: 36951041 DOI: 10.1177/00034894231159000] [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: 03/24/2023]
Abstract
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.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amber Stout
- Medical Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Mangia LRL, Amadeu NT, da Silva Oliveira M, Patzer LS, Somensi EDS, Hamerschmidt R. Success rates and predictors of outcomes of type I tympanoplasty performed by residents in a teaching tertiary hospital. J Otol 2023; 18:214-219. [PMID: 37877068 PMCID: PMC10593571 DOI: 10.1016/j.joto.2023.09.003] [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: 02/06/2023] [Revised: 07/04/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023] Open
Abstract
Several technical variations of tympanoplasty have been reported, usually involving the type of graft and/or instruments used. Few studies have focused on the outcome of type-1 tympanoplasty specifically in teaching scenarios. We aimed to describe the results of type-1 tympanoplasty performed by residents, and to investigate potential predictive factors of surgical success. To do so, we did a retrospective analysis of medical records of patients who underwent type-1 tympanoplasty in a tertiary university hospital. We evaluated the tympanic membrane closure and audiometric outcomes during the first year of follow-up, and compared the results according to some clinical and surgical factors. 130 operated ears were included in the study. The closure rate reached 84.12% after one month and 72.72% after twelve months of surgery. The mean air-bone gap was 22.98 dB preoperatively, and reached 10.55 dB after surgery. Perforation closure rates were 85% and 57.14% for those operated by endoscopic and microscopic-assisted approaches, respectively (p = 0.004). The use of cartilage grafts and time without otorrhea of more than three months prior to surgery were also predictors of surgical success (p = 0.002 and 0.041, respectively). Gender, age, perforation size, contralateral disease, operated side, reoperation, and degree of hearing loss did not significantly interfere with outcomes. Tympanoplasty showed good overall results when performed by residents, although inferior to those reported by experienced surgeons. The use of the endoscope, cartilage grafting, and longer preoperative time without otorrhea were predictors of surgical success in this scenario. Level of evidence IIB.
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Affiliation(s)
- Lucas Resende Lucinda Mangia
- Department of Otolaryngology and Head and Neck Surgery, Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curitiba, Brazil
- Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curso de Medicina, Curitiba, Brazil
| | - Nicole Tássia Amadeu
- Department of Otolaryngology and Head and Neck Surgery, Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curitiba, Brazil
| | - Maurício da Silva Oliveira
- Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curso de Medicina, Curitiba, Brazil
| | - Lucas Santin Patzer
- Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curso de Medicina, Curitiba, Brazil
| | - Eduardo de Souza Somensi
- Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curso de Medicina, Curitiba, Brazil
| | - Rogério Hamerschmidt
- Department of Otolaryngology and Head and Neck Surgery, Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curitiba, Brazil
- Complexo Hospital de Clínicas - Universidade Federal Do Paraná (CHC-UFPR), Curso de Medicina, Curitiba, Brazil
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Dutta M, Gure PK, Ray D, Kar S, Dey U, Dutta S. The socio-demographic determinants of the outcome of type 1 cartilage tympanoplasty in children: Results from a tertiary-care teaching institute in India. Int J Pediatr Otorhinolaryngol 2023; 171:111608. [PMID: 37329700 DOI: 10.1016/j.ijporl.2023.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To explore whether and how the established socio-demographic parameters pertaining to a lower-middle income nation influence the outcome of cartilage tympanoplasty in children with chronic otitis media (COM), inactive mucosal variety. METHODS In this prospective cohort study, children aged 5-12 years with COM (dry, large/subtotal perforation) were considered for type 1 cartilage tympanoplasty following definite selection criteria. Relevant socio-demographic parameters were noted for each child. These included parents' education (literate/illiterate), living area (slum/village/others), mothers' occupation (laborer/business/housewife or home-maker), family type (nuclear/joint), and monthly family income. Outcome at 6 months follow-up was interpreted as "success" (favorable; anatomically intact and well-epithelialized neograft and dry ear) and "failure" (unfavorable; residual or recurrent perforation and/or discharging ear). The role of individual socio-demographic factor in determining the outcomes was analyzed with relevant statistical methods. RESULTS The average age of the 74 children included in the study was 9.30 ± 2.13 years. At six months, 86.5% had a successful outcome, with a statistically significant hearing gain (closure of the air-bone gap) of 17.02 ± 8.96 dB (p = .003). Mothers' education had a significant influence on the success rate (Chi: 4.13; significant at p < .05); children of ∼97% of the literate mothers had a successful outcome. Living area was significantly associated with success (Chi: 13.94; significant at p < .01); ∼90% of children living in the slum areas had success, compared to 50% of those residing in villages. The family type also significantly influenced the surgical outcome (Chi: 3.81; significant at p < .05); ∼97% of the children belonging to the joint families encountered success, compared to ∼81% of those brought up in the nuclear families. The success also depended on the mothers' occupation (Chi: 6.47; significant at p < .05); ∼97% of the housewife mothers had children who were successful, against ∼77% of mothers engaged as laborers. Another factor significantly associated with success was the monthly household income. Nearly 97% of the children belonging to families with a monthly household income of >₹3000 (cut-off limit set by the median value) experienced success, in contrast to 79% of those having a monthly family income of <₹3000 (Chi: 4.83; significant at p < .05). CONCLUSION Socio-demographic parameters are valuable determinants of the outcome of surgical management of COM in children. For type 1 cartilage tympanoplasty, mothers' education and occupation, family type, living area, and monthly family income significantly influenced the surgical outcome.
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Affiliation(s)
- Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India.
| | - Prasanta Kumar Gure
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India
| | - Dhrupad Ray
- Department of Otorhinolaryngology and Head-Neck Surgery, North Bengal Medical College and Hospital, Siliguri, West Bengal, India
| | - Sutarthi Kar
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India
| | - Uposoma Dey
- Indian Statistical Institute, Kolkata, West Bengal, India
| | - Santanu Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Chinsurah Imambara Hospital, Hooghly, West Bengal, India
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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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Nicholas Jungbauer W, Jeong S, Nguyen SA, Lambert PR. Comparing Myringoplasty to Type I Tympanoplasty in Tympanic Membrane Repair: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:922-934. [PMID: 36939595 DOI: 10.1002/ohn.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To compare the anatomic success rates of type I tympanoplasty (tympanoplasty) versus myringoplasty. By our definition, tympanoplasty involves entering the middle ear via elevation of a tympanomeatal flap, while myringoplasty involves surgery to the drumhead without middle ear exposure. DATA SOURCES PubMed, Scopus, CINAHL, Cochrane. REVIEW METHODS To be included, studies must have documented surgical technique, tympanic membrane (TM) perforation size (as % of TM), and success rate using tissue or alloplastic grafts. Exclusion criteria included series with more than 10% of patients with cholesteatoma or middle ear pathology. A meta-analysis of weighted summary proportions under the random effects model was performed, and proportion differences (PD) were calculated. A secondary analysis of hearing outcomes was performed. RESULTS Eighty-five studies met inclusion, with a tympanoplasty cohort of n = 7966 and n = 1759 for myringoplasty. For perforations, less than 50% of the TM, the success rate for tympanoplasty and myringoplasty was 90.2% and 91.4%, respectively (PD: 1.2%, p = .19). In perforations greater than 50%, tympanoplasty and myringoplasty success rates were 82.8% and 85.3%, respectively (PD: 2.5%, p = .29). For both procedures, perforations less than 50% of the TM had higher success rates than perforations greater than 50% of the TM (p < .01). Both techniques endorsed significant improvements to air-bone gap (ABG) metrics. CONCLUSION Our analysis suggests that the anatomic success rate is similar for tympanoplasty and myringoplasty, regardless of perforation size, and that smaller perforations experience higher success rates in both techniques. ABG outcomes were also similar between procedure techniques.
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Affiliation(s)
- Walter Nicholas Jungbauer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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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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Momin ZK, Yancey KL, Mitton TJ, Kutz JW. Patient Factors Predicting Success in Lateral Graft Tympanoplasty. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e015. [PMID: 38516625 PMCID: PMC10950160 DOI: 10.1097/ono.0000000000000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 03/23/2024]
Abstract
Objective To compare the effects of preoperative medical comorbidities and operative findings on the success of lateral graft tympanoplasty. Study Design Retrospective chart review. Setting Tertiary medical center. Patients Ninety-six patients undergoing lateral graft tympanoplasty from December 2008 to November 2020 with at least 2 months follow-up were included. Patient demographics, comorbidities including smoking status, intraoperative findings, and healing, and hearing outcomes were recorded. Interventions Lateral graft tympanoplasty. Main Outcome Measures The primary outcome was perforation closure. Secondary outcomes were postoperative complications and change in air-bone gap (ABG). Results Ninety-nine ears (mean age 40.94 ± 18.44 years) were included. Tympanic membrane perforation closure was achieved in 92 (92.9%) ears. Perforation closure was not associated with diabetes (P > 0.99), smoking (P > 0.99), or the presence of cholesteatoma at the time of lateral graft tympanoplasty (P = 0.10). Increased age (odds ratio [OR] = 1.04, P = 0.31) was also not correlated with tympanic membrane closure rate. An absent malleus resulted in a higher rate of lateralization (31.3% versus 2.1%; OR = 18.41, 95% confidence interval [CI] = 3.09-95.95, P = 0.001) but not blunting (12.5% versus 4.8%; OR = 0.24, 95% CI = 0.49-12.93, P = 0.24). The mean ABG improved 6.82 ± 11.33 dB (P < 0.01). History of prior tympanoplasty was associated with smaller ABG improvement following surgery (ß = 4.038, R2 = 0.262, P = 0.04) but not perforation closure (OR = 3.25, 95% CI = 0.63-16.81, P = 0.24). Conclusions Diabetes, active smoking, and advancing age were not associated with adverse healing in patients undergoing lateral graft tympanoplasty. Lateralization was more common with an absent malleus.
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Affiliation(s)
- Zoha K. Momin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kristen L. Yancey
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Tanner J. Mitton
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joe Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Comparitive Study on Impact of Dry (Rigid) Versus Wet (Soft) Graft on the Outcome of Type 1 Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:16-20. [PMID: 36032912 PMCID: PMC9411427 DOI: 10.1007/s12070-019-01785-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/26/2019] [Indexed: 11/25/2022] Open
Abstract
To analyse the rate of success of dry versus wet temporalis fascia graft in type 1 tympanoplasty. A prospective, randomised study was conducted. One hundred adult patients (males and females) with chronic suppurative otitis media (mucosal type) were divided into 2 groups of 50 each: one group underwent dry temporalis fascia graft tympanoplasty and the other underwent wet temporalis fascia graft tympanoplasty. The dry graft and wet graft groups had overall surgical success rates of 82 and 90%, respectively; this finding was not statistically significant. A dry or wet temporalis fascia graft does not influence the outcome of type I tympanoplasty.
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Does Successful Myringoplasty Affect Eustachian Tube Function? Indian J Otolaryngol Head Neck Surg 2022; 74:724-729. [PMID: 36032907 PMCID: PMC9411378 DOI: 10.1007/s12070-021-02534-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
Eustachian tube (ET) is a tube connecting the middle ear cavity with the nasopharynx and has an important role in equalization of pressure around TM. Many studies investigated the role of ET function tests on the results of myringoplasty/tympanoplasty. Our aim is to assess the effect of successful myringoplasty on Eustachian tube function. A prospective study included 37 patients admitted to the E.N.T Department at Sohag University Hospital in the period between March 2018 and March 2019 suffering from dry central perforation necessitating myringoplasty. Pre-operative E.T function tests using tympanometry and methylene blue dye test were done. Post-operative follow-up tympanometry was done after 3 months for those with successful myringoplasty and compared to the preoperative assessment. Thirty-one (83%) patients had functioning ET, 6 (17%) had non-functioning ET and 32 patients (86.5%) had successful myringoplasty (taken healthy graft). According to the effect of myringoplasty on ET function test 3 months following surgery, (9%) were affected, either improved (3%) or worsen (6%), while (91%) were not affected by tympanometry in those with taken healthy graft cases. In our study, there was no significant effect of myringoplasty on E.T function. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02534-8.
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Abstract
OBJECTIVE We reported on transcanal endoscopic myringoplasty in 25 cases preliminarily in 2014. Now our number of transcanal endoscopic myringoplasty reached to 209 ears and allowed us to adequately investigate the visibility, necessity of canalplasty, treatment results, and multivariate analysis. STUDY DESIGN A prospective case series. SETTING Tertiary referral center. PATIENTS Transcanal endoscopic myringoplasty was performed on 209 ears in 201 patients between 2011 and 2019 and followed up over 1 year. METHODS Preoperative endoscopic and microscopic views for the same patient were compared. We examined success rates at 1 year after surgery according to operation type, perforation size, operation side, gender, cause of perforation, and age, and also examined hearing results. Logistic regression analysis was performed to investigate the basic demographic and clinical characteristics of the patients associated with perforation closure. RESULTS The anterior edge of the preoperative perforation was not visible under microscopy in 14.4% of patients. In contrast, endoscopic views revealed the entire tympanic membrane in one field. However, canalplasty was required in 2.4% of tympanic procedures due to difficulty of manipulation. The overall closure rate for perforations was 90.4%. Logistic regression analysis revealed that age > 11 was the only significant factor associated with perforation closure. The average reduction in air-bone gap was 12.1 dB. CONCLUSION The endoscopic myringoplasty produced better visualization, the same or better closure rates, and the same or lower complication rates as compared with traditional microscopic techniques.
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Shamshudinov T, Kassym L, Taukeleva S, Sadykov B, Diab H, Milkov M. Tympanoplasty and adenoidectomy in children: Comparison of simultaneous and sequential approaches. PLoS One 2022; 17:e0265133. [PMID: 35271666 PMCID: PMC8912196 DOI: 10.1371/journal.pone.0265133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background The authors sought to compare simultaneous and sequential tympanoplasty and adenoidectomy surgery in pediatric patients. Methods This retrospective single-center study included 65 children (36 males, 29 females; mean age 9.16 ± 3.82 years; range 3–17 years) requiring both tympanoplasty and adenoidectomy. Simultaneous surgeries were performed on the same day, during single general anesthesia, whereas sequential surgeries were separated at least 12 weeks. The groups were compared with regard to restoration of hearing, tympanic membrane status, and utilization of medical resources. All study participants had a 12-months follow-up period after surgery. Results No statistically significant differences were observed between the groups regarding pre- and post-operative ABG values and average hearing gains. However, the post-operative ABG was significantly lower than the pre-operative ABG in both groups (p<0.001). There were no significant differences between simultaneous and sequential groups with respect to complete healing rates and complications (all p>0.355). Simultaneous tympanoplasty and adenoidectomy surgery management is associated with a significantly decreased cumulative hospital stay, cumulative operating room time, and cumulative pure surgical time (all p≤0.016). Conclusions The results of first comparative study of simultaneous versus sequential tympanoplasty and adenoidectomy surgery managements demonstrate no advantages for the sequential approach. The same-day surgery can show the clinical outcomes comparable to those in the sequential group. The simultaneous surgery approach appears to be associated with reduced medical resources consumption. Therefore, simultaneous surgery management is an effective and safe option for children with chronic otitis media and adenoid hypertrophy.
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Affiliation(s)
- Timur Shamshudinov
- Center of Pediatric Otorhinolaryngology, General Hospital #5, Almaty, Republic of Kazakhstan
| | - Laura Kassym
- School of Medicine, Nazarbayev University, Nur-Sultan, Republic of Kazakhstan
- * E-mail:
| | - Saule Taukeleva
- Kazakh-Russian Medical University, Almaty, Republic of Kazakhstan
| | - Bolat Sadykov
- Center of Pediatric Otorhinolaryngology, General Hospital #5, Almaty, Republic of Kazakhstan
| | - Hassan Diab
- The National Medical Research Center for Otorhinolaringology, Federal Medico-Biological Agency, Moscow, Russian Federation
| | - Mario Milkov
- Medical University of Varna, Faculty of Dental Medicine, Varna, Bulgaria
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Lan WC, Wang CY, Tsai MH, Lin CD. Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery. PeerJ 2021; 9:e12522. [PMID: 34900435 PMCID: PMC8621709 DOI: 10.7717/peerj.12522] [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: 08/17/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study investigated the long-term surgical outcomes of functional cholesteatoma surgery with canal wall reconstruction using autologous bone grafts as the primary material in patients with acquired cholesteatoma. Subjects and Methods Medical charts were retrospectively reviewed for all patients admitted to one institution for surgical intervention between 2010 and 2018. We analyzed 66 patients (66 ears) who underwent functional tympanomastoidectomy involving the use of autologous bone grafts for canal wall defect reconstruction. Surgical outcomes were evaluated by comparing preoperative audiometric results with follow-up data (at least 36 months after surgery). Logistic regression analyses were performed to determine prognostic factors related to long-term hearing success. These factors included classification and stage of cholesteatoma, stapes condition, ossicular chain damage, active infection of the middle ear, state of the contralateral ear, preoperative hearing thresholds, gender, and age. Results The mean follow-up period was 49.2 months. The recidivism rate was 6% (four of 66 ears). The pure-tone average significantly improved from 50.78 ± 19.98 to 40.81 ± 21.22 dB hearing level (HL; p < 0.001). Air–bone gaps significantly improved from 26.26 ± 10.53 to 17.58 ± 8.21 dB HL (p < 0.001). In multivariate logistic regression analysis, early-stage disease (p = 0.021) and pars flaccida cholesteatoma (p = 0.036) exhibited statistically significant correlations with successful hearing preservation. Conclusion Functional cholesteatoma surgery with autologous bone grafts reconstruction is an effective approach to significantly improve hearing with low recidivism rates. Localized disease and pars flaccida cholesteatoma were two independent predictors of successful hearing preservation.
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Affiliation(s)
- Wei-Che Lan
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Yuan Wang
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Hsui Tsai
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Horváth T, Horváth B, Liktor B, Zrubka Z, Liktor B. Risk stratification in endoscopic type I. tympanoplasty. Eur Arch Otorhinolaryngol 2021; 278:4757-4766. [PMID: 33481078 DOI: 10.1007/s00405-021-06606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Several risk factors were studied in endoscopic type I. tympanoplasty, however, an easy-to-use risk stratification model is still missing. METHODS Retrospective chart review, focusing on individual risk factors and middle ear risk index (MERI). Patients who underwent endoscopic type I. tympanoplasty were included. RESULTS Closed tympanic cavity was succesfully created in 88.1% of the 42 cases, the overall 21,5 dB air-bone gap (ABG) was reduced by 9,8 dB. The average MERI score of the patients was 2.1 ± 1.5. 78.6% of the patients were categorised into the mild, while 21.4% into the moderate risk group. The perforation was considered small in 81.0% of the cases, while large in 19.0%. The size of the perforation and the preoperative ABG, but not the MERI status were the only single predictors of success. Using a risk stratification model that is based on the size of the perforation, the preoperative ABG and MERI status, patients could be referred into two distinct groups of risk: the majority expecting excellent outcomes with maximum one risk factor present, and patients with deteriorated rate of success when having two or three risk factors. CONCLUSIONS Endoscopic type I. tympanoplasty with underlay perichondrium graft can be performed with good chance of success. However, if more than one risk factors are present, the chance of residual perforation becomes great. In addition to the established risk factors, our results point out that despite its strong correlation with perforation size, ABG may have a predictive role.
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Affiliation(s)
- Tamás Horváth
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary.
| | - Barnabás Horváth
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - Bálint Liktor
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - Zsombor Zrubka
- Department of Health Economics, Corvinus University, Budapest, Hungary
| | - Bálint Liktor
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
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16
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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; 1:1-7. [PMID: 33019948 DOI: 10.1097/ono.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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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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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Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:182-189. [PMID: 32862972 DOI: 10.1016/j.otorri.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/11/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake. MATERIAL AND METHODS Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined. RESULTS The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79). CONCLUSION Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.
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Affiliation(s)
- Pedro Salvador
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
| | - Patrícia Gomes
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Francisco Silva
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Rui Fonseca
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
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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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CO 2 Laser for De-epithelialization in Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2019; 71:1364-1368. [PMID: 31750178 DOI: 10.1007/s12070-018-1430-4] [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: 11/27/2017] [Accepted: 06/18/2018] [Indexed: 10/28/2022] Open
Abstract
Tympanoplasty repairs tympanic membrane perforations but also covers an umbrella of procedures characterized by surgery of the mastoid bone. Tympanoplasty is widely regarded as a beneficial procedure with an over 90% graft closure success rate and an over 80% return to normal hearing range. Though surgical technique and graft type are important in determining surgical outcomes of the procedure, results are most greatly correlated with location of the perforation. Marginal perforations are associated with the most complications in reconstruction of the tympanic membrane, lack of vascularization and limited membrane area delaying the healing process (4). Lasers have been used in medical procedures dating back to the 1960s. The advantage of infrared lasers such as CO2 are the precision of cutting and the smooth interaction with tissues (5). The CO2 laser is absorbed by the tympanic membrane and does not damage the middle ear while visible lasers penetrate and can damage the ear drum (6). This retrospective study of 150 patients from 2013-2016 assesses and demonstrates the viability of using carbon dioxide laser as an alternative to the traditional method for de-epithelialization of tympanic perforation margins during tympanoplasty. By comparing closure rates and audiogram data, this study reveals parameters of use, benefits and adverse outcomes on healing and hearing restoration with the CO2 laser-assisted method. Perforation closure rate of 91% and hearing improvement in 66% of patients was observed. Fourteen patients did not undergo closure of the tympanic membrane with an overwhelming majority of the 14 having large and marginal perforations.
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21
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Outcomes of endoscopic transcanal type 1 cartilage tympanoplasty. Eur Arch Otorhinolaryngol 2019; 276:3295-3299. [DOI: 10.1007/s00405-019-05636-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022]
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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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Darouassi Y, Aljalil A, Ennouali A, Hanine MA, Chebraoui Y, Bouaity B, Touati MM, Ammar H. Prognostic factors of myringoplasty: study of a 140 cases series and review of the literature. Pan Afr Med J 2019; 33:323. [PMID: 31692867 PMCID: PMC6815508 DOI: 10.11604/pamj.2019.33.323.18060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/25/2019] [Indexed: 11/25/2022] Open
Abstract
Myringoplasty is one of the most frequent interventions in otology. It aims to restore the eardrum in order to protect against extrinsic contamination by water and to improve hearing. Our study aimed to analyze the factors that may affect anatomical and functional results of myringoplasty or type I tympanoplasty. A retrospective study was performed of a series of 140 cases of myringoplasty over a 6-years period from 2010 to 2015. The approach was post-auricular in 69% of cases and all the patients underwent an underlay technique. Temporal fascia was used in 90.71% of the cases. After an average follow-up of 13 months, the anatomical and functional results were acceptable, with a tympanic closure rate of 88% and an average audiometric gain of 14.22 dB. Several factors affected our results, including the location of the perforation, the active or inactive status of the chronic otitis media, the condition of the opposite ear and the graft material. In light of our results and those of the literature, we believe that the middle ear should be dry at least two months prior to surgery, use of cartilaginous graft material and underlay technique should be preferred and special precautions should be taken in case of anterior or contralateral perforation.
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Affiliation(s)
| | | | - Amine Ennouali
- ENT Department Military Hospital Avicenna, Marrakech, Morocco
| | | | | | - Brahim Bouaity
- ENT Department Military Hospital Avicenna, Marrakech, Morocco
| | | | - Haddou Ammar
- ENT Department Military Hospital Avicenna, Marrakech, Morocco
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What Effect Does Smoking Have on the Surgical Closure of Tympanic Membrane Perforations? A Review. Otol Neurotol 2018; 39:1217-1221. [DOI: 10.1097/mao.0000000000002011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Serum cotinine levels should optimally be measured when evaluating the outcomes of cartilage tympanoplasty in smokers. Eur Arch Otorhinolaryngol 2017; 274:3553-3555. [DOI: 10.1007/s00405-017-4516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE To determine which independent variables influence the efficacy of type I tympanoplasty in adult and pediatric populations. DATA SOURCES A search of the PubMed database and Cochrane Database of Systematic Reviews using the key words "tympanoplasty OR myringoplasty" from January 1966 to July 2014 was performed. STUDY SELECTION Studies reporting outcomes of myringoplasty or Type I tympanoplasty in primary non-cholesteatomatous chronic tympanic membrane (TM) perforation were included. DATA EXTRACTION Of 4,698 abstracts reviewed, 214 studies involving 26,097 patients met our inclusion criteria and contributed to meta-analysis. DATA SYNTHESIS The primary outcome of success was defined as closure rate at 12 months. The independent variables analyzed were age, follow-up period, approach, graft material, perforation cause, size, location, ear dryness, and surgical technique. Only those studies providing data on a given parameter of interest could be included when comparing each variable. CONCLUSION The weighted average success rate of tympanic closure was 86.6%. Based on this meta-analysis, pediatric surgery has a 5.8% higher failure rate than adults and there is no correlation between follow-up period and success. Other variables associated with improved closure rates include perforation with a size less than 50% of total area (improved by 6.1%) and the use of cartilage as a graft (improved by 2.8% compared with fascia), while ears that were operated on while still discharging, those in different locations of the pars tensa, or using different surgical approaches or techniques did not have significantly different outcomes.
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Tseng CC, Lai MT, Wu CC, Yuan SP, Ding YF. Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure. Auris Nasus Larynx 2017; 45:433-439. [PMID: 28739189 DOI: 10.1016/j.anl.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/09/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Since the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty). METHODS We retrospectively reviewed the medical records of patients who underwent endoscopic transcanal myringoplasty for perforations of the tympanic membrane. The main outcome was the overall rate of graft success of endoscopic transcanal myringoplasty. RESULTS A total of 181 patients were included in the analysis. The overall graft success was determined in 163 of 181 patients (92.8%). The mean preoperative and postoperative air-bone gaps were 19.3dB and 7.8dB, respectively, revealing a significant improvement of 11.5dB (Cohen's d, 1.27; 95% CI, 1.03-1.50; P<0.05; paired t test) in the air-bone gap. The rate of graft success with partial visualization of the perforation margin was comparable to that with complete visualization of the perforation margin. Larger sizes of perforations were significantly associated with lower rates of graft success (P<0.01). CONCLUSION Our study revealed that the rate of graft success and hearing results of endoscopic transcanal myringoplasty and microscopic myringoplasty are comparable for repairing perforations of the tympanic membrane. Visualization of the perforation margin by otoscopy did not affect the rate of graft success. However, endoscopic transcanal myringoplasty is less invasive because this technique does not require postauricular incision, canalplasty, and general anesthesia.
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Affiliation(s)
- Chih-Chieh Tseng
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taiwan; Department of Otolaryngology, PoJen General Hospital, Taipei, Taiwan; Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
| | - Ming-Tang Lai
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taiwan
| | - Chia-Che Wu
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taiwan; Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Sheng-Po Yuan
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taiwan
| | - Yi-Fang Ding
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taiwan
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Assessment of the success rates of type 1 cartilage tympanoplasty in pediatric and adult patients. Eur Arch Otorhinolaryngol 2017; 274:2669-2671. [DOI: 10.1007/s00405-017-4459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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Impact of the nature of the temporalis fascia graft on the outcome of type I underlay tympanoplasty. The Journal of Laryngology & Otology 2017; 131:472-475. [DOI: 10.1017/s0022215117000615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:Temporalis fascia has become the most widely used graft for tympanoplasty, as it is strong, durable, and easy to procure and handle. However, the type of temporalis fascia graft to use (i.e. dry or wet) remains controversial. The present review aimed to evaluate the success rates of dry and wet temporalis fascia grafts in type I underlay tympanoplasty.Methods:A literature search was performed, using PubMed up to August 2016, to identify all studies of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. The initial search using the key words ‘temporalis fascia’ and ‘tympanoplasty’ identified 130 articles; these were screened by reviewing the titles or abstracts based on the inclusion and exclusion criteria. Ultimately, this review included seven articles.Results and conclusion:A dry or wet temporalis fascia graft did not affect the outcome of type I underlay tympanoplasty. However, using wet temporalis fascia could shorten the duration of surgery in type I underlay tympanoplasty. Concerns that the fibroblast count of temporalis fascia may beneficially affect success rate have not been substantiated in clinical reports thus far.
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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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Preventing or reducing smoking-related complications in otologic and neurotologic surgery. Curr Opin Otolaryngol Head Neck Surg 2015; 23:334-40. [DOI: 10.1097/moo.0000000000000184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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