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Lou Z, Lou Z, Lv T, Chen Z. Effects of no perforation margin trimming and EAC packing in cartilage underlay myringoplasty for chronic large perforations in children. Int J Pediatr Otorhinolaryngol 2024; 180:111956. [PMID: 38657426 DOI: 10.1016/j.ijporl.2024.111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/17/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Trimming of perforation margins and external auditory canal (EAC) packing are basic procedures in underlay myringoplasty for repairing chronic perforations. The objective of this study was to compare the operation time, graft outcome, hearing improvement, and complications of endoscopic cartilage underlay myringoplasty with and without trimming of perforation margins and EAC packing in children. STUDY DESIGN Prospective, randomized study. SETTING Tertiary referral center. MATERIAL AND METHODS Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups: myringoplasty with trimming of perforation margin and EAC packing (TPME) group or no trimming of perforation margin and EAC packing (NTPME) group. The operation time, graft success rate, hearing improvement, and complications were compared between the two groups. RESULTS Fifty-two patients were ultimately included in the study. The mean operation time was 31.4 ± 4.2 min in the TPME group and 23.6 ± 1.7 min in the NTPME group; the difference was significant (P < 0.01). The rate of aural fullness significantly differed between the TPME and NTPME groups (P = 0.000). All participants were followed up for 12 months; the graft success rate did not significantly differ between the groups (88.5% vs. 96.2%; P = 0.603). No patients developed adhesive otitis media. Between the preoperative and postoperative measurements, the mean air-bone gap improved by 10.2 ± 2.8 dB in the TPME group and 11.6 ± 0.7 dB in the NTPME group; this was significant (P < 0.001) in both groups. CONCLUSIONS Endoscopic cartilage underlay myringoplasty NTPME shorted the operation time and avoided aural fullness and EAC discomfort compared with the TPME technique; however, graft success and hearing improvement were comparable between the two techniques for repairing large perforations in children.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology,Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233, Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233, Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing,Yishan Road 600, 200233, Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology,Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233, Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233, Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing,Yishan Road 600, 200233, Shanghai, China.
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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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Mitton TJ, Killeen DE, Momin ZK, Hunter JB, Isaacson B, Lee K, Kutz JW. Endoscopic Versus Microscopic Pediatric Tympanoplasty: Is There a Difference Between Closure Rates and Hearing Outcomes? Otol Neurotol 2022; 43:1205-1211. [PMID: 36166975 DOI: 10.1097/mao.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare closure rates and hearing outcomes of microscopic and endoscopic tympanoplasty in pediatric patients. STUDY DESIGN Retrospective chart review. SETTING Tertiary university medical center. PATIENTS Pediatric patients who underwent tympanoplasty surgery by a fellowship-trained neurotologist between 2010 and 2019 with a minimum of 2 months of follow-up, a tympanic membrane perforation, and no preoperative cholesteatoma. INTERVENTIONS Transcanal endoscopic tympanoplasty or microscopic tympanoplasty (MT) surgery. MAIN OUTCOME MEASURES The primary outcome is postoperative closure of the tympanic membrane perforation, assessed using otomicroscopy at the last follow-up appointment. Secondary outcomes include operative time and changes in the air-bone gap (ABG) and pure-tone average (PTA). RESULTS Two hundred eleven tympanoplasty operations were analyzed: 121 in the transcanal endoscopic ear surgery (TEES) group and 90 in the MT group. Tympanic membrane closure rates were no different between the two groups (TEES, 82.6%; MT, 88.9%; p = 0.24), and no significant association was found on multivariable analysis (TEES: odds ratio, 0.8; p = 0.61). Both groups showed improvements in the 4-month PTA and ABG and the 12-month PTA, but the 12-month ABG only improved in the TEES group ( p < 0.01). The TEES group had a shorter average operative time (109.8 versus 123.5 min; p = 0.03) and less need for a postauricular incision (2.5% versus 93.3%; p < 0.01). CONCLUSION In pediatric tympanoplasty, TEES gives similar membrane closure and hearing outcomes as the microscopic technique, with less operative time and less need for a postauricular incision.
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Affiliation(s)
- Tanner J Mitton
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zoha K Momin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kenneth Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joe Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Nassif N, Sorrentino T, Losito MT, Zorzi S, Redaelli de Zinis LO. Endoscopic transcanal tympanoplasty type I in children: Evolving experience in tragus perichondrium vs. acellular porcine small intestinal sub-mucosa grafts. Int J Pediatr Otorhinolaryngol 2022; 160:111245. [PMID: 35870255 DOI: 10.1016/j.ijporl.2022.111245] [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: 01/11/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endoscopic trans-canal tympanoplasty type I (ETT) is gradually diffusing worldwide. It mainly allows less invasive surgery in children with respect to a microscope approach by avoiding post-auricular access. The aim of this study is to illustrate our experience in endoscopic reconstruction of tympanic membrane, using autologous tragus perichondrium (TP) and non-autologous acellular porcine small intestinal sub-mucosa (SIS) as grafts. METHODS Between January 2011 and December 2020, the results of a prospective non-randomized series of consecutive ETT were analyzed. The primary outcome was closure rate at 6 months and secondary outcomes are closure rates associated with age, size of perforation, type of perforation and middle ear status, presence of myringosclerosis, type of graft, status of contralateral ear, adenoidectomy and pre-postoperative ABG change. Statistical analysis was performed using the SPSS statistical package. RESULTS One hundred and sixteen consecutive procedures, mean age 9.4 years (range 4-17 years), were evaluated. TP and SIS grafts were used in 65 (56%) and 51 (44%) procedures, respectively. Mean duration of surgical procedure was 53 ± 21 min for SIS and 77 ± 18 min for TP (P = 0.001) Total graft intake was 82.8%; TP and SIS intake were 86.2% and 78.4% (P = 0.3), respectively. Graft intake w.r.t. in age stratified age groups was not statistically significant. Average preoperative and postoperative air-bone gap was 12.1 ± 7.6 dB and 5.5 ± 3.8 dB, respectively (P = 0.001). The difference in closure rates was not significant. Neither intra- nor postoperative complications were observed. CONCLUSIONS In children, ETT is an applicable and less invasive technique compared to the microscope and offers less morbidity. The use of SIS contributes additional less invasiveness to endoscopic surgery by avoiding tragus harvesting with a comparable success rate and granting significantly less surgical duration.
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Affiliation(s)
- Nader Nassif
- Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy.
| | - Tommaso Sorrentino
- Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy
| | - Maria Teresa Losito
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Silvia Zorzi
- Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy
| | - Luca Oscar Redaelli de Zinis
- Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Chen D, Duan M. The study of otoendoscopic tympanoplasty (type I). Acta Otolaryngol 2022; 142:575-578. [PMID: 35984434 DOI: 10.1080/00016489.2022.2104923] [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: 11/01/2022]
Abstract
BACKGROUND With the development of otoendoscopic surgery technology and the update of equipment, more and more otoendoscopic tympanoplasty are carried out. OBJECTIVES To investigate application of otoendoscopic tympanoplasty. METHODS Seventy-six patients with tympanic membrane perforation were randomly enrolled into otoendoscopic group (OP, n = 38) and microscope group (MP, n = 38). We compared two-group patients using operative time, intraoperative blood loss, healing of postoperative perforations, and degree of postoperative hearing improvement. RESULTS Average operation time was statistically significant shorter in the OP than the MP (p < .05); the intraoperative blood loss in the OP was significant less than MP (p < .05); after postoperative follow-up, the healing rate of tympanic membrane perforation was 92.11% in the OP compared to 89.47% in the MP. However, there was no statistically significant difference in the two groups (p > .05). There were no statistically significant differences between the preoperative and postoperative air and bone conduction thresholds in the two groups (p > .05). CONCLUSIONS Otoendoscopic tympanoplasty is a minimally invasive operation but with similar effects as compared to microscopic one. But the operation time and intraoperative blood loss in the OP were significantly better than those in the MP, thus it is a safe, effective and easy to be operated in clinical practice.
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Affiliation(s)
- Dengsheng Chen
- Department of Otolaryngology, People's Hospital of Xuancheng City, The Affiliated Xuancheng Hospital of Wannan Medical College, Xuancheng City, China
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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Mantsopoulos K, Thimsen V, Richter D, Müller SK, Sievert M, Iro H, Hornung J. Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage? Am J Otolaryngol 2021; 42:103122. [PMID: 34166961 DOI: 10.1016/j.amjoto.2021.103122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Performing tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults. OBJECTIVES The aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate. MATERIALS UND METHODS The present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy). RESULTS 83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6-182 months). The anatomical closure rate was 88.0%. Children with "dry" tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB. CONCLUSION Detailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
| | - Vivian Thimsen
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Daniel Richter
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Joachim Hornung
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
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Abood A, Torzynski B, Ovesen T. Pediatric type 1 tympanoplasty - Does age matter? Int J Pediatr Otorhinolaryngol 2020; 137:110219. [PMID: 32804638 DOI: 10.1016/j.ijporl.2020.110219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tympanic membrane perforations might have a negative impact on the patient's quality of life, especially in the pediatric population. Surgery is therefore often required. The most adequate age for surgery remains unclear and is debated in the current literature. The aim of this study was to investigate outcomes of type I tympanoplasty in children and examine the impact of age on surgical outcome. METHODS Retrospective cohort study. All patients under the age of 18 undergoing type I tympanoplasty at Regional Hospital West Jutland, Denmark, from 1/1-2013 to 31/12-2017 had their medical files reviewed. The primary endpoint of interest was tympanic membrane closure rate six months following surgery, i.e. surgical success. Secondary outcomes were air-bone-gap reduction and the correlation between age and surgical success. RESULTS A total of 180 patients undergoing 197 procedures met the predefined criteria. Age at the time of surgery ranged between five and 17 years. Mean age at the time of surgery was 10.1 years (95% CI 9.1-11.2). Surgical success was achieved in 91,3% of the cases. No correlation between age and surgical success was found. Mean air-bone gap was reduced from 19.8 dB (95% CI 18.5-21.0) preoperatively, to 6.9 dB (95% CI 6.1-7.7) at follow-up, p < 0.05. Air-bone gaps ≤10 dB at follow-up were achieved in 155 of the cases (78.6%). Postoperative infection seemed to increase the risk of surgical failure, RR 2.80 ((95% CI 1.06-7.38), p = 0.037). CONCLUSIONS Type 1 tympanoplasty in children is an effective treatment in terms of achieving an intact tympanic membrane and improved hearing. No correlation could be found between age and surgical success. Postoperative infection influences surgical outcome negatively.
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Affiliation(s)
- Ali Abood
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, 7500, Holstebro, Denmark.
| | - Bartosz Torzynski
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, 7500, Holstebro, Denmark.
| | - Therese Ovesen
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, 7500, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, 8200, Aarhus, Denmark.
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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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