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Joo HA, Choi HC, Lee DK, Ahn JH, Park HJ, Chung JW, Kang WS. Clinical Outcomes of Endoscopic Butterfly Inlay Cartilage Myringoplasty. Otol Neurotol 2024; 45:773-776. [PMID: 38956760 DOI: 10.1097/mao.0000000000004234] [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: 07/04/2024]
Abstract
OBJECTIVE To review a 3-year case series of endoscopic butterfly inlay cartilage myringoplasty performed by a single surgeon (W.S.K.) and analyze the clinical surgical outcomes. STUDY DESIGN Retrospective study. SETTING Tertiary care academic center. PATIENTS We enrolled 60 ears with tympanic membrane (TM) perforation, receiving endoscopic inlay butterfly myringoplasty between 2019 and 2022. MAIN OUTCOMES AND MEASURES We reviewed patients' demographics, size and location of TM perforation, operation time, complications, and postoperative pain evaluated by the numerical rating scale (NRS). We analyzed the graft uptake success rate in 5 weeks and the perforation closure rate in 4 months after surgery. We also compared the air-bone gap (ABG) before and after the surgery. RESULTS Among the 60 ears included, the mean age was 57.0 years, and 78.3% (47 of 60) had small perforations. The average operation time was 48.9 ± 11.5 minutes, and the postoperative NRS was 2.0 ± 1.6. The immediate graft uptake success rate evaluated at postoperative 5 weeks was 96.7% (58 of 60), with myringitis occurring in three ears. Except for 11 patients lost to follow-up, the perforation closure rate evaluated at postoperative 4 months was 100% (49 of 49). The mean ABG significantly improved from preoperative status (8.87 ± 5.51 dB HL) to postoperative 4 months (6.22 ± 6.03 dB HL) ( p = 0.019). CONCLUSIONS A single surgeon's success rate for endoscopic butterfly inlay cartilage myringoplasty was almost 100%. This surgical procedure is safe and effective, with a high graft success rate.
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Affiliation(s)
- Hye Ah Joo
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Dong Kyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong Ho Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lotto C, Fink R, Stricker D, Fernandez IJ, Beckmann S, Presutti L, Caversaccio M, Molinari G, Anschuetz L. To detach or not to detach the umbo in type I tympanoplasty: functional results. Eur Arch Otorhinolaryngol 2024; 281:2871-2876. [PMID: 38105363 DOI: 10.1007/s00405-023-08370-6] [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: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over-under tympanoplasty type I (TTI). METHODS The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over-under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air-bone gap (ABG), pre- and postoperatively. RESULTS Both underlay and over-under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over-under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery. CONCLUSIONS Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over-under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights.
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Affiliation(s)
- Cecilia Lotto
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Raffael Fink
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Stricker
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Ignacio J Fernandez
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giulia Molinari
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Albazee E, Salamah M, Althaidy M, Hagr A. Underlay Myringoplasty Versus Overlay Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Indian J Otolaryngol Head Neck Surg 2024; 76:1848-1856. [PMID: 38566745 PMCID: PMC10982238 DOI: 10.1007/s12070-023-04425-6] [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: 10/12/2023] [Accepted: 12/03/2023] [Indexed: 04/04/2024] Open
Abstract
Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43], P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04425-6.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Marzouqi Salamah
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Mubarak Althaidy
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
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Çallıoğlu EE, Bozdemir K, Soyyiğit Ş, Atalay S, Arslan B. The role of allergic and nonallergic rhinitis on success of type 1 cartilage tympanoplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:102-107. [PMID: 37918634 DOI: 10.1016/j.otoeng.2023.10.001] [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: 04/02/2023] [Accepted: 07/03/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To investigate the role of allergic rhinitis (AR) and non-allergic rhinitis (NAR) on success of type 1 cartilage tympanoplasty. METHODS This prospective study was conducted on 60 patients who had type 1 cartilage tympanoplasty. The patients were divided into three groups as no-rhinitis (n = 28), NAR (n = 18) and AR (n = 14) groups, based on their symptoms, skin prick tests and/or serum specific IgE levels. AR and NAR groups were treated for their rhinitis symptoms both pre- and postoperatively. The patients were followed up for a minimum of 6 months and compared for graft success rates and audiological outcomes. RESULTS Three study groups were similar for age, gender distributions and preoperative air-bone gaps (p = 0.780, p = 0.167 and p = 0.676, respectively). Postoperative graft perforation rate was 0% in no-rhinitis and AR groups while it was 16.7% in NAR group, with a significant difference among three groups (p = 0.034). The comparison of three study groups for change in the postoperative air bone gaps in comparison with preoperative air bone gaps did not yield any statistically significant result (p = 0.729). CONCLUSION Although AR does not result in failure of type 1 cartilage tympanoplasty in patients treated for rhinitis compared to the control group, NAR does. Pre- and postoperative treatment of patients for rhinitis and employment of cartilage graft may be the key factors for success of surgery in patients with AR. Further studies with a larger sample size are needed.
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Affiliation(s)
- Elif Ersoy Çallıoğlu
- Ankara Bilkent City Hospital, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey.
| | - Kazım Bozdemir
- Yıldırım Beyazıt University, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Şadan Soyyiğit
- Yıldırım Beyazıt University, Department of Allergy and İmmunology, Ankara, Turkey
| | - Saliha Atalay
- Ankara Bilkent City Hospital, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey
| | - Bengi Arslan
- Ankara Bilkent City Hospital, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey
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Faramarzi M, Faramarzi A, Roosta S, Abbasi N, Monabati A. Comparison of subcutaneous soft tissue versus temporalis fascia as a tympanoplasty graft material: a retrospective cohort study. J Laryngol Otol 2024; 138:153-161. [PMID: 37218630 DOI: 10.1017/s0022215123000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. METHODS A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. RESULTS Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air-bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). CONCLUSION Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nadia Abbasi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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Qin X, Yin Y, Sun H, Feng G, Gao Z. Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis. Front Bioeng Biotechnol 2023; 11:1212303. [PMID: 38026880 PMCID: PMC10644457 DOI: 10.3389/fbioe.2023.1212303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background: For patients with severe tympanic adhesion, reconstructing the tympanic air cavity is often challenging, resulting in poor hearing reconstruction outcomes. Therefore, establishing a sound conduction pathway independent of the tympanic air cavity may be a viable method for reconstructing hearing in these patients. Purpose: The objective of this study was to evaluate the feasibility of sound conduction independent of the tympanic air cavity (i.e., replacing the original cavity with a tympanic vibrating material) using finite element analysis. Methods: We established a sound-structure coupling finite element model of the tympanum vibration conduction system, which included the tympanic membrane (TM), ossicular prosthesis, and tympanic vibrating material. This model was used to simulate middle ear vibrations under sound pressure, and we extracted the frequency response curve of the ossicular prosthesis' vibration displacement amplitude to evaluate the sound conduction effect of the middle ear. Next, we adjusted the structural and mechanical parameters of the tympanic vibrating material to analyze its impact on the sound conduction effect of the middle ear. Finally, we compared the frequency response curve of the stapes footplate in normal subjects to evaluate the feasibility of sound conduction independent of the tympanic air cavity. Results: The Shell tympanic vibrating material had a better vibration conduction effect compared to solid or porous tympanic vibrating material. The vibration amplitude decreases with the increasing elastic modulus of the tympanic vibrating material. Implantation of 40 kPa-shell tympanic vibrating material had the lowest hearing loss less than 5 dB, and the hearing loss with 1 MPa-porous tympanic vibrating material was largest and less than 25 dB. Conclusion: Our study suggests that replacing the tympanic air cavity with a tympanic vibrating material is feasible. The establishment of a sound conduction pathway independent of the tympanic air cavity could potentially provide a method for hearing reconstruction in patients with severe tympanic adhesion.
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Affiliation(s)
- Xiao Qin
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Yin
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huiying Sun
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Guodong Feng
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Poupore NS, Smaily H, Carroll WW, Pecha PP. Outcomes of Tympanoplasty After Cleft Palate Repair: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 169:1-11. [PMID: 35943797 PMCID: PMC10733860 DOI: 10.1177/01945998221118251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze graft success rates and hearing outcomes in patients with a history of cleft palate (CP) repair undergoing tympanoplasty. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per PRISMA guidelines, the databases were searched from date of inception through December 14, 2021. Studies of patients with previous CP repair who underwent tympanoplasty were included. Meta-analysis of proportions, continuous measures, odds ratios (ORs), and meta-regression were used to analyze graft success and hearing outcomes after tympanoplasty. RESULTS A total of 323 patients with CP repair and 1169 controls were included. The proportion of graft success was 86.7% (95% CI, 76.1%-94.5%) in patients with CP repair and 88.8% (95% CI, 76.9-96.8) in controls. There was no difference in odds of graft success between patients with CP repair and controls (OR, 1.0 [95% CI, 0.5-1.8]; P = .870). Age was not a significant moderator of graft success in patients with CP repair (r = 0.1 [95% CI, -0.2 to 0.3]; P = .689) or controls (r = -0.0 [95% CI, -0.1 to 0.1]; P = .952). Comparing mean differences between pre- and postoperative air-bone gap was not statistically significant in patients with CP repair and controls (0.2 dB [95% CI, -3.1 to 3.4]; P = .930). Odds of functional success (postoperative air-bone gap <20 dB) were not different between the groups (OR, 0.8 [95% CI, 0.5-1.4]; P = .450). CONCLUSION This meta-analysis does not endorse anatomic or functional differences between patients with CP repair and controls after tympanoplasty. However, there is a paucity of evidence for younger children. Further studies are warranted to elucidate specific risk factors for tympanoplasty outcomes in young patients with previous CP repair.
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Affiliation(s)
- Nicolas S. Poupore
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hussein Smaily
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William W. Carroll
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Lu NE, McCoy JL, Shaffer AD, Dohar JE. Trichloroacetic acid Alloderm™ Myringoplasty as a novel option for tympanic membrane reconstruction in children. Am J Otolaryngol 2023; 44:103889. [PMID: 37121099 DOI: 10.1016/j.amjoto.2023.103889] [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: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE A novel "Modified TCA Alloderm™ Myringoplasty" (TCA myringoplasty) technique for reconstruction of uncomplicated chronic tympanic membrane (TM) perforations is described. MATERIALS AND METHODS Descriptive surgical technique for TCA myringoplasty on 12 total patients from 1/1/2020 to 12/31/2020. 3 patients were excluded for incomplete records. Statistical analysis employed Wilcoxon signed-rank tests. Both structural (pre/post visual inspection and tympanogram) and functional (pre/post pure tone average, PTA) outcome measures are reported. RESULTS 12 total ears were analyzed from 9 patients. Average age at surgery was 6 (range 3-22). Perforation size ranged from 10 to 60 %. Rate of structural success was 100 %. Functionally, postoperative PTA were significantly decreased from preoperative (mdn(range) = 18.44(13.13-24.38) vs mdn(range) = 11.25(6.25-22.50), p = .008). Only one TM required >1 procedure to achieve closure. CONCLUSIONS Chronic TM perforations are typically reconstructed via Type I tympanoplasties with temporalis fascia, reserving myringoplasty for favorable perforations (<25 % in size and posterior). Our novel TCA myringoplasty technique has excellent outcomes independent of size and location. We apply a chemical peel concept to a modified myringoplasty technique, obviating incisions and graft harvest. Advantages of Alloderm™ include: 1) a more rigid graft, facilitating manipulation and precise placement; 2) various size and thickness options, especially useful for dimeric tympanic membranes, tympanolysis of adhesions, and bilateral perforations; 3) no donor morbidity and harvest time; 4) autologous tissue preservation. The sole disadvantage of cost is mitigated by reduced operative time and complication management. This study revealed encouraging proof-of-concept preliminary data warranting prospective and sufficiently powered analysis, supporting the technique as a viable alternative to the gold standard.
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Affiliation(s)
- Nathan E Lu
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Jennifer L McCoy
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Joseph E Dohar
- UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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Albazee E, Abdelaziz A, Magzoub H, Alanzi A, Aldosari N, Al-Qudah M, Alomar K, Abu-Zaid A. Dry versus wet temporalis fascia graft in type-I tympanoplasty: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 2023; 280:1005-1015. [PMID: 36350366 DOI: 10.1007/s00405-022-07725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the efficacy of dry versus wet temporalis fascia graft among patients undergoing type-I tympanoplasty. METHODS Web of Science, Scopus, PubMed, and CENTRAL databases were screened from inception until July 2022. The Cochrane risk of bias tool was used to assess the quality of included RCTs. The outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) in a random-effects model. RESULTS Eight RCTs with 989 patients (dry group = 514 and wet group = 475) were included. The overall quality was 'low', 'some concerns', and 'high' risk of bias in five, two, and one RCT(s), respectively. There were no significant differences between both groups regarding the surgical success rate (n = 8 RCTs, RR 0.99, 95% CI [0.95, 1.03], p = 0.6), audiological success rate (n = 5 RCTs, RR = 0.93, 95% CI [0.73, 1.13], p = 0.48), mean difference in pure tone average (n = 2 RCTs, MD = 2.73 Hz, 95% CI [- 2.31, 7.77], p = 0.29), and mean difference in graft placement time (n = 3 RCTs, MD = - 2.18 min, 95% CI [- 5.11, 0.76], p = 0.15). However, the mean difference in operative time was significantly lower in favor of the wet compared with the dry temporalis fascia group (n = 2 RCTs, MD = 2.95 min, 95% CI [- 1.80, 4.11], p < 0.001). The surgical success rate was not significantly different between both groups according to the tympanic membrane perforation size and site. CONCLUSIONS The type of temporalis fascia graft (dry or wet) did not influence the clinical outcomes of type-I tympanoplasty.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | | | - Houda Magzoub
- Touro College of Osteopathic Medicine, Harlem, NY, USA
| | - Abdulrahman Alanzi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nasser Aldosari
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Mohannad Al-Qudah
- Department of Special Surgery, Division of ORL-HNS, Jordan University of Science and Technology and King Abdullah University Hospital, Irbid, Jordan
| | - Karim Alomar
- College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. .,College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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Illés K, Gergő D, Keresztély Z, Dembrovszky F, Fehérvári P, Bánvölgyi A, Csupor D, Hegyi P, Horváth T. Factors influencing successful reconstruction of tympanic membrane perforations: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:2639-2652. [PMID: 36811654 PMCID: PMC10175362 DOI: 10.1007/s00405-023-07831-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Based on a systematic review and meta-analysis, our study aimed to provide information about the factors that influence the success of tympanic membrane reconstruction. METHODS Our systematic search was conducted on November 24, 2021, using the CENTRAL, Embase, and MEDLINE databases. Observational studies with a minimum of 12 months of follow-up on type I tympanoplasty or myringoplasty were included, while non-English articles, patients with cholesteatoma or specific inflammatory diseases, and ossiculoplasty cases were excluded. The protocol was registered on PROSPERO (registration number: CRD42021289240) and PRISMA reporting guideline was used. Risk of bias was evaluated with the QUIPS tool. A random effect model was used in the analyses. Primary outcome was the rate of closed tympanic cavities. RESULTS After duplicate removal, 9454 articles were found, of which 39 cohort studies were included. Results of four analyses showed significant effects: age (OR: 0.62, CI 0.50; 0.78, p value: 0.0002), size of the perforation (OR: 0.52, CI 0.29; 0.94, p value: 0.033), opposite ear condition (OR: 0.32, CI 0.12; 0.85, p value: 0.028), and the surgeon's experience (OR: 0.42, CI 0.26; 0.67, p value: 0.005), while prior adenoid surgery, smoking, the site of the perforation, and discharge of the ear did not. Four factors: etiology, Eustachian tube function, concomitant allergic rhinitis, and duration of the ear discharge were analyzed qualitatively. CONCLUSIONS The age of the patient, the size of the perforation, the opposite ear status, and the surgeon's experience have a significant effect on the success of tympanic membrane reconstruction. Further comprehensive studies are needed to analyze the interactions between the factors. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Kata Illés
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary. .,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest, 1106, Hungary.
| | - Dorottya Gergő
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Pharmacognosy, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Keresztély
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest, 1106, Hungary
| | - Fanni Dembrovszky
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Fehérvári
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - András Bánvölgyi
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dezső Csupor
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Faculty of Pharmacy, Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Center for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary. .,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest, 1106, Hungary.
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11
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Lovato A, Frisina A, Frosolini A, Monzani D, Saetti R. Negative Outcome of Temporalis Fascia Graft in Tympanoplasty with Excessive Bleeding: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010161. [PMID: 36676785 PMCID: PMC9864983 DOI: 10.3390/medicina59010161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Background and Objectives: Non-autologous graft materials hold promise for tympanic membrane (TM) perforation closure. In the present manuscript, we aimed to evaluate the influence of clinical and surgical (i.e., graft materials) characteristics on tympanoplasty outcome in chronic otitis media (COM). Materials and Methods: We retrospectively reviewed clinical and surgical characteristics of COM patients with TM perforation treated with tympanoplasty and mastoidectomy. Univariate and multivariate appropriate tests were applied. Results: We used xenograft (porcine submucosal collagen) in 163 patients, and temporalis fascia in 210. The mean follow-up time was 37.2 months. Postoperative TM perforation (i.e., negative outcome) was detected in 11.6% of cases with xenograft, and in 12.8% with temporalis fascia. Performing uni- and multivariate analysis, we determined that large (three or all quadrants) TM perforation (p = 0.04) and moderate-to-severe intraoperative bleeding (p = 0.03) were independent prognostic factors of negative outcome. Considering the 197 patients with moderate-to-severe intraoperative bleeding, we disclosed that the use of temporalis fascia (p = 0.03) was an independent risk factor of postoperative TM perforation. Conclusions: According to our results, large TM perforation and moderate-to-severe intraoperative bleeding were independent prognostic factors of negative outcome in adult COM patients treated with tympanoplasty. In the sub-group of COM patients with excessive intraoperative bleeding, use of temporalis fascia was associated with negative outcome; these patients could benefit from xenograft materials. These findings should be tested in large randomized clinical trials.
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Affiliation(s)
- Andrea Lovato
- Department of Neuroscience DNS, Audiology Unit at Treviso Hospital, University of Padova, 31100 Treviso, Italy
- Otorhinolaryngology Unit, Department of Surgical Specialties, Vicenza Civil Hospital, 36100 Vicenza, Italy
- Correspondence:
| | - Antonio Frisina
- Otorhinolaryngology Unit, Department of Surgical Specialties, Vicenza Civil Hospital, 36100 Vicenza, Italy
| | - Andrea Frosolini
- Department of Neuroscience DNS, Audiology Unit at Treviso Hospital, University of Padova, 31100 Treviso, Italy
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Daniele Monzani
- Otorhinolaryngology Unit, Department of Surgical Specialties, University of Verona, 37100 Verona, Italy
| | - Roberto Saetti
- Otorhinolaryngology Unit, Department of Surgical Specialties, Vicenza Civil Hospital, 36100 Vicenza, Italy
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12
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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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13
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Bao JW, Zhan KY, Wick CC. Comparison of endoscopic underlay and
over‐under
tympanoplasty techniques for type I tympanoplasty. Laryngoscope Investig Otolaryngol 2022; 7:1186-1193. [PMID: 36000055 PMCID: PMC9392374 DOI: 10.1002/lio2.879] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty. Methods Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG). Results Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p < .001) and a higher rate of anterior extension (95% vs. 22%, p < .001) than underlay technique. Perforation closure rate was not different between groups (95% vs. 96%). Patients experienced significant improvement in PTA and ABG in both groups. Conclusion The endoscopic over‐under tympanoplasty is comparable to endoscopic underlay tympanoplasty in terms of graft take and audiologic improvement. The over‐under technique is effective for repairing larger perforations or those with anterior extension. Level of evidence IV
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Affiliation(s)
- James W. Bao
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA
| | - Kevin Y. Zhan
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA
| | - Cameron C. Wick
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA
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14
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Wang J, Chawdhary G, Yang X, Morin F, Khalid-Raja M, Farrell J, MacDougall D, Chen F, Morris DP, Adamson RBA. Optical Clearing Agents for Optical Imaging Through Cartilage Tympanoplasties: A Preclinical Feasibility Study. Otol Neurotol 2022; 43:e467-e474. [PMID: 35239620 DOI: 10.1097/mao.0000000000003502] [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: 11/25/2022]
Abstract
HYPOTHESIS Optical clearing agents (OCAs) can render cartilage tympanoplasty grafts sufficiently transparent to permit visualization of middle ear structures in an operated ear using optical coherence tomography (OCT) imaging. METHODS Pieces of human tragal cartilage were treated with glycerol, a commonly used OCA. A reference reflector was imaged with OCT through the tympanoplasty as it cleared and the optical attenuation of the graft was measured. The reversibility of clearing and the dimensional changes associated with glycerol absorption were also measured. In a separate experiment, a human cadaveric temporal bone was prepared to simulate an ossiculoplasty surgery with cartilage replacement of the tympanic membrane. A partial ossicular replacement prosthesis (PORP) inserted in the ear was imaged with OCT through a 0.4mm cartilage graft optically cleared with glycerol. MAIN OUTCOME MEASURE The optical attenuation of 0.4mm cartilage grafts decreased at 2.3+/-1.1 dB/min following treatment with glycerol, reaching a total decrease in attenuation of 13.6+/-5.9 dB after 7 minutes. The optical and dimensional effects of glycerol absorption were reversable following saline washout. In the temporal bone preparation, treatment of a cartilage graft with glycerol resulted in a 13 dB increase in signal-to-noise ratio and a 13 dB increase in contrast for visualizing the PORP through the graft with OCT. CONCLUSIONS Optical clearing agents offer a potential pathway towards optical coherence tomography imaging of the middle ear in post-surgical ears with cartilage grafts.
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Affiliation(s)
- Junzhe Wang
- School of Biomedical Engineering, Dalhousie University
| | - Gaurav Chawdhary
- Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, U.K
| | - Xiaojie Yang
- School of Biomedical Engineering, Dalhousie University
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Francis Morin
- Family Medicine, McGill University, Montreal, Quebec
| | - Mamoona Khalid-Raja
- Stepping Hill Hospital, Stockport NHS Foundation Trust, Great Manchester, England, U.K
| | | | | | - Fangyi Chen
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - David P Morris
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery
| | - Robert B A Adamson
- School of Biomedical Engineering, Dalhousie University
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery
- Electrical and Computer Engineering Department, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Chen CK, Hsu HC, Wang M. Endoscopic tympanoplasty with post-conchal perichondrium in repairing large-sized eardrum perforations. Eur Arch Otorhinolaryngol 2022; 279:5667-5674. [PMID: 35678875 PMCID: PMC9649492 DOI: 10.1007/s00405-022-07476-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/30/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE This study aimed to compare the outcomes of endoscopic tympanoplasty with post-conchal perichondrium (PCP) and microscopic tympanoplasty with temporalis fascia in repairing large-sized eardrum perforations. METHODS We performed a retrospective chart review of 43 patients who underwent type 1 tympanoplasty for simple large-sized perforations. The patients were divided into two groups: Group I (endoscopic ear surgery with a PCP graft, 22 patients) and Group II (microscopic ear surgery with temporalis fascia, 21 patients). Graft success rate, demographic data, pre- and postoperative pure-tone average and word-recognition score, closure of the air - bone gap, and postoperative pain scale scores were compared between the two groups. RESULTS The graft success rates in groups I and II were 86.3% and 85.7%, respectively. The mean operation time in Group I (79.8 ± 16.5 min) was significantly shorter than that in Group II (99.9 ± 26.7 min) (p = 0.006). Both groups showed significant improvements in the pure-tone average and word-recognition scores. Average closure of the air - bone gap (ABG) in groups I and II was 20.7 ± 6.9 dB and 17.6 ± 8.4 dB, respectively. The reduction in ABG in Group I had a significantly higher magnitude than in Group II at 1000 and 2000 Hz, respectively (p = 0.028 and p = 0.017). The two groups showed no significant difference in postoperative pain scores. CONCLUSION Endoscopic tympanoplasty with PCP showed a reliable, fascia-preserved, and excellent outcome in repairing large-sized perforations.
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Affiliation(s)
- Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan ,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan ,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chiao Hsu
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min Wang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan ,Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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16
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谭 志, 刘 映, 刘 斌, 肖 旭, 肖 欢, 彭 韬, 周 恩. [Clinical study on repairing subtotal perforation of tympanic membrane with cartilage island technique combined with palisade technique under otoscope]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1009-1013. [PMID: 34886605 PMCID: PMC10128369 DOI: 10.13201/j.issn.2096-7993.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 06/13/2023]
Abstract
Objective:To investigate the healing rate of subtotal perforation of tympanic membrane repaired by cartilage island technique combined with palisade cartilage technique under otoscope. Methods:A retrospective analysis was performed on 189 patients with chronic suppurative otitis media who were admitted to the Department of Otolaryngology and Head and Neck Surgery of Hunan Provincial People's Hospital from January 2018 to January 2020. The patients were divided into twogroups, in group onethere were 100 patients treated by senior surgeon, which were divided into two subgroups, Group A (68 cases) were treated with cartilage island technique alone, and Group B (32 cases) were treated with cartilage island technique combined with palisade cartilage technique. In group two there were 89 patients treated by junior surgeons, which were divided into two subgroups. In group C, 50 cases were treated with cartilage island technique alone, and in group D, 39 cases were treated with cartilage island technique combined with palisade cartilage technique. Results:The healing rate of tympanic membrane in group 1 was 96.0% (96/100), and in group 2 was 87.6%(78/89).There was statistically significant in group 1 and group 2(χ²=4.504, P=0.034).The healing rate of tympanic membrane was 94.1% (64/68) in group A, 100%(32/32)in group B, 80.0%(40/50) in group C, and 97.4% (38/39) in group D. There was no statistically significant difference between group A and group B (χ²=1.961, P=0.161), there was statistically significant difference between group C and group D (χ²=6.149, P=0.013), and there was statistically significant difference between group A and group C(χ²=5.492, P=0.019)There was no statistical difference between group B and group D(χ²=0.832, P=0.362). Conclusion:For beginners of tympanoplasty, the use of cartilage island technique combined with palisade cartilage technique in otoscope can significantly improve the success rate of tympanoplasty with subtotal tympanic perforation.
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Affiliation(s)
- 志强 谭
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - 映辰 刘
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - 斌 刘
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - 旭平 肖
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - 欢 肖
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - 韬 彭
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - 恩 周
- 湖南省人民医院 湖南师范大学附属第一医院耳鼻咽喉头颈外科(长沙,410005)Department of Otolaryngology Head and Neck Surgery, Hunan Provincial People′s Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
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17
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Mallouk S, Khadi EB, Bijou W, Oukessou Y, Sami R, Redallah LA, Mohammed M. Specific aspects of tympanoplasty in children: A retrospective cohort study of 95 cases. Ann Med Surg (Lond) 2021; 65:102297. [PMID: 33981425 PMCID: PMC8082206 DOI: 10.1016/j.amsu.2021.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Paediatric tympanoplasty is now a common surgical procedure. The age from which it could be proposed varies regarding children specificities such as Eustachian tube dysfunction, the high incidence of upper airway infections and the immaturity of the immune system. The aim of this study is to describe the specific constitutional, epidemiological and operative aspects as well as the anatomical and functional results of tympanoplasty in children. METHODS From 2014 to 2018, a cohort of 95 patients with ages between 6 and 16 years, operated for a type I tympanoplasty, was reviewed by analysing the medical history, the epidemiological and clinical parameters, in addition to the operative features and the functional results. RESULTS The mean age at surgery was 11,7 years. The main risk factors of tympanic perforation were recurrent otitis (78,9%), auricular trauma (16,8%) and tonsillar and adenoid hypertrophy (7,4%). Good anatomical postoperative results with a closed and reinforced neo-tympanic membrane were seen in 90 (94,7%) cases, while a significant improvement of the hearing loss was observed in 87 (91.6%) patients, with a mean value of 34,23 dB HL before and 21,9 dB HL after surgery (p < 0,0001). CONCLUSIONS The indications of type I tympanoplasty in the paediatric population remain a subject of debate, but still offer good anatomical and functional results as long as it is adapted to each particular case.
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Affiliation(s)
- Sanaa Mallouk
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - El Bouhmadi Khadi
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Walid Bijou
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Youssef Oukessou
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Rouadi Sami
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Larbi Abada Redallah
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Mahtar Mohammed
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
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