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Wu X, Zhang Q, Huang Y, Wang X, Feng G. Predictors of Functional Outcomes and Recovery Time Following Tympanoplasty. EAR, NOSE & THROAT JOURNAL 2023:1455613231194748. [PMID: 37605434 DOI: 10.1177/01455613231194748] [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: 08/23/2023] Open
Abstract
Objectives: To identify the predictors of tympanoplasty success including graft success, hearing outcomes, and recovery time. Methods: Patients who underwent a tympanoplasty between January 2019 and July 2022 were enrolled. Hearing outcomes were measured by air-bone gap from pure tone. Demographic data of the patient, surgical parameters, and Ossiculoplasty Outcome Parameter Staging (OOPS) were reviewed and evaluated to predict the success of tympanoplasty using univariate and multivariate logistic or Cox regression analyzes. Results: Of 138 patients, 151 procedures were studied. At the 6-month follow-up visit, the overall graft success was 90.7% and the overall hearing success was 40.4%. There was a correlation between the OOPS index and postoperative hearing success (Spearman r = 0.322). Blood loss > 10 ml and OOPS ≥ 4 were independent predictors of hearing failure. Blocked aditus ad antrum and blood loss > 10 ml were independent predictors of prolonged recovery time. Conclusions: The OOPS index exhibits a strong predictive influence on hearing outcomes after tympanoplasty. A predictive model that combines the amount of blood loss and blockage of aditus ad antrum can serve as a useful tool in predicting postoperative recovery time.
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Affiliation(s)
- Xuan Wu
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Qing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yu Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xi Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Guodong Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Beijing, China
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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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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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Kelleş M, Guler Y, Guler R. Vitamin D: A Factor affecting the Success of Type 1 Tympanoplasty. EAR, NOSE & THROAT JOURNAL 2022:1455613221137224. [PMID: 36367097 DOI: 10.1177/01455613221137224] [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
OBJECTIVES Vitamin D (VD) plays role in wound healing and protection against infections. The relationship between plasma VD level and the outcomes of Type 1 tympanoplasty (T1T) has not been studied before. METHODS A total of 101 patients with chronic otitis media scheduled for T1T were divided into four groups in relation with their VD levels as severe insufficiency, insufficiency, mild-to-modest deficiency and optimal VD level groups. Graft success, hearing improvement and postoperative infection rates were compared among the groups in 12-month follow-up period. RESULTS The graft success rate (P = 0.014) and air-bone gap gain (P = 0.004) were significantly higher, and postoperative infection rate was significantly lower (P < 0.001) in optimal VD level group. CONCLUSION 25-OH VD deficiency should be considered as a factor for failure in T1T. VD replacement may increase success of tympanoplasty in patients with low preoperative serum VD levels.
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Affiliation(s)
- Mehmet Kelleş
- Department of Otorhinolaryngology, Malatya Turgut Ozal University, Medicine Faculty, Malatya, Turkey
| | - Yavuz Guler
- Department of Otorhinolaryngology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Rukiye Guler
- Department of Otorhinolaryngology, Malatya Hasan Calik State Hospital, Malatya, Turkey
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Zhu X, Zhang Y, Xue R, Xie M, Tang Q, Yang H. Predictors of anatomical and functional outcomes following tympanoplasty: A retrospective study of 413 procedures. Laryngoscope Investig Otolaryngol 2021; 6:1421-1428. [PMID: 34938883 PMCID: PMC8665455 DOI: 10.1002/lio2.689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/17/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To identify the predictors of anatomical and functional outcomes following tympanoplasty. STUDY DESIGN A retrospective cohort study. METHODS Patients with chronic suppurative otitis media (CSOM) who underwent a tympanoplasty at Peking Union Medical College Hospital from January 1, 2015 to December 31, 2019 were retrospectively included. Outcome measures included graft success and postoperative pure tone audiometry air-bone gap (PTA-ABG) at last follow-up (≥6 months). PTA-ABG and MERI were calculated. Descriptive, univariable, and multivariable logistic regression analyses were conducted to evaluate the predictors of the graft and hearing outcomes. RESULTS During the study, 385 patients (167 male, 218 female, median age 44 years) undergoing 413 procedures were studied. Out of this, 219 ears underwent tympanoplasty, 45 ears had tympanoplasty with canal wall up mastoidectomy, and 149 ears had tympanoplasty with canal wall down mastoidectomy. At the last follow-up, the overall graft success rate was 91.3% (377/413) and the overall hearing success rate was 40% (165/413). Multivariable analysis results showed that the obstructed aditus ad antrum (OR 2.67, 95%CI 1.13-6.30; P = .025) was an independent prognostic factor for graft failures. Moreover, the obstructed aditus ad antrum (OR 2.18, 95%CI 1.16-4.08; P = .015) and MERI >3 (OR 6.53, 95%CI 3.55-12.02; P < .001) were independent predictors of hearing failures (PTA-ABG > 20 dB). CONCLUSIONS Aditus ad antrum patency was an independent predictor of both graft and hearing success among patients following tympanoplasty. MERI score greater than three was found to be a significant predictor of postoperative hearing and could serve as a useful tool for assisting clinicians in perioperative risk assessment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Xiao‐Hui Zhu
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yong‐Li Zhang
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ruo‐Yan Xue
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Meng‐Yao Xie
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qi Tang
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hua Yang
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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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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Demir E, Terzi S, Celiker M, Erdivanli OC, Coskun ZO, Dursun E. Revision of cartilage tympanoplasty with endoscopic butterfly inlay myringoplasty. Eur Arch Otorhinolaryngol 2021; 279:187-190. [PMID: 33646345 DOI: 10.1007/s00405-021-06669-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE While the use of cartilage graft for revision tympanoplasty is quite common, the data on the revision of cartilage tympanoplasty are limited. Our study aims to present the results of our patients who underwent endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty. METHODS Demographic data, ear sides, perforation locations, graft success rates and hearing results of the patients who underwent endoscopic butterfly inlay myringoplasty for revision of cartilage tympanoplasty between Sep 2017 and Jan 2020 were evaluated. RESULTS A total of 17 patients with 7 (41%) females and 10 (59%) males were included in our study. Eight of the ears (47%) were right and nine (53%) were left. Perforation locations included ten (59%) anterior, six (35%) inferior, and one (6%) posterior. The graft success rate of our study was 100%. No changes were observed in post-operative air conduction, bone conduction and air-bone gap values compared to the pre-operative period (p > 0.05). CONCLUSIONS Endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty is considered to be a safe surgical technique with satisfactory anatomical and hearing results.
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Affiliation(s)
- Emine Demir
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Sehitler Street, No:74, Rize/ Center, Rize, Turkey.
| | - Suat Terzi
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Sehitler Street, No:74, Rize/ Center, Rize, Turkey
| | - Metin Celiker
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Sehitler Street, No:74, Rize/ Center, Rize, Turkey
| | - Ozlem Celebi Erdivanli
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Sehitler Street, No:74, Rize/ Center, Rize, Turkey
| | - Zerrin Ozergin Coskun
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Sehitler Street, No:74, Rize/ Center, Rize, Turkey
| | - Engin Dursun
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University Faculty of Medicine, Sehitler Street, No:74, Rize/ Center, Rize, Turkey
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Verma B, Dawat N, Dabholkar Y, Patil S. Prospective study of use of Island of tragal cartilage in revision tympanoplasty. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_224_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ko CA, Yang CH, Wu CN, Huang P, Hwang CF. Comparison of the Functional Success of Fat Myringoplasty and Perifascial Areolar Tympanoplasty in Transcanal Endoscopic Ear Surgery. EAR, NOSE & THROAT JOURNAL 2020; 101:314-318. [PMID: 32894700 DOI: 10.1177/0145561320947261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We compared the functional outcomes of fat myringoplasty and areolar tympanoplasty through a small postauricular incision in patients who underwent transcanal endoscopic ear surgery (TEES). METHODS The study included patients who underwent myringoplasty or type I tympanoplasty using TEES in our Department of Otolaryngology between April 2016 and May 2019. The patients were divided into 2 groups according to the type of graft material used, which was selected based on the available amount of subcutaneous fat and the surgeon's experience. RESULTS In total, 63 patients received fat tissue grafts (group A) and 77 received areolar tissue grafts (group B). The median operative time was significantly longer in group B (132 minutes) than in group A (65 minutes); perforations were significantly larger in group B than in group A (61.0% vs 29.7% of the eardrum surface). The postoperative air conduction threshold, air-bone gap, and speech reception threshold values were significantly lower than the preoperative values in both groups. The graft success rate did not significantly differ between groups A (96.8%, 61/63) and B (96.1%, 74/77). In group A, the perforation was > 35% of the eardrum surface in 27.0% (17/63) of the patients; the graft success rate was 100% (17/17). In the remaining 46 patients (perforation > 35%), the graft success rate was 95.7% (44/46); this difference was not statistically significant. CONCLUSIONS Transcanal endoscopic ear surgery increases the usefulness of fat myringoplasty for the repair of perforations > 35% of the eardrum surface. Postauricular fatty and areolar tissues are suitable for this simple and rapid technique, which yields excellent outcomes.
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Affiliation(s)
- Chien-An Ko
- Department of Otolaryngology, Kaohsiung 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chao-Hui Yang
- Department of Otolaryngology, Kaohsiung 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Pingche Huang
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung
| | - Chung-Feng Hwang
- Department of Otolaryngology, Kaohsiung 38014Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
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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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Berglund M, Olaison S, Bonnard Å, Fransson M, Hultcrantz M, Florentzson R, Dahlin C, Eriksson PO, Westman E. Hearing outcome after myringoplasty in Sweden: A nationwide registry‐based cohort study. Clin Otolaryngol 2020; 45:357-363. [DOI: 10.1111/coa.13506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/15/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Malin Berglund
- Department of Otorhinolaryngology NU Hospital Group Trollhättan Sweden
- Department of Biomaterials Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Sara Olaison
- Department of Otorhinolaryngology Örebro University Hospital Örebro Sweden
| | - Åsa Bonnard
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Division of CLINTEC Department of Otorhinolaryngology Karolinska Institute Stockholm Sweden
| | - Mattias Fransson
- Department of Otorhinolaryngology Lund University Hospital Lund Sweden
| | - Malou Hultcrantz
- Division of CLINTEC Department of Otorhinolaryngology Karolinska Institute Stockholm Sweden
| | - Rut Florentzson
- Department of Otorhinolaryngology Sahlgrenska University Hospital Gothenburg Sweden
| | - Christer Dahlin
- Department of Biomaterials Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Oral & Maxillofacial Surgery NU Hospital Group Trollhättan Sweden
| | - Per Olof Eriksson
- Department of Surgical Sciences, Otorhinolaryngology Uppsala University Hospital Uppsala Sweden
| | - Eva Westman
- Department of Clinical Sciences, Otorhinolaryngology Umeå University, site Sundsvall Umeå Sweden
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Bayram A, Bayar Muluk N, Cingi C, Bafaqeeh SA. Success rates for various graft materials in tympanoplasty - A review. J Otol 2020; 15:107-111. [PMID: 32884562 PMCID: PMC7451680 DOI: 10.1016/j.joto.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this paper is to review how successful each type of grafts is in tympanoplasty. Methods Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “graft”, “success” “tympanoplasty”, “success rate” with the search limited to the period 1955 to 2017. Results Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are significant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is. Conclusion Although temporal fascia is the most commonly used graft material for tympanoplasty, poor graft stability may cause failure. This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia. Cartilage grafts offer better ability to resist infection, pressure, and cope with insufficient vascular supply. This means that cartilage grafts are suitable for use in revision cases.
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Affiliation(s)
- Ali Bayram
- Kayseri Training and Research Hospital, Department of Otorhinolaryngology, Kayseri, Turkey
| | - Nuray Bayar Muluk
- Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey
| | - Sameer Ali Bafaqeeh
- King Saud University, Department of Otorhinolaryngology, Riyadh, Saudi Arabia
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Olarieta Soto FJ, Antolí-Candela Cano F, Harguindey Antolí-Candela A. Double Medial and Lateral Graft in Myringoplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Olarieta Soto FJ, Antolí-Candela Cano F, Harguindey Antolí-Candela A. Miringoplastia con injerto doble medial y lateral. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:123-130. [DOI: 10.1016/j.otorri.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/26/2018] [Accepted: 04/12/2018] [Indexed: 12/01/2022]
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Hassannia F, Rutka JA. Our experience of long-term result of tympanoplasty using areolar tissue in 359 patients. Clin Otolaryngol 2018; 44:80-83. [DOI: 10.1111/coa.13232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/13/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Fatemeh Hassannia
- Department of Otolaryngology-Head and Neck Surgery; University Health Network; Toronto Ontario Canada
| | - John Alexander Rutka
- Department of Otolaryngology-Head and Neck Surgery; University Health Network; Toronto Ontario Canada
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Iso-Mustajärvi M, Dietz A, Löppönen H. Myringoplasty Quality Control Is Necessary: Comparison of Surgical Results of Two Consecutive Series in A Single Institution. J Int Adv Otol 2018; 14:135-139. [PMID: 29764787 DOI: 10.5152/iao.2018.4276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate and compare myringoplasty results from two different consecutive series conducted at the Kuopio University Hospital during a four-decade period. MATERIALS AND METHODS We reviewed 315 patients (a total of 338 ears) who underwent myringoplasty at Kuopio University Hospital between the years 1986 and 2012. The results from this series were compared with those form a previously published series of 404 patients who underwent myringoplasty between 1970 and 1985 at the same institution. RESULTS Myringoplasty was considered to be successful whenever the tympanic membrane remained closed without atelectasis. The results were analyzed at the 1- and 3-year follow-up. The overall success rate after 1 year was 82.8% compared with 88% in the previous series. The success rate after 3 years was 87.4%. The best closure rate after 1 year (85.7%) was achieved with fascia grafts (n=272) and perichondrium (85.7%, n=14). The closure rate of 61.9% with the perichondrium/cartilage graft (n=21) and 71.0% with the fat graft (n=31) was statistically significantly lower (p < 0.05) compared with that with the fascia graft. The postoperative air-bone gap (0.5-4 kHz) was < 10 dB(HL) in 56.2% and < 20 dB(HL) in 79.6% cases compared with 61% and 87%, respectively, in previous series. CONCLUSION Myringoplasty is a safe procedure with a reasonably high success rate. We observed a slight deterioration in the overall results compared with the previous series. This study highlights the importance of systematic quality control and the results and the need for follow-up of the learning curve after the introduction of new surgical techniques and materials.
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Affiliation(s)
- Matti Iso-Mustajärvi
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Kouhi A, Hajimohammadi F, Dabiri S, Amali A, Enayati N, Manavi S, Saeedi N, Bidar Z. Effects of anesthesia with nitrous oxide on tympanoplasty outcomes: a randomized controlled trial. Acta Otolaryngol 2018; 138:363-366. [PMID: 29043904 DOI: 10.1080/00016489.2017.1388541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate effects of nitrous oxide (N2O), as inhalational anesthetic agent, on tympanoplasty outcomes. METHODS In this randomized controlled trial, patients were randomized into two groups: 39 patients who received N2O as an inhalant anesthesia and 47 patients who did not receive. All were operated on with standard type of ear surgery. The protocol for the two groups was identical. Before surgery baseline audiometry was performed. Postoperative audiological controls were carried out at 3 months. RESULTS There was no statistically significant difference between two groups regarding graft outcomes. No significant differences were found between the two groups regarding air-bone gap or bone conduction hearing level. CONCLUSIONS Nitrous oxide usage does not seem to have significant impact on graft or hearing outcome of patients undergoing surgical repair of tympanic membrane.
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Affiliation(s)
- Ali Kouhi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hajimohammadi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Amali
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Enayati
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Manavi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloufar Saeedi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ziba Bidar
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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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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Tasleem M, Rahman A, Aslam M. Comparative Study of Outcome of Endoscopic Myringoplasty in Active and Inactive Mucosal Chronic Otitis Media Patients. Indian J Otolaryngol Head Neck Surg 2017; 69:319-322. [PMID: 28929062 DOI: 10.1007/s12070-017-1121-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
Abstract
The objective of this study was to compare graft uptake and hearing improvement in active and inactive mucosal chronic otitis media patients after endoscopic myringoplasty. This is prospective study conducted at a government medical college and hospital from February 2014 to August 2015. A total of 40 active (wet) ears with mucoid discharge and 40 inactive (dry) ears (at least 6 weeks dry before surgery) with mucosal chronic otitis media were operated on by endoscopic myringoplasty by transcanal approach. Graft uptake and hearing gain rates 3 months after surgery were compared for both groups. Endoscopic myringoplasty using temporal fascia graft via transcanal approach was used. The graft take rate was 77.5% for the active ear group and 85% for the inactive ear group. The hearing gain rate was 82.5% for the inactive ear group and 72.5% for the active ear group. Differences were found to be statistically insignificant for both graft uptake and hearing gain. The success of endoscopic myringoplasty is not adversely affected by the presence of mucoid ear discharge at the time of surgery, and outcomes are comparable to those of the operation done for inactive ear.
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Affiliation(s)
- Mohd Tasleem
- Department of Otorhinolaryngology, JNMCH AMU, Aligarh, India
| | - A Rahman
- Department of Otorhinolaryngology, JNMCH AMU, Aligarh, India
| | - M Aslam
- Department of Otorhinolaryngology, JNMCH AMU, Aligarh, India
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Santosh UP, Prashanth KB, Rao MSS. Study of Myringoplasty in Wet and Dry Ears in Mucosal Type of Chronic Otitis Media. J Clin Diagn Res 2016; 10:MC01-MC03. [PMID: 27790476 PMCID: PMC5071976 DOI: 10.7860/jcdr/2016/17589.8527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/07/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic otitis media is the most common cause of hearing impairment in the developing countries. Hearing loss can have serious effects on day to day life. Ear discharge in chronic otitis media may continue for months to years with increasing hearing impairment and also life threatening infective complications, which is more common in active and also in inactive disease form as well. Myringoplasty is an operative procedure to close the perforation in tympanic membrane. AIM To compare the success rate of graft uptake in dry and wet ears and to compare the postoperative hearing improvement in dry and wet ear following myringoplasty. MATERIALS AND METHODS The comparative study was carried out on total 30 patients with chronic otitis media with central perforation. Of these 15 patients belong to dry ear group and 15 patients with wet ear group. These selected patients on simple random basis were subjected to clinical, audiological, radiological and laboratory investigations and one day before operation, patients were admitted to the hospital and written informed consent was taken in all cases. All patients underwent underlay technique myringoplasty. Postoperatively all patients were evaluated for graft uptake and hearing improvement by pure tone audiometry at 3rd month follow-up. RESULTS In our study, the successful graft uptake was seen in 80% in dry ear and 73.3% in wet ear, statistically p-value (χ2=1.24) is (p>0.05) which is insignificant. Postoperatively hearing gain was (0-5 dB) in 3 patients (20%) with dry ear and 2 patients (13.5%) with wet ear; (6-10 dB), in 4 patients (26.6%) with dry ear and 6 patients (40%) with wet ear; more than 10 dB in 5 patients (33.3%) with dry ear and 3 patients (20%) with wet ear, statistically p-value is χ2=1.24 (p >0.05) which is not significant. CONCLUSION In this study the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ear by using underlay technique of myringoplasty, also found statistically insignificant.
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Affiliation(s)
- UP Santosh
- Professor, Department of ENT, J.J.M. Medical College, Davangere, Karnataka, India
| | - KB Prashanth
- Professor, Department of ENT, J.J.M. Medical College, Davangere, Karnataka, India
| | - MS Sudhakar Rao
- Postgraduate Student, Department of ENT, J.J.M. Medical College, Davangere, Karnataka, India
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Abstract
AbstractObjective:To identify factors that significantly influence myringoplasty success.Methods:A retrospective study was performed of all adults and children who underwent myringoplasty from January 2005 to January 2010 in a teaching hospital. Outcome measures were tympanic membrane perforation closure and air–bone gap closure to within 20 dB HL. The factors assessed were the surgeon grade, pre-operative condition of the ipsilateral and contralateral middle ears, perforation site, perforation size, graft material, and whether simultaneous cortical mastoidectomy was performed. Factors with statistically significant effects were determined by logistic regression analysis.Results:In the adult group, the perforation site significantly influenced tympanic membrane closure (p = 0.016): anterior (p = 0.008) and subtotal (p = 0.017) sites had the greatest influence. None of the factors proved to have a significant influence on tympanic membrane closure in the paediatric group.Conclusion:There was a significant association between perforation site and tympanic membrane perforation closure in adults. Anterior and subtotal perforations had a significantly reduced closure rate.
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Gun T, Sozen T, Boztepe OF, Gur OE, Muluk NB, Cingi C. Influence of size and site of perforation on fat graft myringoplasty. Auris Nasus Larynx 2014; 41:507-12. [PMID: 25199735 DOI: 10.1016/j.anl.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results. METHODS The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium-large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients' follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year. RESULTS The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium-large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p>0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p<0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations. CONCLUSION Fat graft myringoplasty (FGM) may be used in all small and medium-large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium-large perforations; patients with small perforations had more satisfied audiological outcome than medium-large perforations.
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Affiliation(s)
- Taylan Gun
- İstanbul Bahçeşehir University, Faculty of Medicine, ENT Department, İstanbul, Turkey
| | - Tevfik Sozen
- Hacettepe University Faculty of Medicine, ENT Department, Ankara, Turkey
| | | | - Ozer Erdem Gur
- Antalya Education and Research Hospital, ENT Department, Antalya, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Cemal Cingi
- Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey
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Does glubran 2 improve the graft uptake in tympanoplasty? A retrospective study. Eur Arch Otorhinolaryngol 2014; 272:3-8. [PMID: 24619202 DOI: 10.1007/s00405-014-2979-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
Tympanoplasty is a common procedure in otolaryngology practice and several factors have been described to increase graft uptake. Independent of the technique and graft material, the revascularization process of the graft is related to patient factors as well as contact of the tympanic membrane remnant's edges with the graft material. A number of different tissue glue materials and other packing methods have been used for graft stabilization. Glubran 2, a cyanoacrylate containing surgical tissue adhesive, has highly effective anticoagulant and adhesive properties, and the present study aims to reveal the effectiveness of this glue on tympanoplasty surgery. The study is designed as retrospective chart review and it was set up at Etlik İhtisas Research and Training Hospital which is a tertiary care center. The study population consisted of 68 consecutive patients aged between 9 and 75 years who underwent over-underlay tympanoplasty. The patients were divided into two groups according to use of glubran 2 as a sealing material for graft fixation. The patients in whom glubran 2 was not used served as the control group. There were 20 women and 16 men in the glubran 2 group, 17 women and 15 men in the control group. These two groups were also subdivided into two groups for the graft type used (temporal muscle fascia or tragal cartilage). The overall graft take rate was 88.9 % in the tympanoplasty group sealed with glubran 2 and 84.4 % in the control group. A statistically significant decrease was seen in hearing thresholds in both groups postoperatively when compared to the preoperative values (p < 0.001 for both). There was no significant otorrhea in either group. Graft uptake and hearing recovery were similar in glubran 2 and control groups. These findings suggest that glubran 2 is an effective material for fixation of the graft in tympanoplasty, but it does not have a notable effect on the success of the surgery.
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Lade H, Choudhary SR, Vashishth A. Endoscopic vs microscopic myringoplasty: a different perspective. Eur Arch Otorhinolaryngol 2013; 271:1897-902. [PMID: 23999592 DOI: 10.1007/s00405-013-2673-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/19/2013] [Indexed: 11/26/2022]
Abstract
The objectives of this study were to ascertain the feasibility of transcanal endoscopic underlay myringoplasty using temporalis fascia and compare the results with microscopic myringoplasty. This prospective randomized trial included 60 patients with mucosal chronic otitis media with tympanic membrane perforations of all sizes and locations apart from posteriorly based small or moderate sized perforations. In the endoscopy group, 30 patients underwent exclusive transcanal myringoplasty using tympanomeatal flap elevation with underlay graft placement. In the microscopy group, 30 patients underwent myringoplasty using the postaural approach. Intra-operative variables compared were canalplasty and canal wall curettage for assessment of ossicular status. Graft uptake, hearing outcomes using pure tone audiometry and subjective cosmetic outcomes were assessed 24 weeks post-operatively and compared in the two groups. Resident feedback on the feasibility of endoscopic myringoplasty was obtained using a questionnaire. In the microscopy group, 5/30 patients required canalplasty due to canal overhangs and 4/30 required canal wall curettage for ossicular assessment, whereas none of the patients in the endoscopy group required these procedures. A graft uptake rate of 83.3% was observed in both groups post-operatively after 24 weeks. Mean air-bone gap pre- and post-operatively in the endoscopy group was 28.5 and 18.13 dB, respectively, whereas these values were 32.4 and 16.9 dB, respectively, in the microscopy group. Subjective cosmetic outcomes were better in the endoscopy group. Resident feedback on endoscopic myringoplasty was positive. Endoscopic myringoplasty appears to be an effective alternative to microscopic myringoplasty and results in excellent hearing with good cosmetic outcomes.
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Affiliation(s)
- Himani Lade
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Mills R, Thiel G, Mills N. Results of myringoplasty operations in active and inactive ears in adults. Laryngoscope 2013; 123:2245-9. [DOI: 10.1002/lary.23772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Robert Mills
- Otolaryngology Unit; University of Edinburgh; Edinburgh; United Kingdom
| | - Gundula Thiel
- Otolaryngology Unit; University of Edinburgh; Edinburgh; United Kingdom
| | - Nadtaya Mills
- Department of Otolaryngology-Head and Neck Surgery; Khon-kaen Hospital; Khon-kaen; Thailand
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Factors affecting hearing improvement following successful repair of the tympanic membrane. The Journal of Laryngology & Otology 2013; 127:349-53. [PMID: 23433057 DOI: 10.1017/s0022215113000157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The main aim of tympanic membrane repair is the elimination of chronic or intermittent aural discharge. Hearing improvement may or may not occur following a technically successful operation. METHOD This study entailed a retrospective analysis of prospectively collected data from 203 operations that resulted in an intact tympanic membrane 6 months after surgery. RESULTS Complete hearing data were available for 169 operations on 160 patients. Of these, 53 per cent resulted in closure of the air-bone gap to within 10 dB, and 54 per cent of cases had post-operative hearing thresholds of at least 30 dB. The mean hearing change after surgery was +8.3 dB. Multiple regression analysis indicated that hearing improvement was more likely in large compared with small perforations. Smaller hearing gains occurred in ears with erosion of the stapes arch and/or fixation of the stapes, as well as in those with active discharge at the time of surgery and in revision cases. CONCLUSION Greater hearing improvement can be expected following successful repair of perforations involving more than 50 per cent of the drum area. Poorer results are likely to occur in ears with additional middle-ear pathology and in revision cases.
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Altuna X, Navarro JJ, Algaba J. Island cartilage tympanoplasty in revision cases: anatomic and functional results. Eur Arch Otorhinolaryngol 2011; 269:2169-72. [DOI: 10.1007/s00405-011-1875-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022]
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