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Gutierrez JA, Cabrera CI, Stout A, Mowry SE. Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:1453-1466. [PMID: 36951041 DOI: 10.1177/00034894231159000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. METHODS A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. RESULTS Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. CONCLUSION Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. LEVEL OF EVIDENCE 3B.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amber Stout
- Medical Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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2
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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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3
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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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Study of Outcomes of Tympanoplasty Between Wet and Dry Ears in Mucosal Type of COM. Indian J Otolaryngol Head Neck Surg 2022; 74:79-83. [PMID: 36032900 PMCID: PMC9411415 DOI: 10.1007/s12070-020-01835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022] Open
Abstract
This study compares the results of Tympanoplasty in terms of graft uptake and hearing improvement in patients with Chronic Otitis Media which are divided on the basis of discharging ear and non discharging ear with perforation at the time of surgery. Total 110 patients were selected suffering from chronic otitis media. Out which 55 patients had discharging ear (wet ear) and 55 patients had non discharging ear (dry ear). Tympanoplasty was performed using temporalis fascia graft. Hearing improvement and graft uptake was seen in both wet and dry ears. No statistically difference is noted in the results between the two. Mucoid ear discharge at the time of surgery is not a contraindication for Tympanoplasty as it has no adverse effects on the outcomes of the surgery in respect to graft uptake and hearing improvement.
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Xie F, Zhen X, Zhu H, Kou Y, Li C, Guo L, Shi L, Han J, Zhou X. Development and Validation of a Prognostic Model to Predict Hearing Recovery for Patients With Chronic Otitis Media. EAR, NOSE & THROAT JOURNAL 2021:1455613211065519. [PMID: 34907786 DOI: 10.1177/01455613211065519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the factors affecting postoperative hearing recovery in chronic otitis media (COM) patients, establish a clinical prediction model for hearing recovery, and verify the accuracy of the model. METHODS Data of patients with COM who were admitted to our hospital between January 1, 2012 and September 30, 2020 were retrospectively analyzed. We collected data on relevant clinicopathological characteristics of patients. The patients were randomly divided into the development cohort and validation cohorts. A postoperative air-bone gap (ABG) ≤20 dB was defined as successful hearing recovery. Univariate and multivariable logistic regression analyses were used to investigate the association of several prognostic factors with hearing recovery. These factors were then used to establish a nomogram. The model was subjected to bootstrap internal validation and performance evaluation in terms of discrimination, calibration, and clinical validity. RESULTS This study included 2146 patients with COM: the development cohort comprised 1610 patients (mean [standard deviation; SD] age, 44.1 [14.7] years; 733 men [45.5%]) and the validation cohort included 536 patients (mean [SD] age, 42.9 [14.4] years; 234 men [43.7%]). Multivariable logistic regression analysis showed that age, duration of onset, styles of surgery (tympanoplasty, canal wall up-CWU, or canal wall down-CWD), ossicular prosthesis, granulation or calcified blocks around the ossicular chain, ossicular chain integrity, duration of drilling, eustachian tube dysfunction, mixed hearing loss, semicircular canal fistula, and second surgery were associated with hearing recovery. A nomogram based on these variables was constructed. The area under the curve was 0.797 (95% confidence interval [CI], 0.778-0.812) in the development cohort and 0.798 (95% CI, 0.7605-0.8355) in the validation cohort. CONCLUSIONS This study demonstrated the various clinical factors correlated with hearing recovery in patients with COM. The nomogram developed with these data could provide personalized risk estimates of hearing recovery to enhance preoperative counseling and help to set realistic expectations in patients.
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Affiliation(s)
- Fengyang Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, 34708Shandong University, Jinan, China
| | - Xiaoyue Zhen
- Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haiyuan Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yan Kou
- Neonatal Department, 518873The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Changle Li
- Department of Otorhinolaryngology Head and Neck Surgery, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ling Guo
- Department of Otorhinolaryngology Head and Neck Surgery, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li Shi
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, 12589Shandong University, Jinan, China
| | - Jie Han
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, 34708Shandong University, Jinan, China
| | - Xuanchen Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, 34708Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Yang B, Zhang L, Chen X. Evaluation and comparison of tympanoplasty efficacy with tympanic membrane perforation after chronic suppurative otitis media in dry ear with different microorganisms. Am J Otolaryngol 2021; 42:102900. [PMID: 33454455 DOI: 10.1016/j.amjoto.2021.102900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the distribution of pathogenic bacteria in patients with tympanic membrane perforation after chronic suppurative otitis media (CSOM) in dry ear and its influence on the success rate of tympanoplasty and postoperative infection. METHODS 740 patients with tympanic membrane perforation after CSOM underwent endoscopic tympanoplasty were selected. The mucosal surface secretion of middle-ear was collected for bacterial culture and drug sensitivity test. The patients were followed up several times from 1 week to 3 months after the surgery. RESULTS 740 cases of ear secretions samples, raise the pathogens of 208 cases (28.1%), the success rate of surgery with microorganism grown and with no grown was 93.8% and 91.5%. fungus (14.6%) was the most species among the patients with the positive result, followed by methicillin-sensitive Staphylococcus aureus (4.1%), Pseudomonas (2.0%), Staphylococcus epidermidis (1.9%), methicillin-resistant Staphylococcus aureus (1.6%) and so on. There was no statistical difference in the proportion of perforation and infection in each group. There were no statistically significant differences in gender, age and duration of disease among the groups. CONCLUSION There were still microbial colonization in patients with tympanic membrane perforation after CSOM in dry ear, include fungus, Staphylococcus aureus and Pseudomonas aeruginosa. Different microbial colonization had no influence on the success rate of tympanoplasty and postoperative infection.
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7
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Yang J, Lyu J, Wang Y, Chen B, Xu J, Ren D. Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media. EAR, NOSE & THROAT JOURNAL 2021; 102:NP177-NP182. [PMID: 33719601 DOI: 10.1177/0145561321999263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty. METHODS This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups. RESULTS The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group. CONCLUSION Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.
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Affiliation(s)
- Juanmei Yang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Jihan Lyu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Yanmei Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Binjun Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Jianghong Xu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
| | - Dongdong Ren
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine of National Health Commission, Shanghai, People's Republic of China
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8
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The myringoplasty of the perforation with otomycosis. Am J Otolaryngol 2020; 41:102732. [PMID: 32981763 DOI: 10.1016/j.amjoto.2020.102732] [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: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
In consideration of the American Journal of Otolaryngology's reviewing and editing my submission, the author(s) undersigned transfers, assigns and otherwise conveys all copyright ownership to Elsevier Inc. in the event that such work is published in the American Journal of Otolaryngology.
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9
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Tiwari R, Singhal P, Verma N, Sehra R, Yadav R, Agarwal S, Prasad B. Is It Wise to Wait for Ear to Become Dry in Indian Scenario? Indian J Otolaryngol Head Neck Surg 2020; 72:448-452. [PMID: 33088773 DOI: 10.1007/s12070-020-01896-9] [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: 03/30/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022] Open
Abstract
Tympanoplasty is the standard and well-established procedure for closure of tympanic membrane perforations. Tympanoplasty in wet ear is still a topic of debate among ENT surgeons. This study discusses the balance between wait and watch policy and early intervention in wet ear. It also compares the rate of graft uptake and hearing improvement in Type I tympanoplasty in dry and wet ears. This is a hospital based, observational, descriptive and comparative study. Total 246 patients enrolled in the study. Two groups were created with 123 patients in each group. One included dry ears and another included wet ears. All patients had mucosal type of chronic otitis media. They all underwent Type I tympanoplasty. Graft uptake rate and hearing was compared between both groups. The overall success rate (graft uptake) was 91.06% (224). The success rate in dry ear group was 93.50% (115) and in wet ear group it was 88.62% (109). This study concluded that there is no added advantage of drying the ear rather the delay in treatment increases morbidity and drop outs in Indian scenario.
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Affiliation(s)
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Namita Verma
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Ritu Sehra
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Rajeev Yadav
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
- Department of Preventive and Social Medicine, SMS Medical College, Jaipur, Rajasthan India
| | - Sunita Agarwal
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
| | - Beni Prasad
- Department of Otorhinolaryngology, SMS Medical College, 78 A, Lipi Clinics, Vishnupuri, Durgapura, Jaipur, Rajasthan 302018 India
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Lou Z, Li X. A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media. J Laryngol Otol 2020; 134:1-6. [PMID: 32753085 DOI: 10.1017/s0022215120001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The outcomes of dry and wet ears were compared following endoscopic cartilage myringoplasty performed to treat chronic tympanic membrane perforations in patients with mucosal chronic otitis media. METHODS Patients with chronic perforations, and with mucosal chronic otitis media with or without discharge, were recruited; all underwent endoscopic cartilage myringoplasty. The graft success rate and hearing gain were evaluated at six months post-operatively. RESULTS The graft success rates were 85.9 per cent (67 out of 78) in dry ears and 86.2 per cent (25 out of 29) in wet ears; the difference was not significant (p = 0.583). Among the 29 wet ears, the graft success rates were 100 per cent in 11 ears with mucoid discharge and 77.8 per cent in the 18 patients with mucopurulent otorrhoea. CONCLUSION The wet or dry status of ears in patients with chronic perforations with mucosal chronic otitis media did not affect graft success rate or hearing gain after endoscopic cartilage myringoplasty. However, ears with mucopurulent discharge were associated with increased failure rates and graft collapse, whereas ears with mucoid discharge were associated with higher graft success rates.
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Affiliation(s)
- Z Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, China
| | - X Li
- Department of Otolaryngology, Jining No. 1 People's Hospital, China
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11
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Cavel O, Ungar OJ, Oron Y, Ben Ami R, Dekel M, Handzel O. Outcome of surgery for chronic suppurative otitis media with resistant Pseudomonas aeruginosa. Eur Arch Otorhinolaryngol 2020; 278:959-964. [PMID: 32583180 DOI: 10.1007/s00405-020-06152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of surgical treatment of active chronic suppurative otitis media (CSOM) with ciprofloxacin-resistant Pseudomonas aeruginosa (P. aeruginosa) that failed comprehensive local and systemic treatment. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Eleven patients with ciprofloxacin-resistant P. aeruginosa CSOM that remained active despite comprehensive local and systemic treatment. All patients were operated by a single surgeon between February 2016 and July 2019 INTERVENTION(S): Tympanoplasty alone was performed in seven cases and accompanied by mastoidectomy in the other four cases. MAIN OUTCOME MEASURE(S) Resolution of infection and tympanic graft take on otoscopy. The secondary outcome measure is hearing. RESULTS Tympanic graft take was successful and the infectious process was resolved in 8 out of the 11 cases, yielding a success rate of 73%. The average follow-up was 20 months. No surgical complications occurred. CONCLUSIONS Tympanoplasty, with or without mastoidectomy, is safe and yields acceptable anatomical and functional success rates when intensive local and systemic treatment fails to stop the purulent discharge.
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Affiliation(s)
- O Cavel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel.
| | - O J Ungar
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - Y Oron
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
| | - R Ben Ami
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Dekel
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Handzel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, 6423906, Tel-Aviv, Israel
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12
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Darouassi Y, Aljalil A, Ennouali A, Hanine MA, Chebraoui Y, Bouaity B, Touati MM, Ammar H. Prognostic factors of myringoplasty: study of a 140 cases series and review of the literature. Pan Afr Med J 2019; 33:323. [PMID: 31692867 PMCID: PMC6815508 DOI: 10.11604/pamj.2019.33.323.18060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/25/2019] [Indexed: 11/25/2022] Open
Abstract
Myringoplasty is one of the most frequent interventions in otology. It aims to restore the eardrum in order to protect against extrinsic contamination by water and to improve hearing. Our study aimed to analyze the factors that may affect anatomical and functional results of myringoplasty or type I tympanoplasty. A retrospective study was performed of a series of 140 cases of myringoplasty over a 6-years period from 2010 to 2015. The approach was post-auricular in 69% of cases and all the patients underwent an underlay technique. Temporal fascia was used in 90.71% of the cases. After an average follow-up of 13 months, the anatomical and functional results were acceptable, with a tympanic closure rate of 88% and an average audiometric gain of 14.22 dB. Several factors affected our results, including the location of the perforation, the active or inactive status of the chronic otitis media, the condition of the opposite ear and the graft material. In light of our results and those of the literature, we believe that the middle ear should be dry at least two months prior to surgery, use of cartilaginous graft material and underlay technique should be preferred and special precautions should be taken in case of anterior or contralateral perforation.
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Affiliation(s)
| | | | - Amine Ennouali
- ENT Department Military Hospital Avicenna, Marrakech, Morocco
| | | | | | - Brahim Bouaity
- ENT Department Military Hospital Avicenna, Marrakech, Morocco
| | | | - Haddou Ammar
- ENT Department Military Hospital Avicenna, Marrakech, Morocco
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Sharma Y, Mishra G, Patel JV. Comparative Study of Outcome of Type I Tympanoplasty in Chronic Otitis Media Active Mucosal Disease (Wet Ear) Versus Chronic Otitis Media Inactive Mucosal Disease (Dry Ear). Indian J Otolaryngol Head Neck Surg 2017; 69:500-503. [PMID: 29238681 DOI: 10.1007/s12070-017-1233-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022] Open
Abstract
To compare the outcome of type I tympanoplasty with cortical mastoidectomy in chronic otitis media active mucosal disease (wet ear) versus chronic otitis media inactive mucosal disease (dry ear). An observational analytic study was conducted and data collection was done from August 2014 to August 2016. All patients of chronic otitis media with mucosal disease were divided into two groups, one with active disease (group A) and another with inactive disease (group B). The outcome was studied in the form of graft take up rate. Total 103 patients were studied, group A (wet ear) had 67 and group B (dry ear) had 36 patients. Graft take up rate was 94% in wet ear and 100% in dry ear and p value was 0.2. There was no statistically significant difference found between the two groups.
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Affiliation(s)
- Yojana Sharma
- Shri Krishna Hospital, Pramukh Swami Medical College, Karamsad, Anand, Gujarat 388325 India
| | - Girish Mishra
- Shri Krishna Hospital, Pramukh Swami Medical College, Karamsad, Anand, Gujarat 388325 India
| | - Jaykumar V Patel
- Shri Krishna Hospital, Pramukh Swami Medical College, Karamsad, Anand, Gujarat 388325 India
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Serum cotinine levels should optimally be measured when evaluating the outcomes of cartilage tympanoplasty in smokers. Eur Arch Otorhinolaryngol 2017; 274:3553-3555. [DOI: 10.1007/s00405-017-4516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
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Jin ZH, Lou ZH, Lou ZC. Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding. Am J Otolaryngol 2017; 38:479-483. [PMID: 28479299 DOI: 10.1016/j.amjoto.2017.04.014] [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: 01/31/2017] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs). STUDY DESIGN A case series with chart review. SETTING A tertiary university hospital. MATERIALS AND METHODS The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test. RESULTS One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0). CONCLUSION This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.
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Assessment of the success rates of type 1 cartilage tympanoplasty in pediatric and adult patients. Eur Arch Otorhinolaryngol 2017; 274:2669-2671. [DOI: 10.1007/s00405-017-4459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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17
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The future of British otorhinolaryngology is in safe hands. The Journal of Laryngology & Otology 2017; 131:471. [DOI: 10.1017/s0022215117000937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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A moist edge environment aids the regeneration of traumatic tympanic membrane perforations. The Journal of Laryngology & Otology 2017; 131:564-571. [PMID: 28502255 DOI: 10.1017/s0022215117001001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To review the history of moist therapy used to regenerate traumatic tympanic membrane perforations. STUDY DESIGN Literature review. METHODS The literature on topical agents used to treat traumatic tympanic membrane perforations was reviewed, and the advantages and disadvantages of moist therapy were analysed. RESULTS A total of 76 studies were included in the analysis. Topical applications of certain agents (e.g. growth factors, Ofloxacin Otic Solution, and insulin solutions) to the moist edges of traumatic tympanic membrane perforations shortened closure times and improved closure rates. CONCLUSION Dry tympanic membrane perforation edges may be associated with crust formation and centrifugal migration, delaying perforation closure. On the contrary, moist edges inhibit necrosis at the perforation margins, stimulate proliferation of granulation tissue and aid eardrum healing. Thus, moist perforation margins upon topical application of solutions of appropriate agents aid the regeneration of traumatic tympanic membrane perforations.
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Lou Z. Inclusion Criteria and Follow-Up Duration Are Important When Evaluating the Outcomes of Inlay Butterfly Cartilage Tympanoplasty. Otol Neurotol 2017; 38:780-782. [PMID: 28333773 DOI: 10.1097/mao.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, China
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Authors' reply. The Journal of Laryngology & Otology 2016; 130:413-4. [PMID: 27447015 DOI: 10.1017/s0022215116000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Authors' reply. The Journal of Laryngology & Otology 2016; 130:412-3. [PMID: 27447014 DOI: 10.1017/s0022215116000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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"Dry", "moist", and "wet" status of the middle ear in the regeneration of the eardrum. Eur Arch Otorhinolaryngol 2016; 273:4643-4645. [PMID: 27115908 DOI: 10.1007/s00405-016-4054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study. The Journal of Laryngology & Otology 2016; 130:412. [PMID: 26991878 DOI: 10.1017/s0022215116000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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