1
|
Lou Z, Lou Z, Lv T, Chen Z. Additional cartilage reinforcement of the annulus in myringoplasty for subtotal perforation. Am J Otolaryngol 2024; 45:104232. [PMID: 38417260 DOI: 10.1016/j.amjoto.2024.104232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/03/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE In this study, graft success, hearing outcome, and complications were compared following the repair of subtotal perforation using a cartilage reinforcement underlay technique (CRUT) versus the traditional cartilage underlay technique (TCUT). STUDY DESIGN Randomized controlled trial. MATERIALS AND METHODS Seventy-six patients with subtotal perforations were prospectively randomized to the CRUT (n = 38) or TCUT (n = 38) group. The graft success rate, hearing outcome, and complications were compared at 12 months. RESULTS The mean operation time was 32.9 ± 4.2 (range: 26-47) min in the CRUT group and 51.8 ± 6.3 (range: 48-73) min in the TCUT group (P < 0.001). At 12 months postoperatively, no residual perforation was seen in either group. The graft success rate was 94.7 % (36/38) in the CRUT group and 92.1 % (35/38) in the TCUT group; the difference was not significant (P = 0.643). The postoperative air bone gap (ABG) was significantly improved compared to the preoperative value in both groups, without significant between-group differences in either the preoperative (P = 0.741) or postoperative (P = 0.865) ABG or the mean ABG gain (P = 0.812). Additionally, there were no significant between-group differences in the preoperative (P = 0.887) or postoperative (P = 0.753) mean bone-conduction pure tone average. In the TCUT group, seven (18.4 %) patients developed temporary hypogeusia and two (5.3 %) had external auditory canal scarring. Graft cholesteatoma was not observed in either group. CONCLUSION In the treatment of subtotal perforations, lateral reinforcement of the annulus with additional cartilage is simpler than traditional cartilage underlay for achieving graft and hearing success. The technique also does not involve raising the tympanomeatal flap or removing perforation margins.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang province, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang province, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
| |
Collapse
|
2
|
Keskin S, Tatlıpınar A, Beyazgün V, Dündar TA. Effect of Supporting Anterior Tympanomeatal Angle with Temporofacial Graft in Type 1 Tympanoplasty on Hearing Results and Graft Success in Early Period. Indian J Otolaryngol Head Neck Surg 2023; 75:2966-2973. [PMID: 37974732 PMCID: PMC10646111 DOI: 10.1007/s12070-023-03914-y] [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: 03/05/2023] [Accepted: 05/27/2023] [Indexed: 11/19/2023] Open
Abstract
The treatment of persistent tympanic membrane perforation is tympanoplasty. Presence of perforation in the anterior annulus of the patients undergoing tympanoplasty surgery is a commonly encountered problem in the postoperative period. In this study, we investigated the effects of supporting anterior tympanomeatal angle with a secondary layer of temporal muscle fascia graft in the patients undergoing type 1 tympanoplasty on postoperative hearing outcomes and early graft success. Twenty-seven patients from our clinic who underwent surgery due to chronic otitis media (COM) and whose anterior tympanomeatal angles were supported with temporal muscle fascia graft as a secondary layer were included in the study. Twelve of the patients were male and 15 of them were female. The mean age of the patients was 43,1 years. The data obtained with retrospective investigations of the patient files were statistically analyzed. Audiological results of 27 patients were obtained in the postoperative 3rd month and were compared with the preoperative results. Preoperative pure tone average of bone-conduction and air conduction were 14,68 ± 7,08 dB and 41,63 ± 9,83 dB, respectively. Postoperative pure tone averages of bone-conduction and air conduction were determined to be 15,02 ± 6,40 dB and 26,38 ± 12,79 dB, respectively. The grafts of all patients were intact at the postoperative 3rd month. We can describe the technique we used as modified sandwich tympanoplasty. In this study we found that in patients that undergoing type 1 tympanoplasty, supporting the anterior tympanomeatal angle with temporal muscle fascia graft as a secondary layer is successful in terms of hearing outcomes and graft success.
Collapse
Affiliation(s)
- Serhan Keskin
- Health Sciences University Fatih Sultan Mehmet Health Practice and Research Center, İstanbul, Turkey
| | - Arzu Tatlıpınar
- Health Sciences University Fatih Sultan Mehmet Health Practice and Research Center, İstanbul, Turkey
| | - Vehip Beyazgün
- Health Sciences University Fatih Sultan Mehmet Health Practice and Research Center, İstanbul, Turkey
| | - Tuğba Aslan Dündar
- Health Sciences University Fatih Sultan Mehmet Health Practice and Research Center, İstanbul, Turkey
| |
Collapse
|
3
|
Aziz AARA, Hafez MAS, Mahmoud AG, Hamad AH. Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation. Int Arch Otorhinolaryngol 2023; 27:e667-e671. [PMID: 37876686 PMCID: PMC10593524 DOI: 10.1055/s-0043-1761174] [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: 07/01/2022] [Accepted: 08/24/2022] [Indexed: 03/06/2023] Open
Abstract
Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.
Collapse
Affiliation(s)
| | | | - Ashraf Gamal Mahmoud
- Department of Otorhinolaryngology, Faculty of Medicine, El Minia university, Egypt
| | - AbdelMoneim H. Hamad
- Department of Otorhinolaryngology, Faculty of Medicine, El Minia university, Egypt
| |
Collapse
|
4
|
Lou Z, Lou Z, Wang J, Zhang B, Hu Y, Chen Z. Comparison of Cartilage Reinforcement and Push-Through Techniques for the Treatment of Large Perforations. EAR, NOSE & THROAT JOURNAL 2023:1455613231182661. [PMID: 37341102 DOI: 10.1177/01455613231182661] [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: 06/22/2023] Open
Abstract
Objective: To compare the graft success rate and hearing outcomes of endoscopic cartilage reinforcement perichondrium-cartilage composite graft and push-through techniques for the treatment of large marginal perforations. Study Design: Randomized controlled trial. Materials and Methods: A total of 57 large marginal perforations were prospectively randomized to cartilage reinforcement (n = 29) and cartilage push-through technique (n = 28) groups. The graft success rate, audiometric outcomes, and complications were compared between the 2 groups at 6 months. Results: All patients completed 6 months of follow-up. The graft success rate in the cartilage reinforcement group was significantly higher compared to that in the push-through group (100.0% vs 78.6%, P < .01). Residual perforation was observed in 5 (17.9%) patients, and re-perforation in 1 (3.6%) patient, in the push-through group. The preoperative air-bone gap (ABG) was 17.6 ± 3.5 dB in the cartilage reinforcement group and 16.8 ± 8.4 dB in the push-through group (P > .05). Postoperatively, although the postoperative ABG in the cartilage reinforcement group was higher than that in the push-through group, no significant difference was observed (11.8 ± 4.3 dB vs 8.9 ± 2.5 dB, P > .05). Additionally, no significant difference was found in ABG closure between the 2 groups (6.6 ± 1.9 dB vs 7.9 ± 4.7 dB, P > .05). Conclusion: Cartilage reinforcement myringoplasty is a simpler and more useful technique to achieve graft success compared to cartilage-perichondrium push-through for the treatment of large marginal perforations, and it does not affect hearing levels.
Collapse
Affiliation(s)
- Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, Yiwu, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Boya Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Yibing Hu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| |
Collapse
|
5
|
Bhandarkar AM, Krishnan NV, Mathew NM. Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media. Indian J Otolaryngol Head Neck Surg 2022; 74:32-38. [PMID: 35070923 PMCID: PMC8743324 DOI: 10.1007/s12070-020-02150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022] Open
Abstract
To study the efficacy of interlay cartilage rim augmented fascia tympanoplasty in mucosal chronic otitis media. A retrospective, observational study was conducted in a tertiary care hospital including charts of patients spanning a duration of one year, where 15 patients diagnosed with chronic otitis media-mucosal disease with large and subtotal perforations (with or without ossicular erosion), and had undergone interlay cartilage rim augmented fascia tympanoplasty, were analysed for morphological and functional improvement following surgery. Pre- and post-operative otomicroscopic examination and pure tone audiometry findings were the parameters considered. 86.6% had a well-healed, non-retracted, undisplaced mobile neotympanum, 6.7% who underwent a type III (minor columella) tympanoplasty had a medialised neotympanum and 1 subject (6.7%) who underwent a type I tympanoplasty had a residual pinpoint perforation which healed with conservative management. The overall morphological success rate was 93.3%. The mean hearing gain following surgery was 20.84 dB with a minimum gain of 10 dB and a maximum gain of 30 dB. The mean air-bone gap closure gain achieved was 19.2 dB with a minimum gain of 6.4 dB and a maximum gain of 30 dB. The interlay cartilage-fascia rim augmentation tympanoplasty is a novel, effective graft model suggested for large and sub-total central perforations. Future randomized studies with a larger sample size could be performed with longer follow-up to assess the outcome of this technique.
Collapse
Affiliation(s)
- Ajay M. Bhandarkar
- Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Neethu V. Krishnan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Neethu Mary Mathew
- Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
6
|
Zhang Z, Li JB, Li X, Zhu CY, Ren L, Huang XJ, Wu J, Ji J, Xu ZK. Janus membranes with asymmetric cellular adhesion behaviors for regenerating eardrum perforation. J Mater Chem B 2022; 10:2719-2727. [PMID: 35138320 DOI: 10.1039/d1tb02418c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The tympanic membrane plays an important role in the human hearing system, which is easily perforated under unfavorable conditions, leading to loss of hearing and otitis media. Many autologous materials and artificial materials have been used to repair a perforated tympanic membrane, but these materials sometimes can cause severe hearing loss because of their adhesion to the ossicle during the healing process and the postoperative process. Herein, we report Janus membranes with asymmetric cellular adhesion behaviors for regenerating the eardrum. These Janus membranes are constructed by co-depositing a tannic acid (TA)/3-aminopropyltriethoxysilane (APTES) coating on one surface of the polypropylene microfiltration membrane. Cellular experiments indicate that the Janus membranes have good biocompatibility and asymmetric cellular adhesion properties. The repair of the tympanic membrane perforation experiment and laser Doppler vibrometer (LDV) measurements prove that the hydrophilic surface of Janus membranes repairs perforated eardrums, and meanwhile the hydrophobic surface can avoid adhering to the inner ear tissue for reducing hearing loss. The Janus membranes have good prospects in the treatment of tympanic membrane perforation.
Collapse
Affiliation(s)
- Zhili Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The first affiliated hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jin-Bo Li
- Department of Chemistry, Zhejiang University, Hangzhou 310027, China.
| | - Xu Li
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Cheng-Ye Zhu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Liujie Ren
- Department of FPRS, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.
| | - Xiao-Jun Huang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Jian Wu
- Department of Chemistry, Zhejiang University, Hangzhou 310027, China.
| | - Jian Ji
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Zhi-Kang Xu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, and Key Laboratory of Adsorption and Separation Materials & Technologies of Zhejiang Province, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| |
Collapse
|
7
|
Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 134:1-7. [PMID: 33019948 DOI: 10.1017/s0022215120001978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
Collapse
Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
| |
Collapse
|
8
|
Lou ZC. Endoscopic myringoplasty: comparison of double layer cartilage-perichondrium graft and single fascia grafting. J Otolaryngol Head Neck Surg 2020; 49:40. [PMID: 32571414 PMCID: PMC7310158 DOI: 10.1186/s40463-020-00440-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To compare surgical results of endoscopic myringoplasty using double layer cartilage-perichondrium grafts versus single fascia grafts. Study design Prospective, randomized, controlled. Setting University-affiliated teaching hospital. Subjects and methods In total,134 patients who underwent endoscopic myringoplasty were included in this study. Patients in group A received a double layer tragal cartilage-perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air-bone gap (ABG) and the graft success rate. Results The graft success rate was 98.5% (66/67) in the Group A and 94.0% (63/67) in the Group B at 6 months, the difference wasn’t statistically significant (p = 0.362). However, the graft success rate was 97.0% (65/67) in the Group A and 85.1% (57/67) in the Group B at 12 months, the difference was statistically significant (p = 0.034). In addition, only one patient (1.49%) had small keratin pearls in the Group A, no patients developed cholesteatoma of middle ear in either group. Conclusions The endoscopic double layer perichondrium-cartilage graft technique is feasible for repairing medium or larger perforations, it has a better long-term graft success rate and less operative time compared with the single layer fascia graft technique. However, long-term hearing outcomes were the same for the single and double layer closure techniques.
Collapse
Affiliation(s)
- Zheng Cai Lou
- Department of Otorhinolaryngology, the affiliated Yiwu hospital of Wenzhou medical university (Yiwu central Hospital), 699 jiangdong road, Yiwu city, 322000, Zhejiang provice, China.
| |
Collapse
|
9
|
Ismi O, Gorur K, Gur H, Ozcan C, Vayisoglu Y. Double-Layered (Cartilage Island + Extra Perichondrium) Graft for Type 1 Tympanoplasty. Otolaryngol Head Neck Surg 2020; 163:806-813. [PMID: 32539598 DOI: 10.1177/0194599820931400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the graft success rates and hearing results of single-layered (composite island) grafting (SLG) vs double-layered (composite plus second layer of perichondrium) grafting (DLG) for over-under type 1 tympanoplasty techniques. STUDY DESIGN Retrospective chart review. SETTINGS Tertiary center otorhinolaryngology clinic. SUBJECTS AND METHODS Medical charts of the patients who underwent type 1 tympanoplasty via the microscopic technique by a single surgeon between 2015 and 2019 were analyzed. RESULTS A total of 48 patients were included. The DLG (n = 26) group had higher graft take rates as compared to the SLG group (n = 22) for all patients (P = .038) and for moderate- to high-risk patients according to Middle Ear Risk Index (MERI) scores (P = .029) but not for patients with mild disease (P = .429) or myringosclerotic patients (P = .242). The DLG group exhibited higher air-bone gap closure (C-ABG) values as compared to the SLG group for all patients (P = .018). However, there was no noticeable difference in C-ABG values within the patients with successful grafting (P = .217). Only graft success status had a significant effect on C-ABG values when the multivariate linear regression was performed. (P = .016). Higher MERI scores and presence of myringosclerosis were related to the unsuccessful grafting (P < .01). CONCLUSION DLG tympanoplasty is encouraged, especially for patients with higher MERI scores, to increase the graft success rates. Better hearing outcomes of DLG tympanoplasty were related to the higher graft success status of this technique; DLG had no additional hearing effect for patients with successful grafting. Higher MERI scores and presence of myringosclerosis were related to graft failure.
Collapse
Affiliation(s)
- Onur Ismi
- Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin, Turkey
| | - Kemal Gorur
- Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin, Turkey
| | - Harun Gur
- Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin, Turkey
| | - Cengiz Ozcan
- Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin, Turkey
| | - Yusuf Vayisoglu
- Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin, Turkey
| |
Collapse
|
10
|
Bedri EH, Korra B, Redleaf M, Worku A. Double-Layer Tympanic Membrane Graft in Type I Tympanoplasty. Ann Otol Rhinol Laryngol 2019; 128:795-801. [DOI: 10.1177/0003489419843551] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques. Materials and Methods: A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement. Results: A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( P = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( P < .0001). Preoperative hearing levels ( P = .179), postoperative hearing ( P = .857), and decibels of hearing improvement ( P = .356) were the same for all 3 groups. Conclusion: Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.
Collapse
Affiliation(s)
- Es-hak Bedri
- OtoRino ENT Speciality Clinic, Honorary Otology Faculty, University of Illinois, Addis Ababa, Ethiopia
| | | | - Miriam Redleaf
- Department of OHNS, University of Illinois, Chicago, Chicago, Illinois, USA
| | - Alemayehu Worku
- Addis Ababa University, Tikkur Anbessa, Addis Ababa, Ethiopia
| |
Collapse
|