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Del Puppo M, Farinetti A, Roman S, Rossi ME, Le Treut C, Nicollas R, Moreddu E. Tympanic Perforations in Children: When to Propose Surgical Closure? Otol Neurotol 2024; 45:419-425. [PMID: 38437809 DOI: 10.1097/mao.0000000000004148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE This study aims to analyze the impact of age and other prognostic factors on the success of myringoplasty. STUDY DESIGN A retrospective case series. SETTINGS Pediatric ENT department of a tertiary academic center. PATIENTS Two hundred forty-one children (318 ears) aged 3 to 17 years with tympanic perforation. INTERVENTION Myringoplasty performed between 2009 and 2019. MAIN OUTCOMES MEASURES The rate of tympanic closure, perforation recurrence, revision surgery, and audiometric gain were collected. The impact of age and anatomical and surgical factors was analyzed for each procedure. RESULTS With a mean follow-up time of 1 year, the tympanic closure rate was 87.7%, the perforation recurrence rate was 18.6%, and 16.7% of ears required reoperation. The mean air-bone gap decreased from 21 dB preoperatively to 12 dB postoperatively ( p < 0.0001). We did not find different anatomical and audiometric results for our three groups of patients classified according to age. Audiometric results were associated with the location of the perforation, intraoperative inflammation of the middle ear mucosa, and the surgical technique performed. CONCLUSION Myringoplasty in children is associated with excellent anatomical and functional results, even in the youngest patients. It can be proposed whatever the child's age if the patients are well selected before giving the indication.
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Affiliation(s)
- Marine Del Puppo
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, AP-HM, Aix Marseille Université, Marseille, France
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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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Ferlito S, Fadda G, Lechien JR, Cammaroto G, Bartel R, Borello A, Cavallo G, Piccinini F, La Mantia I, Cocuzza S, Merlino F, Achena A, Brucale C, Mat Q, Gargula S, Fakhry N, Maniaci A. Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study. J Clin Med 2022; 11:jcm11237000. [PMID: 36498572 PMCID: PMC9740685 DOI: 10.3390/jcm11237000] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.
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Affiliation(s)
- Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Gianluca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Ambroise Paré Hospital (APHP), Paris Saclay University, 75016 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1000 Brussels, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75016 Paris, France
| | - Giovanni Cammaroto
- Department of Otolaryngology-Head and Neck Surgery, Morgagni Pierantoni Hospital, 47121 Forli, Italy
| | - Ricardo Bartel
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitario Mutua Terrasa, 8080 Barcelona, Spain
| | - Andrea Borello
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Francesca Piccinini
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Andrea Achena
- U.O.C. di Otorinolaringoiatria ASST Grande Ospedale Metropolitano Niguarda, 20100 Milano, Italy
| | - Cristina Brucale
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Quentin Mat
- Department of Medicine, Neurology, CHU de Charleroi, 15022 Charleroi, Belgium
| | - Stéphane Gargula
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, 75016 Paris, France
| | - Nicolas Fakhry
- Service d’Otorhinolaryngologie et de Chirurgie Cervico-Faciale, Université Aix-Marseille, Hôpital de La Conception, 147, Boulevard Baille, 13005 Marseille, France
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-3204154576
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Deschuytere L, Van Hoecke H, De Leenheer E, Loose D, Dhooge I. Long-term anatomic and functional outcome of pediatric myringoplasty in primary and revision cases. Int J Pediatr Otorhinolaryngol 2022; 162:111313. [PMID: 36103794 DOI: 10.1016/j.ijporl.2022.111313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/08/2022] [Accepted: 09/03/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the long-term anatomical and functional results of myringoplasty in a large cohort of children and analyse factors determining outcome of surgery. METHODS A retrospective analysis of 469 cases of primary and revision pediatric myringoplasties conducted between 2003 and 2018 at the Ghent University Hospital was performed. Anatomical success was defined as an intact tympanic membrane postoperatively. Overall success was defined as an intact tympanic membrane, preservation or improvement of hearing and an ear free from otitis media with effusion, atelectasis, ear discharge and myringitis. The impact of different variables on outcome was investigated by univariate analysis. RESULTS In primary cases, anatomical success was achieved in 96.8% and 94.3% at early respectively late evaluation (after 1 resp. 12 months). Overall success was achieved in 65.4% and 68.5% at early and late evaluation respectively. In revision cases, early anatomical and overall success were achieved in 96.8% and 53.8%, dropping to respectively 88.9% and 47.1% at late evaluation. In primary cases, presence of bilateral perforations was a significant predictor of a negative anatomical outcome. Further analysis of anatomical, audiological, and overall success rates in primary and revision cases could not withhold any significant predictors. CONCLUSION Anatomical success rates of myringoplasty in children are high, in primary as well as revision surgery. When taking the functional status in account however, success rates are lower. The presence of a bilateral perforation predicts a worse outcome with higher anatomical failure rates. No other factors with significant predictive effect on outcome were identified.
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Affiliation(s)
- Lien Deschuytere
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium.
| | - Helen Van Hoecke
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - David Loose
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Department of Otorhinolaryngology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Bruno C, Guidi M, Locatello LG, Gallo O, Trabalzini F. Current outcomes of myringoplasty in a European referral children's hospital. Int J Pediatr Otorhinolaryngol 2022; 160:111246. [PMID: 35863147 DOI: 10.1016/j.ijporl.2022.111246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Myringoplasty is a frequently performed procedure in children, with a heterogeneous failure rate. Our study aimed to evaluate the outcome of myringoplasty in a pediatric hospital and to identify which are risk factors for reperforation or poor hearing improvement after surgery. METHODS Preoperative and intraoperative variables between pediatric patients who had undergone myringoplasty with an intact tympanic membrane at follow-up and the cases with reperforation were compared. The same factors were investigated as potential predictors of audiological success. Pre and postoperative PTA and ABG were compared in the whole population, in structural success and failure groups and closure of ABG was calculated and used to compare the audiological outcomes between the two groups. RESULTS Parameters that affected the postoperative integrity of TM were age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure. Early perforations occurred mostly after surgeries performed by trainees, while late perforations were more frequently in autumn. Myringoplasty, regardless of the structural outcome, can improve the ABG and PTA. No preoperative and intraoperative parameters affected the audiological outcome. CONCLUSION Pediatric myringoplasty is a safe and successful procedure that can improve hearing, regardless of the structural outcome. In light of our results, parameters to consider before surgery are age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure.
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Affiliation(s)
- Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy.
| | - Mariapaola Guidi
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
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Comparitive Study on Impact of Dry (Rigid) Versus Wet (Soft) Graft on the Outcome of Type 1 Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:16-20. [PMID: 36032912 PMCID: PMC9411427 DOI: 10.1007/s12070-019-01785-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/26/2019] [Indexed: 11/25/2022] Open
Abstract
To analyse the rate of success of dry versus wet temporalis fascia graft in type 1 tympanoplasty. A prospective, randomised study was conducted. One hundred adult patients (males and females) with chronic suppurative otitis media (mucosal type) were divided into 2 groups of 50 each: one group underwent dry temporalis fascia graft tympanoplasty and the other underwent wet temporalis fascia graft tympanoplasty. The dry graft and wet graft groups had overall surgical success rates of 82 and 90%, respectively; this finding was not statistically significant. A dry or wet temporalis fascia graft does not influence the outcome of type I tympanoplasty.
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Maharjan M, Shrestha M, Bajracharya R. Early Results of Type I Tympanoplasty in Underprivileged Nepalese Children and Factors Influencing the Surgical Outcomes. Int Arch Otorhinolaryngol 2022; 27:e50-e55. [PMID: 36714895 PMCID: PMC9879643 DOI: 10.1055/s-0042-1743288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/22/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Type I Tympanoplasty is a common ear surgery performed in Nepalese children, but no studies have been published about the success rate of the procedure and the factors affecting surgical outcomes. Objectives To find out the surgical outcome of type I tympanoplasty and to evaluate the factors affecting the success of the surgery in Nepalese children. Methods This is a retrospective study conducted by analyzing the medical records of a five-year period. Children aged 8-16 years who underwent type I tympanoplasty were included in the study. Surgical pro-forma and records of pre and post-operative pure tone audiometry were documented. Outcome of the surgery was considered a success in terms of graft uptake and hearing improvement six months after surgery. Results Out of 629 children who underwent type I tympanoplasty, anatomical success was observed in 93.32% ( n = 587) and functional success in 76% ( n = 478). Factors such as age, site and size of the perforation, status of the middle ear and contralateral ear, surgical approach, and the graft used were not the predictors of the surgical outcome. Conclusions The surgical outcome of type I tympanoplasty in Nepalese children was good. Although surgical outcome was better with older children, post-aural approach, temporalis fascia, inferiorly positioned perforations, and in children with dry middle ear mucosa, none of the parameters considered in this study were found to be a significant predictive factor of the surgical outcome.
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Affiliation(s)
- Milan Maharjan
- Otology Department, Ear Care Nepal, Lalitpur, Nepal,Address for correspondence Milan Maharjan, MBBS, MS, Ear Nose Throat and Head Neck Surgeon Ear Care NepalLalitpur 44600Nepal
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Housley DM, Irani D, Housley GD, Ten Cate WJF. Audiological and Surgical Correlates of Myringoplasty Associated with Ethnography in the Bay of Plenty, New Zealand. Audiol Neurootol 2022; 27:406-417. [PMID: 35477110 DOI: 10.1159/000524312] [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: 12/01/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This retrospective cohort study of myringoplasty performed at Tauranga Hospital, Bay of Plenty, New Zealand from 2010 to 2020 sought to identify predictive factors for successful myringoplasty with particular consideration given to the known high prevalence of middle ear conditions in New Zealand Māori. METHODS Outcomes were surgical success (perforation closure at 1 month) and hearing improvement, which were correlated against demographic, pathological, and surgical variables. RESULTS 174 patients underwent 221 procedures (139 in children under 18 years old), with 66.1% of patients being New Zealand Māori and 24.7% New Zealand European ethnicity. Normalized by population demographics, New Zealand Māori were 2.3 times overrepresented, whereas New Zealand Europeans were underrepresented by 0.34 times (a 6.8 times relative treatment differential). The rate of surgical success was 84.6%, independent of patient age, gender, and ethnicity. A postauricular approach and the use of temporalis fascia grafts were both correlated with optimal success rates, whereas early postoperative infection (<1 month) was correlated with ∼3 times increased failure. Myringoplasty improved hearing in 83.1% of patients (average air-bone gap reduction of 10.7 dB). New Zealand Māori patients had ∼4 times greater preoperative conductive hearing loss compared to New Zealand Europeans, but benefited the most from myringoplasty. DISCUSSION/CONCLUSION New Zealand Māori and pediatric populations required greater access to myringoplasty, achieving good surgical and audiological outcomes. Myringoplasty is highly effective and significantly improves hearing, particularly for New Zealand Māori. Pediatric success rates were equivalent to adults, supporting timely myringoplasty to minimize morbidity from untreated perforations.
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Affiliation(s)
- David M Housley
- Department of Otolaryngology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Dinaz Irani
- Department of Otolaryngology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Gary D Housley
- Translational Neuroscience Facility & Department of Physiology, School of Medical Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Wouter-J F Ten Cate
- Department of Otolaryngology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Mantsopoulos K, Thimsen V, Richter D, Müller SK, Sievert M, Iro H, Hornung J. Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage? Am J Otolaryngol 2021; 42:103122. [PMID: 34166961 DOI: 10.1016/j.amjoto.2021.103122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Performing tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults. OBJECTIVES The aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate. MATERIALS UND METHODS The present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy). RESULTS 83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6-182 months). The anatomical closure rate was 88.0%. Children with "dry" tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB. CONCLUSION Detailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
| | - Vivian Thimsen
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Daniel Richter
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Joachim Hornung
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
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Significance of the middle ear risk index in predicting tympanoplasty success in the elderly. Eur Arch Otorhinolaryngol 2020; 278:3689-3695. [PMID: 33068171 DOI: 10.1007/s00405-020-06430-9] [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: 06/28/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the relationship between middle ear risk index (MERI) score and success of tympanoplasty in elderly (≥ 60 years) compared with young patients (18-59 years) and to investigate the prognostic factors affecting the success of tympanoplasty. METHODS Patients were subdivided into three subgroups according to the MERI score as follows: mild (0-3), moderate (4-6), and severe (≥ 7). Ages, perforation sides and location, preoperative and postoperative audiological results, and the graft success of 29 patients aged over 60 years were compared with those of 52 patients aged between 18 and 59 years. RESULTS Preoperative and postoperative air conduction, preoperative and postoperative bone conduction, and preoperative and postoperative air-bone gap (ABG) were higher in the older group compared with the younger group (p < 0.05). The hearing gain in the younger group was 12.63 (6.43), and in the older group was 12.66 (7.85), while did not differ significantly between groups (p = 0.689). Results demonstrated that cases with low/moderate score of MERI had a higher graft success rate compared with patients with a high score of MERI (Φ = 0.391; p < 0.001) as well as, patients with low/moderate score of MERI had the lower need for mastoidectomy compared with patients with a high score of MERI (Φ = 0.385; p = 0.001). CONCLUSION Low/medium MERI scores were the variables that provided realistic expectations and increased the success of tympanoplasty more precisely before surgery. The surgeon will also be able to design an operation strategy as a case study for elderly patients by doing so.
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Huang YB, Hu LL, Ren DD, Han Z. Myringoplasty With an Ultrathin Cartilage-Perichondrium Complex Graft Versus Temporalis Fascia Graft: A Propensity Score-Matched Analysis. Otolaryngol Head Neck Surg 2020; 164:1287-1293. [PMID: 33048615 DOI: 10.1177/0194599820965940] [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: 12/20/2022]
Abstract
OBJECTIVE To compare endoscopic myringoplasty using the cartilage-perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group). STUDY DESIGN A retrospective cohort study. SETTING Department of Otorhinolaryngology in a tertiary Chinese hospital. METHODS Data were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score-matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed. RESULTS In the control and test groups, 90.90% and 86.36% of patients had a mean air-bone gap ≤20 dB after the surgery, respectively (P = .843). The air conduction (AC) threshold gain at each frequency was similar in the 2 groups (P > .05). The closure rates were 95.45% and 93.18%, respectively (P = .645). The air-bone gap improved significantly after surgery, F(1, 61) = 6.729, P = .012. Age, group, middle ear mucosal status, and location of the perforation did not affect the change in air-bone gap or the drum closure rate (P > .05). However, there was an interaction between the change in air-bone gap and the size of the perforation, F(1, 61) = 11.067, P = 0001. CONCLUSION Endoscopic myringoplasty using a cartilage-perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air-bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air-bone gap improvement.
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Affiliation(s)
- Yi-Bo Huang
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Lu-Lu Hu
- Department of Otolaryngology-Head and Neck Surgery, Fuyang People's Hospital, Fuyang City, Anhui Province
| | - Dong-Dong Ren
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, Xuhui District, China
| | - Zhao Han
- Department of Otorhinolaryngology, HuaDong Hospital affiliated to Fudan University, Shanghai, China
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12
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Abood A, Torzynski B, Ovesen T. Pediatric type 1 tympanoplasty - Does age matter? Int J Pediatr Otorhinolaryngol 2020; 137:110219. [PMID: 32804638 DOI: 10.1016/j.ijporl.2020.110219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tympanic membrane perforations might have a negative impact on the patient's quality of life, especially in the pediatric population. Surgery is therefore often required. The most adequate age for surgery remains unclear and is debated in the current literature. The aim of this study was to investigate outcomes of type I tympanoplasty in children and examine the impact of age on surgical outcome. METHODS Retrospective cohort study. All patients under the age of 18 undergoing type I tympanoplasty at Regional Hospital West Jutland, Denmark, from 1/1-2013 to 31/12-2017 had their medical files reviewed. The primary endpoint of interest was tympanic membrane closure rate six months following surgery, i.e. surgical success. Secondary outcomes were air-bone-gap reduction and the correlation between age and surgical success. RESULTS A total of 180 patients undergoing 197 procedures met the predefined criteria. Age at the time of surgery ranged between five and 17 years. Mean age at the time of surgery was 10.1 years (95% CI 9.1-11.2). Surgical success was achieved in 91,3% of the cases. No correlation between age and surgical success was found. Mean air-bone gap was reduced from 19.8 dB (95% CI 18.5-21.0) preoperatively, to 6.9 dB (95% CI 6.1-7.7) at follow-up, p < 0.05. Air-bone gaps ≤10 dB at follow-up were achieved in 155 of the cases (78.6%). Postoperative infection seemed to increase the risk of surgical failure, RR 2.80 ((95% CI 1.06-7.38), p = 0.037). CONCLUSIONS Type 1 tympanoplasty in children is an effective treatment in terms of achieving an intact tympanic membrane and improved hearing. No correlation could be found between age and surgical success. Postoperative infection influences surgical outcome negatively.
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Affiliation(s)
- Ali Abood
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, 7500, Holstebro, Denmark.
| | - Bartosz Torzynski
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, 7500, Holstebro, Denmark.
| | - Therese Ovesen
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, 7500, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, 8200, Aarhus, Denmark.
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13
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Polanik MD, Trakimas DR, Black NL, Cheng JT, Kozin ED, Remenschneider AK. High-Frequency Conductive Hearing following Total Drum Replacement Tympanoplasty. Otolaryngol Head Neck Surg 2020; 162:914-921. [PMID: 32097057 DOI: 10.1177/0194599820907600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Conventional reporting of posttympanoplasty hearing outcomes use a pure-tone averaged air-bone gap (ABG) largely representing a low-frequency sound conduction. Few studies report high-frequency conductive hearing outcomes. Herein, we evaluate high-frequency ABG in patients following temporalis fascia total drum replacement. STUDY DESIGN Case series with chart review. SETTING Tertiary care center. SUBJECTS AND METHODS All patients who underwent type 1 tympanoplasty using a lateral graft total drum replacement technique between August 2016 and February 2019 were identified. Patients with pre- and postoperative audiograms were included. Low-frequency ABG was calculated as the mean ABG at 250, 500, and 1000 Hz. High-frequency ABG was calculated at 4 KHz. Pre- and postoperative ABGs were compared. RESULTS Twenty-three patients were included, and the mean age at surgery was 44 years (range, 9-68 years). Perforation etiology was from trauma (n = 14) or chronic otitis media (n = 9). Preoperative mean low-frequency ABG was 27.8 ± 12.6 dB and mean high-frequency ABG was 21.5 ± 15.1 dB (P = .044). Postoperatively, the mean low-frequency ABG was significantly reduced by 15.5 ± 13.3 dB (P < .001) while the mean high-frequency ABG insignificantly changed (reduced by 2.6 ± 16.2 dB, P = .450). CONCLUSION In a series of patients undergoing temporalis fascia total drum replacement, low-frequency ABG improved; however, high-frequency conductive hearing loss persists. Conventional methods of reporting ABG may not identify persistent high-frequency ABG. These results merit further study across a range of tympanoplasty graft materials and surgical techniques.
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Affiliation(s)
- Marc D Polanik
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Danielle R Trakimas
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicole L Black
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jeffrey T Cheng
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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14
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Lou Z. Fungal otitis externa and wet ear with mucopurulent should be influencing factors on tympanic membrane closure. Eur Arch Otorhinolaryngol 2020; 277:1557-1558. [DOI: 10.1007/s00405-020-05815-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
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15
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Chandra M, Jassal SS. Longitudinal Study of Type I Interlay Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2019; 71:1090-1095. [PMID: 31750131 PMCID: PMC6841855 DOI: 10.1007/s12070-017-1185-3] [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] [Received: 07/25/2016] [Accepted: 08/16/2017] [Indexed: 10/19/2022] Open
Abstract
The aim of the present study was to access success rate of tympanoplasty and complications with interlay technique of tympanoplasty. This Longitudinal Prospective study was carried out in the Department of Otorhinolaryngology and Head and Neck Surgery, Era's Lucknow Medical College, Lucknow. 50 patients aged between 10 and 50 years of chronic otitis media mucosal type disease with dry ears were selected. Otomicroscopic, tunning fork test, pure tone audiometry were done in all patients. All patients underwent interlay tympanoplasty. Patients were followed up regularly for a minimum period of 1.5 years. Successful graft uptake was noted in 48 (96%) cases. Interlay tympanoplasty results in excellent graft uptake and good post operative Air Bone Gap closure.
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Affiliation(s)
- Manish Chandra
- Department of ENT, Era’s Lucknow Medical College, Lucknow, India
| | - Satveer Singh Jassal
- Department of ENT, Era’s Lucknow Medical College, Room No C1, PG Boy’s Hostel, Sarfrazganj, Hardoi Road, Lucknow, Uttar Pradesh 226003 India
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16
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Chen SL, Yang SW. Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations. Eur Arch Otorhinolaryngol 2019; 276:3005-3012. [PMID: 31377902 DOI: 10.1007/s00405-019-05583-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. METHODS The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. RESULTS A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51 years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR = 0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). CONCLUSION As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Yang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
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17
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Shishegar M, Faramarzi M, Rashidi Ravari M. Evaluation of middle ear risk index in patients undergoing tympanoplasty. Eur Arch Otorhinolaryngol 2019; 276:2769-2774. [PMID: 31317321 DOI: 10.1007/s00405-019-05539-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tympanoplasty is a standard surgical procedure for the treatment of chronic otitis media. In this study, we aimed to determine the effect of the predictive factors of middle ear risk index (MERI) in patients undergoing tympanoplasty. MATERIALS AND METHODS A total of 200 patients who underwent tympanoplasty surgery from 2008 to 2018 at Khalili hospital in Shiraz were evaluated. In this study, variables such as age, sex, systemic diseases (diabetes mellitus, hypertension), location and size of tympanic membrane perforation (TMP), health of the opposite ear, dryness duration of the ear, presence or absence of myringosclerosis during surgery, type of operation and the risk of MERI were evaluated. RESULTS The success rate for a 6-month follow-up of patients was 88%. Results showed that there was a significant difference between the MERI scores and the three types of operation of intact canal wall (ICW), canal wall down (CWD) and non mastoidectomy (P < 0.001). The longer the dryness duration of the ear, the MERI score was lower. When MERI score is low, the patient doesn't need mastoidectomy. Also, the worse the opposite ear, the higher the MERI score was. The highest MERI score was in patients undergoing CWD, and the lowest MERI score was in patients undergoing simple tympanoplasty. CONCLUSION MERI score is a useful tool for predicting the success rate of tympanoplasty and helps the surgeon planning the type of tympanoplasty.
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Affiliation(s)
- Mahmood Shishegar
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Faramarzi
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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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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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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20
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Impact of the nature of the temporalis fascia graft on the outcome of type I underlay tympanoplasty. The Journal of Laryngology & Otology 2017; 131:472-475. [DOI: 10.1017/s0022215117000615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:Temporalis fascia has become the most widely used graft for tympanoplasty, as it is strong, durable, and easy to procure and handle. However, the type of temporalis fascia graft to use (i.e. dry or wet) remains controversial. The present review aimed to evaluate the success rates of dry and wet temporalis fascia grafts in type I underlay tympanoplasty.Methods:A literature search was performed, using PubMed up to August 2016, to identify all studies of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. The initial search using the key words ‘temporalis fascia’ and ‘tympanoplasty’ identified 130 articles; these were screened by reviewing the titles or abstracts based on the inclusion and exclusion criteria. Ultimately, this review included seven articles.Results and conclusion:A dry or wet temporalis fascia graft did not affect the outcome of type I underlay tympanoplasty. However, using wet temporalis fascia could shorten the duration of surgery in type I underlay tympanoplasty. Concerns that the fibroblast count of temporalis fascia may beneficially affect success rate have not been substantiated in clinical reports thus far.
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21
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Bluestone CD, Klein JO, Rosenfeld RM, Berman S, Casselbrant ML, Chonmaitree T, Giebink GS, Grote JJ, Ingvarsson LB, Linder T, Lous J, Maw AR, Paradise JL, Sando I, Stool SE, Takasaka T. 9. Treatment, Complications, and Sequelae. Ann Otol Rhinol Laryngol 2016. [DOI: 10.1177/00034894021110s312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Dangol K, Shrivastav RP. Study of Various Prognostic Factors Affecting Successful Myringoplasty in a Tertiary Care Centre. Int Arch Otorhinolaryngol 2016; 21:250-254. [PMID: 28680493 PMCID: PMC5495587 DOI: 10.1055/s-0036-1593818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/18/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction
Myringoplasty is a commonly performed otologic surgery.
Objectives
The objective of this study is to evaluate the effect of prognostic factors like - size, site of perforation, status of operating ear, approach, status of contralateral ear, experience of surgeon, primary or revision myringoplasty, and smoking in graft uptake, as well as to evaluate the hearing results after myringoplasty.
Methods
This is a prospective study. We included in our sample patients aged over 13 years with a Tubotympanic Chronic Otitis Media diagnosis. The patients underwent preoperative evaluation and Pure Tone Audiogram within one week prior to surgery. We performed myringoplasty using temporalis fascia graft with conventional underlay technique. We evaluated postoperative graft uptake and various factors related to the study and did a Pure Tone Audiogram at one year after surgery.
Results
The graft uptake rate after myringoplasty was 83.1% at one year in 219 patients. Graft uptake with normal opposite ear was 88.2%, and with Tubotympanic Chronic Otitis Media was 75% (statistically significant). We found no statistically significant difference in graft uptake results with other factors. We calculated hearing results of 132 patients with normal ossicular status who underwent myringoplasty. The average Air Conduction Threshold improvement was 11.44dB (
p
< 0.001) and the average Air-Bone Gap closure was 8.89dB, highly statistically significant (
p
< 0.001).
Conclusion
Diseased contralateral ear was a statistically significant poor prognostic factor for graft uptake after myringoplasty. Other factors studied were not statistically significant determining factor for graft uptake. Hearing improves significantly after myringoplasty if the ossicles are normal.
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Affiliation(s)
- Kripa Dangol
- Department of Ganesh Man Singh Memorial Academy of Ear, Nose, Throat - Head and Neck Surgery, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Rakesh Prasad Shrivastav
- Department of Ganesh Man Singh Memorial Academy of Ear, Nose, Throat - Head and Neck Surgery, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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23
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Albera R, Ferrero V, Lacilla M, Canale A. Tympanic Reperforation in Myringoplasty: Evaluation of Prognostic Factors. Ann Otol Rhinol Laryngol 2016; 115:875-9. [PMID: 17214259 DOI: 10.1177/000348940611501202] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The most frequent failure in myringoplasty is reperforation. This complication appears at a rate of 7% to 27%. The aim of this study was to evaluate the importance of the principal prognostic factors to the risk of reperforation. Methods: This is a study of prognosis based on an inception cohort. The prognostic factors considered in the study refer to clinical and surgical aspects; follow-up ranged from 5 to 7 years (mean, 68 months). The study was performed on 212 patients with or without otorrhea who underwent operation for tympanic perforation. All subjects underwent myringoplasty by means of an underlay or overlay technique depending on the size and site of the perforation. Results: Healing of the tympanic perforation was obtained in 182 cases (86%). Age, otorrhea, status of the contralateral ear, and conductive hearing loss did not significantly affect the outcome of surgery. On the other hand, time from surgery, the site of perforation, the type of anesthesia, the approach, the surgical technique, and the type of graft were significantly related to the outcome. Conclusions: In the analysis of our results, the surgical approach proved to be the principal prognostic factor in the anatomic outcome of myringoplasty. The results obtained suggest that the principal factors influencing the outcome of myringoplasty are technical and not clinical.
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Affiliation(s)
- Roberto Albera
- Division of Clinical Physiopathology, Department of Otorhinolaryngology, University of Turin, Turin, Italy
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Bastier P, Leroyer C, Lashéras A, Rogues AM, Darrouzet V, Franco-Vidal V. Early and late surgical site infections in ear surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2016; 36:127-34. [PMID: 27196077 PMCID: PMC4907159 DOI: 10.14639/0392-100x-666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/25/2015] [Indexed: 11/23/2022]
Abstract
A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach. During follow-up, surgical site infections were defined as "early" if occurring within 30 days after surgery or as "late" if occurring thereafter. The data of 102 patients were analysed. Concerning early surgical site infections, four cases were diagnosed (3.9%) and a significant association was found with preoperative antibiotic therapy, wet ear at pre-operative examination, class III (contaminated) in the surgical wound classification, NNIS (National Nosocomial Infection Surveillance) index > 1, and oral post-operative antibiotic use. Seven late surgical site infections were diagnosed (7.1%) between 90 and 160 days after surgery and were significantly correlated to otorrhoea during the 6 months before surgery, surgery duration ≤60 minutes, canal wall down technique and use of fibrin glue. Surgical site infections after chronic otitis media surgery seem to be associated with factors related to the inflammatory state of the middle ear at the time of surgery in early infections and with chronic inflammation in late infections.
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Affiliation(s)
- P.L. Bastier
- ENT and Head and neck surgery department, Bordeaux University Hospital, Bordeaux, France
| | - C. Leroyer
- Infection control unit, Bordeaux University Hospital, Bordeaux, France
| | - A. Lashéras
- Infection control unit, Bordeaux University Hospital, Bordeaux, France
| | - A.-M. Rogues
- Infection control unit, Bordeaux University Hospital, Bordeaux, France
| | - V. Darrouzet
- ENT and Head and neck surgery department, Bordeaux University Hospital, Bordeaux, France
| | - V. Franco-Vidal
- ENT and Head and neck surgery department, Bordeaux University Hospital, Bordeaux, France
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Lou ZC. In Response to: Heparin Binding-Epidermal Growth Factor-Like Growth Factor for the Regeneration of Chronic Tympanic Membrane Perforations in Mice. Tissue Eng Part A 2016; 22:568-9. [PMID: 26879548 DOI: 10.1089/ten.tea.2016.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University , Yiwu, China
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Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations. Clin Exp Otorhinolaryngol 2015; 8:224-9. [PMID: 26330916 PMCID: PMC4553352 DOI: 10.3342/ceo.2015.8.3.224] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/25/2014] [Accepted: 08/14/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate endoscopic push-through technique cartilage myringoplasty results. METHODS This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies. RESULTS Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences. CONCLUSION Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.
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Sánchez Barrueco A, Lora Pablos D, Villafruela Sanz M, Almodóvar Álvarez C. Pediatric myringoplasty: Prognostic factors in surgical outcome and hearing threshold recovery. Acta Otolaryngol 2015. [PMID: 26211488 DOI: 10.3109/00016489.2015.1069396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS This study shows as decisive factors the history of tympanostomy tube insertion and surgical approach. The closure of the perforation observed at the 6th post-operative month is almost definitive, without finding significant differences ahead. The myringoplasty can be performed simultaneously in bilateral perforations and in a day-case basis with same success rates. Astatistically significant audiometric improvement area is described, after myringoplasty, undescribed previously in literature. OBJECTIVES The aim of this study was to evaluate prognostic factors in surgical outcome and hearing threshold after myringoplasty, in pediatric age. METHODS A 10-year retrospective review of 142 myringoplasties performed by a single surgeon of the Pediatric ENT Department of 12 de Octubre University Hospital. Multiple prognostic factors were investigated, such as those related to perforation and surgery, contralateral ear status, and pre- and post-operative hearing threshold. RESULTS The overall rate of closure of the perforation was 74.64%. The re-perforation rate was directly proportional to the number of tympanostomy tube insertion (OR = 1.64). Other determining factors were the surgical approach, the graft position and side. There was a post-operative significant improvement (p < 0.001) insuring that the more affected frequencies, low (125-500 Hz) and high frequencies (4000-8000 Hz), were the more improved after the procedure.
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Affiliation(s)
- A Sánchez Barrueco
- a 1 Department of Otolaryngology, Hospital 12 de Octubre , Madrid, Spain
| | - D Lora Pablos
- b 2 Clinical Research Unit, Clinical Trials , CIBERESP (imas12)
| | | | - C Almodóvar Álvarez
- c 3 Department of Otolaryngology, Children ENT Section, Hospital 12 de Octubre , Madrid, Spain
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Migirov L, Wolf M. Transcanal microscope-assisted endoscopic myringoplasty in children. BMC Pediatr 2015; 15:32. [PMID: 25884359 PMCID: PMC4387589 DOI: 10.1186/s12887-015-0351-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Background Myringoplasty can be technically difficult in the pediatric patients due to the narrowness of the external auditory canal and the generally small size of the ear. Moreover, temporalis fascia grafts and myringoplasties for anterior perforations are more likely to fail in children. Surgical management of anterior perforations requires total exposure of the anterior angle however a microscope may fail to provide a view of the anterior edge in most of perforations. Recently, different endoscopes are used in the performance of ear surgery in general and myringoplasty in particular. Current study aimed to investigate the outcome of transcanal microscope-assisted endoscopic myringoplasty in homogenous group of children. Methods The medical records of 22 children were retrospectively reviewed for age, perforation size and location, surgical and audiological findings, and outcome. All myringoplasties were performed by first author with a chondro-perichondrial graft that has been harvested from the tragus and placed medial to the tympanic membrane remnants, utilizing the underlay technique and 14-mm length, 3-mm diameter, 0° and 30° endoscopes. A microscope was occasionally used for removal of the sclerotic plaques and releasing adhesions surrounding the ossicles when bimanual manipulations were needed. Surgical success was defined as a tympanic membrane with no perforation, retraction, or graft lateralization for at least 18 months following surgery. Results Thirteen large-, 8 medium- and 1 small-sized perforations (defined as 75, 50 or 25%, respectively, of the tympanic membrane area), of which 14 were anterior, 2 central and 6 posterior marginal, were repaired. The edges of the defect could not be visualized under a microscope due to bone overhanging or a curved or narrow EAC in 8 anterior perforations. Intact tympanic membranes and dry ears were achieved in all operated children. The audiometric air conduction level (average of 0.5-3 kHz) for the entire cohort ranged between 10–51.3 dB (mean 32.8) preoperatively and between 5–35 dB (mean 18.2) postoperatively. Conclusion The transcanal microscope-assisted endoscopic myringoplasty had a 100% rate of surgical success in children. This technique can be especially appropriate for patients with narrow external canals, anterior defects and bone overhang making the perforation margins barely visible under a microscope.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 5262l, Israel.
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Duval M, Grimmer JF, Meier J, Muntz HR, Park AH. The effect of age on pediatric tympanoplasty outcomes: a comparison of preschool and older children. Int J Pediatr Otorhinolaryngol 2015; 79:336-41. [PMID: 25613932 DOI: 10.1016/j.ijporl.2014.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Determine whether the outcome of tympanoplasty in preschool children is different from that of older children. STUDY DESIGN Retrospective case series. METHODS Retrospective review of children having undergone a primary tympanoplasty by 4 surgeons for a tympanic membrane perforation between 2002 and 2013. RESULTS Data from 50 children age 2-4, 130 children age 5-7 and 105 children age 8-13 years old were reviewed. Median follow-up was 7.5 months. On crude analysis, the incidence of anatomical success was not significantly different between the different age groups (p=0.38), the success rate was respectively 69.4%, 68.5% and 79.1% with an overall rate of 72.5%. 5.9% of all children required later insertion of tympanostomy tubes, 10.2% in preschool children. The post-operative audiology results were similar for all groups with a mean improvement of 9dB in the air-bone gap. When limiting the analysis to the 155 children having at least 6 months of follow-up, the rate of success was respectively 50.0%, 60.8% and 74.0% (p=0.10). After multivariate analysis controlling for the effect of surgeon, approach and etiology, the odds ratio of perforation was respectively 5.48, 2.27 and 1.00 for the different age groups. CONCLUSION Children younger than 4 years of age have the worst outcome after tympanoplasty. It remains uncertain whether the benefits of hearing improvement and quality of life may outweigh that of a high rate of a residual, usually smaller, perforation. Prospective studies are needed to confirm these results and delineate the patient characteristics and technique most likely to lead to successful results.
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Affiliation(s)
- Melanie Duval
- Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA.
| | - J Fredrik Grimmer
- Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA
| | - Jeremy Meier
- Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA
| | - Harlan R Muntz
- Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA
| | - Albert H Park
- Division of Otolaryngology, University of Utah, 50 N Medical Drive, SOM 3C120, Salt Lake City, UT 84132, USA
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Abdellatif H, Youssef R, Omar M, Hassan N, Lahcen A, Abdelaziz R. Myringoplasty in children: retrospective analysis of 60 cases. Pan Afr Med J 2015; 20:82. [PMID: 26090040 PMCID: PMC4450024 DOI: 10.11604/pamj.2015.20.82.3620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 09/06/2014] [Indexed: 11/13/2022] Open
Abstract
Myringoplasty or type 1 tympanoplasty aims the restoration of the anatomic integrity of the tympanic membrane; it's a very common surgery in otology. The objective was to evaluate the anatomic and functional results of this surgery in children using the retro-auricular approach. Sixty young patients with diagnosis of simple tympanic perforation were evaluated; these patients underwent myringoplasty by a retro-auricular approach (underlay technique) between November 2010 and May 2013. It's a retrospective evaluation of the anatomic and functional results of theses myringoplasties. Mean age at surgery was 8, 5 years old, cartilage was used as graft in our entire patient, closure of perforation was successful in 48 cases (80%), and audiometric results showed functional improvement in 27 (45%) patients, no significant change was noted in the remaining patients. The results of myringoplasty in children seem worse than those in adults. However, a large study with a long follow up is warranted in order to come to definitive conclusions.
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Affiliation(s)
| | - Rouchdi Youssef
- ENT Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Maliki Omar
- ENT Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Nouri Hassan
- ENT Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Aderdour Lahcen
- ENT Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Raji Abdelaziz
- ENT Department, Mohammed VI University Hospital, Marrakech, Morocco
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Das A, Sen B, Ghosh D, Sengupta A. Myringoplasty: Impact of Size and Site of Perforation on the Success Rate. Indian J Otolaryngol Head Neck Surg 2014; 67:185-9. [PMID: 26075176 DOI: 10.1007/s12070-014-0810-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/27/2014] [Indexed: 11/30/2022] Open
Abstract
Myringoplasty aims to reconstruct the tympanic membrane, restoring protection to the middle ear and improve hearing. Success of Myringoplasty in terms of anatomical closure is influenced by many factors. This study focuses on the influence of size and site of tympanic membrane perforation on success rate of Myringoplasty. This is a prospective study of 60 patients who underwent myringoplasty and were then followed up for 6 months from the date of operation. Patients with dry perforation, with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Video Otoendoscopy of all cases with storz 0 degree endoscope were done. All images were recorded on the computer [DELL VOSTRO 3400]. Using 'Image J' [version 1.35j] geometrical package, the area of perforation (P) and the entire area of the tympanic membrane (T) were calculated. Then, the percentage area of the perforation [P/T × 100 %] for each ear was obtained. Site of perforation also documented. Success rate for pin-point and small perforations was 100 %, for medium size 80 %, and for large & subtotal perforations 69.2 and 42.9 % respectively. We regard size of the perforation as a major factor that influences success of Myringoplasty. Site of perforation failed to be a statistically significant influencing factor in this study.
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Affiliation(s)
- Arindam Das
- Department of ENT, SSKM Hospital, Kolkata, India
| | - Bhavika Sen
- Department of ENT, SSKM Hospital, Kolkata, India
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Takahashi-Tatsumi E, Mishiro Y, Katsura H, Sakaguchi A, Sakagami M. Longitudinal Follow-up After Pediatric Myringoplasty. Otol Neurotol 2014; 35:126-8. [DOI: 10.1097/mao.0000000000000226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Castro O, Pérez-Carro AM, Ibarra I, Hamdan M, Meléndez JM, Araujo A, Espiña G. Myringoplasties in children: our results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:87-91. [PMID: 23260779 DOI: 10.1016/j.otorri.2012.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/07/2012] [Accepted: 06/19/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Myringoplasty, one of the most frequent surgical techniques in otology, is the repair of tympanic membrane when the ear has only a perforation without any ossicular damage. The main objective of our work was to study the outcome of myringoplasty in patients less than 15 years of age. We also reviewed the existence of prognostic factors, such as Eustachian tube functionality, surgical technique and the hearing outcome after surgery. METHOD We present a retrospective study (1994-2010) with a total of 81 children (under 15 years of age) who had undergone myringoplasty during that period of time. For these children, we analysed age, sex, technique, approach, type of graft, type of perforation, anaesthesia, hearing gain and perforation closure. We correlated these variables with the success of the surgery. RESULTS The percentage of closure was 84% (n=68). The techniques used were underlay in 79.01% (n=64), overlay in 11.11% (n=9) and sandwich in 9.87% (n=8). The percentage of patients with hearing improvement was 88.40% (n=61). CONCLUSION Myringoplasty is a surgical technique that offers good anatomical and functional results in children. We did not find prognostic factors in our study. We found postoperative improvement of hearing but it was not statistically significant.
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Affiliation(s)
- Olalla Castro
- Servicio de Otorrinolaringología, Hospital Xeral-Cíes (CHUVI), Vigo, Pontevedra, Spain.
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Boronat-Echeverría NE, Reyes-García E, Sevilla-Delgado Y, Aguirre-Mariscal H, Mejía-Aranguré JM. Prognostic factors of successful tympanoplasty in pediatric patients: a cohort study. BMC Pediatr 2012; 12:67. [PMID: 22691304 PMCID: PMC3411453 DOI: 10.1186/1471-2431-12-67] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/12/2012] [Indexed: 11/10/2022] Open
Abstract
Background Tympanoplasty in children is a current and controversial theme. The success of tympanoplasty traditionally has been measured only by the post-operative integrity of the graft. Yet, there are other variables that may be used to determine success. The objectives of the present work were to analyze which factors are predictive of successful tympanoplasty in pediatric patients and to construct and validate a prognostic index that could be used as a tool to predict the success of tympanoplasty in children. Methods Setting. Department of Pediatric Otorhinolaryngology, tertiary-care hospital, Mexico City. Patients. Forty-eight patients, who were older that five years of age, had persistent perforation of the tympanic membrane, and had undergone tympanoplasty (January 2005–June 2008), were followed for a year. Main Outcome Measures. The factors tested for their value as predictors were the following: age at time of surgery, state of contralateral ear, previous adenoidectomy, cause of perforation, size of perforation, infection at the time of surgery, state of mucosa, age at first occurrence of perforation, presence of craniofacial dysmorphia, and surgical technique. These factors were compared with the criterion, success, which was defined as attaining three positive outcomes: 1) integrity of the implant or membrane; 2) minimum of 10-dB gain in the auditory threshold or, in the case of normal hearing, conservation of same; and 3) air-filled space in the middle ear. The best model was obtained through logistic regression analysis; the model was validated. Results The most balanced prediction model was that in which the three success criteria were included, with age, surgical technique, and infection at surgery being excluded as variables. The additional 12 pediatric cases used in the validation had a probability of success >0.425 (best cut-off level); two patients (17%) had poor evolution. Conclusions This is the first study that validated a predictive index of the result of tympanoplasty in children. This index predicted 81% of the successful outcomes.
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Affiliation(s)
- Nuria Esperanza Boronat-Echeverría
- Department of Pediatric Otorhinolaryngology, High Specialty Medical Care Unit of the Pediatric Hospital of the Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, México City 06720, Mexico
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Balaguer García R, Morales Suárez-Varela MM, Tamarit Conejeros JM, Agostini Porras G, Murcia Puchades V, Dalmau Galofre J. Myringoplasties. A Retrospective Analysis of Our Surgical Outcomes. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2010.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Balaguer García R, Morales Suárez-Varela MM, Tamarit Conejeros JM, Agostini Porras G, Murcia Puchades V, Dalmau Galofre J. [Myringoplasties. A retrospective analysis of our surgical outcomes]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:213-9. [PMID: 21315317 DOI: 10.1016/j.otorri.2010.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 10/28/2010] [Accepted: 12/07/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. MATERIALS AND METHODS A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. RESULTS Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. CONCLUSIONS Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results.
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Affiliation(s)
- Ramón Balaguer García
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España.
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Nevoux J, Lenoir M, Roger G, Denoyelle F, Ducou Le Pointe H, Garabédian EN. Childhood cholesteatoma. Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127:143-50. [PMID: 20860924 DOI: 10.1016/j.anorl.2010.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although cholesteatoma was first described in 1683, its etiopathogeny remains unexplained. In children, there are two forms: acquired cholesteatoma, resembling the adult form, and congenital cholesteatoma. The acquired form has become less frequent in recent years, thanks to progress in the treatment of childhood otitic pathology. Diagnosis of congenital cholesteatoma, on the contrary, is increasing, due to improvements in information to health care professionals and in diagnostic tools. Clinical and histological evidence points to greater aggressiveness in childhood forms, although this difference cannot, at present, be precisely explained. Diagnosis is clinical, but CT and MR imaging is indispensable for preoperative assessment and postoperative follow-up. New delayed gadolinium-enhanced T1-weighted and diffusion-weighted MRI sequences have recently been developed and provide more precise radiological diagnosis. Treatment is surgical; alternatives, notably by laser, have proved unsuccessful. Complications concern involvement of neighbouring structures, and are mainly infectious; some can be life-threatening, and should be systematically screened.
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Affiliation(s)
- J Nevoux
- Inserm U, hôpital d'enfants Armand-Trousseau, AP-HP, UMPC, université Paris, France.
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Tympanoplasty in children: A review of 91 cases. Auris Nasus Larynx 2010; 38:21-5. [PMID: 20561760 DOI: 10.1016/j.anl.2010.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/22/2010] [Accepted: 05/26/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVES There is a marked diversity in the reported success rates for achieving an intact tympanic membrane following tympanoplasty. Controversy exists about the factors thought to influence surgical outcome. These facts have important implications for the selection of patients who would benefit the most. This study reviews the factors thought to determine the anatomical and functional success of tympanoplasty in children. MATERIALS AND METHODS Retrospective study of the anatomical and functional results of 91 tympanoplasties performed in children. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, pre-operative and post-operative hearing levels, post-operative follow-up time and post-operative complications were recorded. We divided our population into two groups according to the expected eustachian tube maturity (younger group (N=24): ≤10 years old, older group (N=67): >10 years old). All patients were evaluated in terms of anatomical and functional outcome and complications. RESULTS Anatomical success was achieved in 85.7% and functional success was 76.9% after a mean follow-up of 25.6 ± 17.1 months. Anatomical success (intact tympanic membrane) was achieved in 83% of younger vs 87% of older patients (p=n.s.). Functional (air bone gap closure) success was 75% in the younger group vs 78% in the older group (p=n.s.). There were no significant differences in post-operative gain at different frequencies (500, 1000, 2000 and 3000 Hz) between the two groups. A previous adenoidectomy in children older than 10 years seems to be an independent predictor of functional success The incidence of minor and major complications were 29% in patients aged ≤10 and 21% in those older than 10 (p=n.s.). We report 12.9% minor post-operative complications in successful cases: injury to the chorda tympani nerve (5.7%), wound infection (2.9%), otitis externa (2.9%) and transient vertigo (1.4%). Among the 21 reperforations observed, 92.3% occurred before 1 year. CONCLUSIONS This study shows that tympanoplasty is a valid treatment modality for tympanic membrane perforation in the pediatric population. A tympanic membrane perforation can be closed at any age. There is no age limit below which perforation should not be closed. A previous adenoidectomy in children older than 10 years seems to be an independent predictor of functional success.
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Pediatric myringoplasty: does previous adenoidectomy improve the likelihood of perforation closure? Otol Neurotol 2010; 30:939-42. [PMID: 19692939 DOI: 10.1097/mao.0b013e3181b4c5e8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether perforation closure after pediatric myringoplasty is more likely to be achieved in patients who have undergone a previous adenoidectomy and to evaluate the impact of other demographic and clinical parameters on operative success. STUDY DESIGN Retrospective case review. SETTING : Teaching hospital. PATIENTS Children younger than 16 years. INTERVENTION Primary or revision myringoplasty undertaken between 1999 and 2007. MAIN OUTCOME MEASURE The integrity of the tympanic membrane was assessed by otoscopy or tympanometry during postoperative follow-up. Success was defined as an intact tympanic membrane with no evidence of middle ear disease. RESULTS Two hundred thirteen consecutive myringoplasties were performed. Patients' mean age was 12.1 years (range, 4-15 yr) and mean length of follow-up was 16 months (range, 2-99 mo). The overall perforation closure rate was 71.8%. The adenoidectomy group comprised 79 patients (37.1%). Perforation closure was achieved in 79.1% of these patients compared with 67.4% in the nonadenoidectomy group (p = 0.157). Older age (p = 0.032), smaller perforations (p = 0.042), nonanterior perforations (p = 0.022), and operations performed by a consultant (p = 0.047) all resulted in significantly higher rates of perforation closure. CONCLUSION This study suggests that adenoidectomy before pediatric myringoplasty may not improve the likelihood of a successful outcome.
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Piédrola Maroto D, Escalona Gutiérrez JJ, Conde Jiménez M, Casado Morente JC, Povedano Rodríguez V, Benítez-Parejo N. Functional results in myringoplasties. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70016-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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[Functional results in myringoplasties]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 61:94-9. [PMID: 19963198 DOI: 10.1016/j.otorri.2009.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 09/25/2009] [Accepted: 09/29/2009] [Indexed: 11/24/2022]
Abstract
GOAL The aim of this study was to assess hearing improvement after myringoplasty. MATERIAL AND METHODS We present a retrospective study with a total of 119 cases undergoing myringoplasty at our Department analyzing the air conduction thresholds before and 6 months after surgery. We conducted an analysis of variance for the different variables and contrasted hypotheses using Student's T-test. RESULTS We obtained a hearing improvement at all frequencies, except at 8.000 Hz, at which surgery noticeably worsens hearing. The lower the frequency, the higher the hearing improvement, with the best results at 250 Hz, where the mean hearing improvement reached 13.49 dB. CONCLUSIONS Myringoplasty is an effective technique in the recovery of hearing thresholds secondary to a tympanic membrane perforation.
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D'Eredità R, Lens MB. Anterior Tab Flap Versus Standard Underlay Myringoplasty in Children. Otol Neurotol 2009; 30:777-81. [DOI: 10.1097/mao.0b013e3181b285d4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sarkar S, Roychoudhury A, Roychaudhuri BK. Tympanoplasty in children. Eur Arch Otorhinolaryngol 2009; 266:627-33. [DOI: 10.1007/s00405-008-0908-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 12/24/2008] [Indexed: 05/25/2023]
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Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg 2008; 139:386-90. [PMID: 18722218 DOI: 10.1016/j.otohns.2008.05.623] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 05/19/2008] [Accepted: 05/28/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine the role of the prognostic factors and middle ear risk index on the success of tympanoplasty. STUDY DESIGN Case series. SUBJECTS AND METHODS The charts of 231 patients who underwent tympanoplasty operations between 2002 and 2007 were reviewed. Prognostic factors such as age, sex, presence of systemic diseases, location and size of perforation, duration of dry period, presence of myringosclerosis, presence of septal and conchal pathology, operation type, and status of the opposite ear and middle ear risk index were investigated. RESULTS The overall success rate was 74.4%. Multivariate analysis was carried out on significant prognostic factors to obtain independent variables and yielded the following results (95% CI): size of the perforation (<50%) (OR:8.11), healthy opposite ear (OR:5.64), more than 3 months dry period (OR:2.21), absence of myringosclerosis (OR:4.01) and low middle ear risk index (OR:87.1). CONCLUSION Size of the perforation(<50%), healthy opposite ear, absence of myringosclerosis, more than 3 months dry period, and low middle ear risk index were found to be significant independent prognostic factors.
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Affiliation(s)
- Ercan Pinar
- Ataturk Training and Research Hospital, ENT Clinic, Izmir, Turkey.
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Tringali S, Dubreuil C, Bordure P. [Tympanic membrane perforation and tympanoplasty]. ACTA ACUST UNITED AC 2008; 125:261-72. [PMID: 18778811 DOI: 10.1016/j.aorl.2008.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/18/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report anatomic and physiologic characteristics of the tympanic membrane, to discuss the etiology and pathogenesis of tympanic perforation, and to discuss its management. MATERIAL AND METHODS After a review of the literature, different surgical techniques and the postoperative results were evaluated. RESULTS The rate of tympanic membrane closure is greater than 90% for the majority of authors. Age, mucosa inflammation, pathological contralateral ear (perforation, otitis media, cholesteatoma), and surgical experience influence this result. DISCUSSION Even if surgical results are good, abstention must always be proposed and all complications must be explained. CONCLUSION Palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closures.
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Affiliation(s)
- S Tringali
- Service d'oto-neurochirurgie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France.
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Skotnicka B, Hassmann-Poznańska E. Myringoplastyka u dzieci – czynniki wpływające na wynik leczenia chirurgicznego. Otolaryngol Pol 2008; 62:65-70. [DOI: 10.1016/s0030-6657(08)70211-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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