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Transtympanic soft tissue tympanoplasty can replace conventional techniques elevating tympanic membranes. Eur Arch Otorhinolaryngol 2022; 279:5639-5645. [PMID: 35590078 DOI: 10.1007/s00405-022-07427-2] [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: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Most traditional tympanoplasties require elevating the tympanic membrane (TM). These techniques are rather complicated and success rates are not perfect. Therefore, the authors developed a novel technique, transtympanic soft tissue (TST) tympanoplasty, which does not require raising eardrums, and evaluated its surgical efficiency compared to perichondrium underlay (PU) tympanoplasty. STUDY DESIGN A retrospective study was conducted in a single center. METHODS 152 cases who underwent TST tympanoplasty (n = 70) or PU tympanoplasty (n = 82) between 2011 and 2020 were included in the study. Perforation location, pure tone audiometry, complications, and closure rates were analyzed according to the size of the TM perforations: moderate perforation (25-40%, n = 100) and large perforation (≥ 40%, n = 52). RESULTS For the moderate perforations, the closure rates of the TST (n = 45) and PU (n = 55) groups were 93.3% and 89.1%, respectively (p = 0.461), and even for the large perforations, the success rates were 88.0% in the TST group (n = 25) and 81.5% in the PU group (n = 27) (p = 0.515). The mean postoperative air-bone gap (ABG) values of the TST group for moderate and large perforations were 5.3 ± 5.8 dB and 6.6 ± 5.7 dB, respectively. There was no significant difference in postoperative ABG between the two surgical procedures (p > 0.05). The total operation time for TST tympanoplasty was significantly shorter than that for PU tympanoplasty (p = 0.002). CONCLUSIONS TST tympanoplasty is considered a novel, simple technique to replace traditional tympanoplasty techniques involving raising eardrums, even for large-sized perforations.
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Outcomes following tympanoplasty surgery using porcine derived small intestinal submucosa (SIS). The Journal of Laryngology & Otology 2021; 136:304-308. [PMID: 34819189 DOI: 10.1017/s0022215121003716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Azimi B, Milazzo M, Danti S. Cellulose-Based Fibrous Materials From Bacteria to Repair Tympanic Membrane Perforations. Front Bioeng Biotechnol 2021; 9:669863. [PMID: 34164386 PMCID: PMC8215662 DOI: 10.3389/fbioe.2021.669863] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
Perforation is the most common illness of the tympanic membrane (TM), which is commonly treated with surgical procedures. The success rate of the treatment could be improved by novel bioengineering approaches. In fact, a successful restoration of a damaged TM needs a supporting biomaterial or scaffold able to meet mechano-acoustic properties similar to those of the native TM, along with optimal biocompatibility. Traditionally, a large number of biological-based materials, including paper, silk, Gelfoam®, hyaluronic acid, collagen, and chitosan, have been used for TM repair. A novel biopolymer with promising features for tissue engineering applications is cellulose. It is a highly biocompatible, mechanically and chemically strong polysaccharide, abundant in the environment, with the ability to promote cellular growth and differentiation. Bacterial cellulose (BC), in particular, is produced by microorganisms as a nanofibrous three-dimensional structure of highly pure cellulose, which has thus become a popular graft material for wound healing due to a number of remarkable properties, such as water retention, elasticity, mechanical strength, thermal stability, and transparency. This review paper provides a comprehensive overview of the current experimental studies of BC, focusing on the application of BC patches in the treatment of TM perforations. In addition, computational approaches to model cellulose and TM are summarized, with the aim to synergize the available tools toward the best design and exploitation of BC patches and scaffolds for TM repair and regeneration.
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Affiliation(s)
- Bahareh Azimi
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Florence, Italy
| | - Mario Milazzo
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Florence, Italy
| | - Serena Danti
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), Florence, Italy
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The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty. Otol Neurotol 2021; 41:644-653. [PMID: 32080032 DOI: 10.1097/mao.0000000000002599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia. STUDY DESIGN Retrospective patient review and posttreatment questionnaire survey. SETTING Tertiary referral center. PATIENTS Sixty adult patients with chronic dry tympanic membrane perforation. INTERVENTIONS Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used. MAIN OUTCOME MEASURES Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey. RESULTS Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method. CONCLUSION This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.
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Han JS, Han JJ, Park JM, Seo JH, Park KH. The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration. ORL J Otorhinolaryngol Relat Spec 2020; 83:85-92. [PMID: 33341797 DOI: 10.1159/000512084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS This study was conducted to evaluate the long-term stability of fat-graft myringoplasty (FGM) for chronic tympanic membrane perforations, analyzing the perforation closure rate and re-gained hearing outcome with respect to the size and location of the perforations. METHODS Between August 2007 and June 2018, a total of 193 patients who underwent FGM due to chronic tympanic membrane perforation at a tertiary referral center were enrolled and analyzed. RESULTS The mean follow-up was 14.6 months (range 6-39). The complete perforation closure rate after FGM was 89.6%, with no statistical difference among the perforation size groups. The mean postoperative air-bone gap (ABG) was 11.0 dB and mean ABG improvement was 4.9 dB. CONCLUSION Our FGM technique had a favorable tympanic closure rate for small to large perforations, and yielded relatively good hearing improvement in the mid-size perforation cases over long-term follow-up periods. According to the topographic evaluation of FGM, this procedure resulted in a reliable perforation closure rate and audiological results regardless of the perforation site.
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Affiliation(s)
- Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Ju Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Mee Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Republic of Korea
| | - Jae-Hyun Seo
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung Ho Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
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Diaz AR, Reina CO, Plaza G, Posadas ER, Arevalo FV, Iriarte MTG. Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter? EAR, NOSE & THROAT JOURNAL 2020; 100:229S-234S. [PMID: 33314958 DOI: 10.1177/0145561320973555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. STUDY DESIGN Prospective case series. SETTING Tertiary care facility. PATIENTS Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. INTERVENTION In-office fat graft myringoplasty technique under local anesthesia. MAIN OUTCOME MEASURES Complete perforation closure rate and audiometric outcomes. RESULTS A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air-bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. CONCLUSION In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.
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Affiliation(s)
- Alfonso Rodriguez Diaz
- Hospital Naval de San Carlos, Otorhinolaryngology Department Hospital Naval de San Carlos, San Fernando Cadiz, Spain
| | - Carlos O'Connor Reina
- Othorhinolaryngology Department, 170643Hospital Quironsalud Marbella, Marbella, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada. Universidad Rey Juan Carlos. 207202Hospital Sanitas La Zarzuela. Madrid. Spain
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Abstract
Herein we provide a broad overview of the literature as it applies to endoscopic myringoplasty and type I tympanoplasty. Advantages and disadvantages of the endoscopic approach are reviewed for both the adult and pediatric populations and are compared with conventional microscopic techniques.
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Affiliation(s)
- Zachary G Schwam
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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Chatelet F, Leboulanger N, Achard S, Couloigner V, Denoyelle F, Simon F. Myringoplasty without tympanomeatal flap elevation in children: A systematic review. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:93-99. [PMID: 32888888 DOI: 10.1016/j.anorl.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Systematic review of the literature on myringoplasty techniques without tympanomeatal flap elevation in children. MATERIAL AND METHODS A systematic review following PRISMA guidelines reported papers on patients under 18years of age undergoing myringoplasty for chronic tympanic perforation on a transcanal approach without tympanomeatal flap elevation. Tympanic closure rates and audiometric results were analyzed. RESULTS Twenty studies were included. Nine reported the butterfly technique, using a microscope or endoscope, with closure rate of 82.3% (246/299), for perforations of various sizes. Ten reported the fat-plug technique, with closure rate of 86.8% (869/1001), mostly for perforations of less than one-third of the tympanum. Both techniques improved audiometric results. Morbidity was very low. The absence of chronic otitis or co-morbidities (contralateral otitis media with effusion, craniofacial malformations, Down's syndrome) implies that patient selection technique may be necessary to obtain the best results. CONCLUSION Fat-plug myringoplasty, for small perforations, and butterfly cartilage myringoplasty seem to be reliable procedures in selected patients, with low morbidity in children.
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Affiliation(s)
- F Chatelet
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, Paris, France.
| | - N Leboulanger
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, Paris, France; Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
| | - S Achard
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, Paris, France
| | - V Couloigner
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, Paris, France; Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
| | - F Denoyelle
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, Paris, France; Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
| | - F Simon
- Service d'Oto-Rhino-Laryngologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, Paris, France; Faculté de Médecine Paris Descartes, Université de Paris, Paris, France
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Can Fat-plug Myringoplasty Be a Good Alternative to Formal Myringoplasty? A Systematic Review and Meta-analysis. Otol Neurotol 2019. [PMID: 29533328 DOI: 10.1097/mao.0000000000001732] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study reviewed available literature to evaluate the success rate of fat myringoplasty compared with methods using other graft materials and suggests proper indications for this procedure. DATA SOURCES Studies reporting the success rate of fat myringoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2017. STUDY SELECTION The following terms were used for the literature search: ("Fat" OR "Adipose") and ("Myringoplasty" OR "Tympanoplasty"). DATA EXTRACTION Eight case series reported the data of perforation size and audiologic results. The success rate varied according to the perforation size with a cutoff value of 3 to 5 mm in length or 30% of the total tympanic membrane area. The success rate in anterior perforation was lower than that in other sites, ranging from 76.7 and 85.2% to 84.5 and 91.7%, respectively. The meta-analysis was performed on 10 articles. The overall success rate in fat myringoplasty and paper patch technique was not significantly different, while the success rate of fat myringoplasty was lower than that for the conventional myringoplasty technique using fascia or perichondrium (OR 0.63, 95% CI 0.49-0.80). Hyaluronic acid showed a significantly higher success rate than fat myringoplasty (90.1% versus 69.9%) (OR 0.20, 95% CI 0.09-0.46). CONCLUSIONS The success rate of fat myringoplasty may be associated with the perforation site and size. The success rate of fat myringoplasty was equivalent to that of the paper patch but inferior to a conventional method using perichondrium or fascia.
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10
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Ayache S, Beltran M, Guevara N. Endoscopic transcanal myringoplasty for anterior tympanic membrane perforation. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:413-415. [DOI: 10.1016/j.anorl.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Carvalho T, Guedes G, Sousa FL, Freire CSR, Santos HA. Latest Advances on Bacterial Cellulose-Based Materials for Wound Healing, Delivery Systems, and Tissue Engineering. Biotechnol J 2019; 14:e1900059. [PMID: 31468684 DOI: 10.1002/biot.201900059] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/18/2019] [Indexed: 01/10/2023]
Abstract
Bacterial cellulose (BC) is a nanocellulose form produced by some nonpathogenic bacteria. BC presents unique physical, chemical, and biological properties that make it a very versatile material and has found application in several fields, namely in food industry, cosmetics, and biomedicine. This review overviews the latest state-of-the-art usage of BC on three important areas of the biomedical field, namely delivery systems, wound dressing and healing materials, and tissue engineering for regenerative medicine. BC will be reviewed as a promising biopolymer for the design and development of innovative materials for the mentioned applications. Overall, BC is shown to be an effective and versatile carrier for delivery systems, a safe and multicustomizable patch or graft for wound dressing and healing applications, and a material that can be further tuned to better adjust for each tissue engineering application, by using different methods.
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Affiliation(s)
- Tiago Carvalho
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland.,Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Gabriela Guedes
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland.,Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Filipa L Sousa
- Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Carmen S R Freire
- Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193, Aveiro, Portugal
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland.,Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, FI-00014, Finland
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12
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Ayache S, Beltran M, Guevara N. Endoscopic classification of the external auditory canal for transcanal endoscopic ear surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:247-250. [DOI: 10.1016/j.anorl.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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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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14
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Bacterial cellulose graft versus fat graft in closure of tympanic membrane perforation. Am J Otolaryngol 2019; 40:168-172. [PMID: 30594403 DOI: 10.1016/j.amjoto.2018.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 11/20/2022]
Abstract
OBJECT To compare between results of bacterial cellulose graft myringoplasty and fat graft myingoplasty in patients had mild or moderate size safe perforation. METHODS 120 patients undergoing myringoplasty due to mild or moderate size perforation were divided into 3 groups: group I: 40 patients undergoing myringoplasty with use of bacterial cellulose graft, group II: 40 patients undergoing myringoplasty with use of fat graft, group III: 40 patients undergoing usual myringoplasty with use of temporalis fascia graft (control group). RESULTS Healing in 20 patients with small perforation and 17 patients with moderate perforation in Group I, Healing in 15 patients with small perforation and 10 patients with moderate perforation in Group II, Healing in 18 patients with small perforation and 12 patients with moderate perforation in Group III. CONCLUSION Bacterial cellulose graft myringoplasty would be a good, simple, rapid and safe surgery that could be done under local anesthesia in outpatient clinic with shorter time of surgery than fat graft myringoplasty and temporalis fascia graft myringoplasty, with better hearing and healing. SUMMARY AT GLANCE 120 patients undergoing myringoplasty were divided into 3 groups to compare between results of bacterial cellulose graft myringoplasty, fat graft myringoplasty and temporalis fascia graft myringoplasty.
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Fouad YA, Abdelhady M, El-Anwar M, Merwad E. Topical platelet rich plasma versus hyaluronic acid during fat graft myringoplasty. Am J Otolaryngol 2018; 39:741-745. [PMID: 30173940 DOI: 10.1016/j.amjoto.2018.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effect of adding platelet rich plasma (PRP) or Hyaluronic acid (HA) to fat graft myringoplasty (FGM) for medium sized central tympanic membrane (TM) perforations. METHODS This is a retrospective study conducted on 69 patients with medium sized central TM perforations. In 21 patients, PRP was used with the FGM; and in 23 patients, HA was used with the FGM; while in 25 patients, pure FGM was performed without adding an enhancing material. RESULTS Successful TM perforation repair was achieved in 18 ears (85.7) with using PRP with FGM and in 20 ears (87%) with using HA with FGM and in 15 ears (60%) with pure FGM. CONCLUSION FGM with adding PRP or HA is more successful in closure of TM perforation than pure FGM in case of medium sized central TM perforation.
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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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El-Anwar MW, Elnashar I, Foad YA. Platelet-rich plasma myringoplasty: A new office procedure for the repair of small tympanic membrane perforations. EAR, NOSE & THROAT JOURNAL 2018; 96:312-326. [PMID: 28846786 DOI: 10.1177/014556131709600818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a prospective study to assess the effectiveness of a platelet-rich plasma hourglass graft in the repair of small tympanic membrane perforations as an office-based procedure. Our study population was made up of 25 patients-10 men and 15 women, aged 19 to 45 years (mean: 30.4 ± 7.2)-who each underwent repair of one eardrum. After administration of topical anesthesia, a single piece of platelet-rich plasma approximately double the size of the perforation was obtained from each patient's intravenous blood sample. After the margin of the perforation was freshened, the platelet-rich plasma was placed in an hourglass configuration, with equal portions lying medial and lateral to the perforation. Successful perforation repair was achieved in 21 of the 25 ears (84%). No patient developed an infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. We conclude that office-based platelet-rich plasma myringoplasty is a safe and effective minimally invasive procedure that is suitable for repairing small tympanic membrane perforations.
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Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otolaryngology-Head and Neck Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt.
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Malafronte G, Filosa B. One hundred twenty-five fat myringoplasties: Does marginal perforation matter? Clin Otolaryngol 2017; 43:362-365. [DOI: 10.1111/coa.12976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - B. Filosa
- ENT Departement A. O.”S.G. Moscati”; Avellino Italy
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Knutsson J, Kahlin A, von Unge M. Clinical and audiological short-term and long-term outcomes of fat graft myringoplasty. Acta Otolaryngol 2017; 137:940-944. [PMID: 28537107 DOI: 10.1080/00016489.2017.1326063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Results of fat graft myringoplasty are often reported with only short-term follow-up. Audiological results are less commonly reported, as well as long-term follow-up results. MATERIALS AND METHODS One hundred consecutive patients scheduled for fat graft myringoplasty were included in a prospective cohort study. Clinical and audiological outcomes were assessed at six weeks and one year postoperatively. RESULTS Perforation sizes ranged from 0.5 to 4 mm. The six-week follow-up showed a total perforation closure rate of 72.9% with a statistically significant (p = .03) higher rate for the pediatric age group (83.0%). 64.4% of all patients were healed at one-year follow-up. Statistical analyses for background factors did not reveal any significant difference in healing rates with regard to patient sex or location or cause of the perforation. The mean preoperative air-conduction (AC) threshold was 25 dB with an air-bone gap of 12 dB. At the one-year follow-up the mean air conduction threshold for healed ears was improved to 16.6 dB, still 54.2% of them had a type B tympanogram. CONCLUSIONS Children had a higher perforation closure rate at six-week follow-up than adult patients. Recurrent tympanic membrane perforations were common after initially successful fat graft myringoplasties. Long-term hearing was improved after successful fat graft myringoplasty, resulting in a mean AC threshold of 16.6 dB.
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Affiliation(s)
- Johan Knutsson
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden
| | - Annika Kahlin
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
| | - Magnus von Unge
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden
- Department of Otorhinolaryngology, Akershus University Hospital and University of Oslo, Oslo, Norway
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Lou X. It is important to measure changes in the bone-conduction threshold when evaluating whether FGF-2 can be used to repair blast-induced total or near-total tympanic membrane perforations. Am J Otolaryngol 2017; 38:267-268. [PMID: 28132727 DOI: 10.1016/j.amjoto.2017.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Xudan Lou
- Department of Otorhinolaryngology Operating Theatre (OR), Yiwu Central Hospital, Yiwu City, Zhejiang Province, China.
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21
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Reply to the letter to the editor concerning: 'Fat-plug myringoplasty of ear lobule vs abdominal donor sites'. Eur Arch Otorhinolaryngol 2017; 274:2665-2667. [PMID: 28213777 DOI: 10.1007/s00405-017-4460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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Fat volume is critical when performing fat-plug myringoplasty. Eur Arch Otorhinolaryngol 2017; 274:2661-2663. [DOI: 10.1007/s00405-017-4458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
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D'Eredità R. Porcine small intestinal submucosa (SIS) myringoplasty in children: A randomized controlled study. Int J Pediatr Otorhinolaryngol 2015; 79:1085-9. [PMID: 25956867 DOI: 10.1016/j.ijporl.2015.04.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 04/19/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A novel bioactive material for tissue graft, derived from porcine small intestinal mucosa (SIS) has been marketed. This material promotes early vessel growth, provides scaffolding for the remodeling tissues, and is inexpensive and ready-to-use. We evaluated efficacy, safety, and surgery time of SIS myringoplasty, in comparison with autologous temporalis fascia (PTF) repair in children in a prospective, two-group (SIS and PTF) randomized, blinded study at a tertiary-care pediatric institution. MATERIALS AND METHODS 404 children with tympanic membrane (TM) repair were randomly assigned to receive SIS or PTF myringoplasty. Primary outcome was the healing of the TM at 6 months. Secondary outcomes were surgical time, and adverse events. Long-term follow-up ranging from 11 to 2 years was obtained in all enrolled children. Audiometric tests as pure-tone thresholds were applied in all patients. The Fisher's exact test and the Kriskal-Wallis test were applied for statistical analysis. RESULTS AND DISCUSSIONS Four-hundred-thirty-two TM perforations were treated, 217 in the SIS and 215 in the PTF groups. There were 209 stable TM closures in the SIS (96.3%) and 204 (94.8%) in the PTF arm. This difference was not statistically significant (odds ratio=0.4, 95%; confidence interval=0.12-1.41). SIS myringoplasty yielded reduced surgical time. No adverse reaction to SIS was encountered. Audiometric tests revealed no statistically significant difference in the two groups. CONCLUSIONS SIS myringoplasty is a safe and effective method for TM closure in children with reduced surgical time, as compared to PTF.
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Gun T, Sozen T, Boztepe OF, Gur OE, Muluk NB, Cingi C. Influence of size and site of perforation on fat graft myringoplasty. Auris Nasus Larynx 2014; 41:507-12. [PMID: 25199735 DOI: 10.1016/j.anl.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results. METHODS The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium-large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients' follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year. RESULTS The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium-large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p>0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p<0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations. CONCLUSION Fat graft myringoplasty (FGM) may be used in all small and medium-large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium-large perforations; patients with small perforations had more satisfied audiological outcome than medium-large perforations.
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Affiliation(s)
- Taylan Gun
- İstanbul Bahçeşehir University, Faculty of Medicine, ENT Department, İstanbul, Turkey
| | - Tevfik Sozen
- Hacettepe University Faculty of Medicine, ENT Department, Ankara, Turkey
| | | | - Ozer Erdem Gur
- Antalya Education and Research Hospital, ENT Department, Antalya, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Cemal Cingi
- Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey
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Acar M, Yazıcı D, San T, Muluk NB, Cingi C. Fat-plug myringoplasty of ear lobule vs abdominal donor sites. Eur Arch Otorhinolaryngol 2014; 272:861-866. [PMID: 24469028 DOI: 10.1007/s00405-014-2890-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/13/2014] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to compare the success rates of fat-graft myringoplasties harvesting adipose grafts from different donor sites (ear lobule vs abdomen). The clinical records of 61 patients (24 males and 37 females) who underwent fat-plug myringoplasty (FPM) were reviewed retrospectively. Fat from ear lobule (FEL) and abdominal fat were used as graft materials. The impact of age, gender, systemic diseases, topography of the perforation, utilization of fat graft materials of different origin on the tympanic membrane closure rate and the effect of FPM on hearing gain was analyzed. Our tympanic membrane (TM) closure rate was 82 %. No statistical significant difference was observed regarding age, gender, comorbidities (septal deviation, hypertension and diabetes mellitus) or habits (smoking). Posterior TM perforations had significantly lower healing rate. The change in TM closure rate considering different adipose tissue donor sites was not statistically significant. The hearing gain of the patients was mostly below 20 dB. Fat-plug myringoplasty (FPM) is a safe, cost-effective and easy operation for selected patients. Abdominal fat graft is as effective as ear lobe fat graft on tympanic membrane healing, has cosmetic advantages and should be taken into consideration when planning fat as the graft source.
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Affiliation(s)
- Mustafa Acar
- ENT Department, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Demet Yazıcı
- ENT Department, Tarsus State Hospital, İsmetpaşa Mh., 33440, Tarsus, Mersin, Turkey.
| | - Turhan San
- ENT Department, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cemal Cingi
- ENT Department, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Konstantinidis I, Malliari H, Tsakiropoulou E, Constantinidis J. Fat Myringoplasty Outcome Analysis With Otoendoscopy. Otol Neurotol 2013. [DOI: 10.1097/mao.0b013e318278c1e3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ayache S. Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol 2012; 270:853-60. [DOI: 10.1007/s00405-012-2056-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 05/08/2012] [Indexed: 11/28/2022]
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Saliba I, Woods O. Hyaluronic acid fat graft myringoplasty: A minimally invasive technique. Laryngoscope 2011; 121:375-80. [DOI: 10.1002/lary.21365] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/21/2010] [Indexed: 11/12/2022]
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Kim DK, Park SN, Yeo SW, Kim EH, Kim JE, Kim BY, Kim MJ, Park KH. Clinical efficacy of fat-graft myringoplasty for perforations of different sizes and locations. Acta Otolaryngol 2011; 131:22-6. [PMID: 20735182 DOI: 10.3109/00016489.2010.499881] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Fat-graft myringoplasty (FGM) has a reliable tympanic closure rate for small to large perforations, but yields poor hearing improvement in the latter case. A topographic evaluation of FGM showed that the procedure resulted in a reliable perforation closure rate and audiologic outcome, regardless of perforation location. OBJECTIVES This study assessed the utility of FGM in treating perforations of different sizes and locations. METHODS This retrospective study involved 45 patients (46 ears) who underwent FGM at St Mary's Hospital (Seoul, Korea) between August 2007 and February 2010. RESULTS The total perforation closure rate after FGM was 87% (40 cases), with no statistical difference among perforation size groups, even though the mean closure rates of the 10-20% and >30% perforation groups were lower than other groups. The difference in the closure rates of patients with anteriorly located perforations and those with perforations in other sites was not significant. The mean postoperative air-bone gap (ABG) was 14.3 (±7.5) dB. Mean postoperative ABG improved significantly after FGM; however, on a per-group basis, the >30% perforation group had the poorest results and the difference was statistically significant. The difference in mean postoperative ABGs of the two groups depending on the location of the perforation (anterior and other) was not significant.
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Affiliation(s)
- Dong-Kee Kim
- Department of Otolaryngology-Head & Neck Surgery, Catholic University of Korea, Seoul, Korea
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The selection and strategy in otoendoscopic myringoplasty with autogenous adipose tissue. Indian J Otolaryngol Head Neck Surg 2010; 62:25-8. [PMID: 23120675 DOI: 10.1007/s12070-010-0010-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To summarize the experience and explore the clinical application of myringoplasty with autogenous adipose tissue by endotoscope. METHODS In this study, we retrospectively analyzed 56 cases (64 ears) of otoendoscopic myringoplasty with autogenous adipose tissue performed between January 2006 and April 2007. RESULT All patients were followed up more than 6 months. The global closing rate was 92.19% (59 perforations among 64 total operations), 95.08% (diameter of perforation ≤5 mm), 33.33% (>5 mm). CONCLUSION Otoendoscopic myringoplasty with adipose tissue is a simple and minimally invasive technique for tympanic membrane perforations. With optimal choice at indication and correct treatment to complication, the technique will give the advantages of slighter trauma, simpler procedure, lower cost and reduced complication rate.
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Albera R, Dagna F, Lacilla M, Canale A. Equine versus bovine pericardium in transmeatal underlay myringoplasty. Ann Otol Rhinol Laryngol 2009; 118:287-91. [PMID: 19462850 DOI: 10.1177/000348940911800409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Many different grafting materials have been proposed in myringoplasty. The aim of this study was to evaluate the results obtained in transmeatal underlay myringoplasty using bovine and equine pericardium. The results were compared with those obtained by using autologous temporalis fascia. METHODS The study group consisted of 52 patients with tympanic perforation. Twenty-nine patients were randomly selected for treatment with bovine pericardium and 23 for equine pericardium. A group of 14 patients was treated with autologous temporalis fascia. RESULTS Closure of the perforation was achieved in 19 of 29 patients (66%) treated with bovine pericardium, in 19 of 23 (83%) treated with equine pericardium, and in 13 of 14 (93%) treated with autologous fascia. The best functional results in patients who gained closure of the perforation were obtained by means of equine pericardium. CONCLUSIONS The overall long-term tympanic closure rate demonstrates that equine pericardium has a greater take rate than bovine pericardium. The results obtained are inferior to those obtained with autologous fascia, but this technique is less aggressive. The higher success rate with equine pericardium may be due to the fact that it is thinner and easier to handle and model than bovine pericardium.
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Affiliation(s)
- Roberto Albera
- Department of Otorhinolaryngology, San Giovanni Battista Hospital, Turin, Italy
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Abstract
OBJECTIVE To evaluate the impact of patient and graft variables on the successful closure of tympanic membrane perforations treated with myringoplasty at the Children's Hospital of Pittsburgh from 2000 to 2005. STUDY DESIGN Retrospective chart review at an academic tertiary-care children's hospital. METHODS Charts were reviewed for 604 children, ages 1 to 18 years old, with complete records who underwent myringoplasty by the pediatric otolaryngology practice at Children's Hospital of Pittsburgh of UPMC from 2000 to 2005, totaling 777 procedures. RESULTS Significant variables include patient age, number of prior tubes, perforation etiology (P < .000), presence of a retained tube (P < .000) as well as tube type (P = .016), graft material (P = .001), and history of Down syndrome (P = .035). Nonsignificant variables include season of procedure (P = .599), status of adenoid tissue (P = .910), prior otorrhea (P = .175), as well as perforation location (P = .318) and duration (P = .150). CONCLUSIONS Proper patient and graft material selection can affect the outcome of myringoplasty procedures. Practical implications from these data suggest that Gelfoam myringoplasty is more successful than either paper patch or fat graft closures, with a 90.8% success rate (P = .001). Myringoplasty should not be deferred during the winter months as the season of procedure does appear to not affect the success of closure (P = .60). Similarly, the presence or absence of adenoid tissue did not affect the success of closure (P = .91).
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Ruellan K, Huy PTB. [Myringoplasty: an office procedure using a subdermal graft]. ACTA ACUST UNITED AC 2007; 125:109-11. [PMID: 18001690 DOI: 10.1016/j.aorl.2007.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 04/10/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Katell Ruellan
- Hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris, France
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Fiorino F, Barbieri F. Fat graft myringoplasty after unsuccessful tympanic membrane repair. Eur Arch Otorhinolaryngol 2007; 264:1125-8. [PMID: 17487499 DOI: 10.1007/s00405-007-0323-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 04/12/2007] [Indexed: 01/06/2023]
Abstract
The objective of the present study was to evaluate the efficacy of fat graft myringoplasty in repairing residual or recurrent tympanic membrane perforation. A retrospective analysis was performed on 31 patients, aged 25-57 years (mean 43.3), submitted to myringoplasty revision using fat graft. Fourteen were males and 17 females. Perforation size ranged from 1 to 5 mm. Follow-up time ranged from 4 to 62 months (mean 26 months). Fat graft myringoplasty was performed under local anesthesia, using ear lobe fat in 26 patients and abdominal fat in five patients closure of tympanic membrane perforation was achieved in 87.1% of ears. No modification of the hearing level was evidenced at the statistical analysis. Fat graft myringoplasty is a safe, effective and minimally invasive procedure, suitable to repair small residual/recurrent perforations of the tympanic membrane. The angiogenic properties of the fat are ideal to overcome the poor vascular supply in the vicinity of the tympanic membrane perforation.
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Affiliation(s)
- Francesco Fiorino
- Department of Otolaryngology, Civil Hospital Borgo Trento, Verona, Italy.
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Abstract
BACKGROUND Historical vignettes are often included in scientific otological articles. However, they may contain inaccuracies and errors when authors use secondary or compiled texts rather than primary source material. METHODS Examples of errors arising from the use of secondary sources are obtained from compiled works in comparison with original publications, with a particular focus on Hildanus' speculum. RESULTS Different types of inaccuracies may be found in historical vignettes. In Hildanus' works, two different specula are depicted: one was described by himself during his lifetime, and the other after his death, probably by his publisher. Only the posthumous description of Hildanus' speculum has been retained historically, but it is uncertain that it was really developed by Hildanus himself. Other such inaccuracies exist because of confusion with the original terminology of referring to an instrument, such as the otoscopes of Toynbee and Brunton, inaccuracies in dates, misinterpretation of the original text, such as the attribution to Charcot as the first to propose the intracranial division of the eighth nerve in Menière's disease, and problems of translation (e.g., the different translations of the book titled Diseases of the Ear by Wilhelm Kramer). CONCLUSION These different examples of inaccuracies show the common problems encountered in writing a historical report. Authors must be aware of such errors and work almost exclusively with original references. Secondary and compiled references should be reserved for a background of discussion and not as a source of direct support.
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Affiliation(s)
- Albert Mudry
- Institute for History of Medicine University Lausanne, Lausanne, Switzerland.
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Thomassin JM, Facon F, Gabert K. Intérêt de l’oto-endoscopie dans la myringoplastie par greffon adipocytaire. ACTA ACUST UNITED AC 2004; 121:346-9. [PMID: 15711473 DOI: 10.1016/s0003-438x(04)95532-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to present our results of endoscopic-guided myringoplasty using adipose graft tissue. Due to its simplicity and reliability, this technique seems be as efficient as other classical graft techniques (fascia temporalis, perichondrium...). PATIENTS AND METHODS We analyzed data from 81 patients operated on for a tympanic perforation between 1993 and 2002 using an endoscopic-guided technique with adipose graft. Patients were evaluated postoperatively at seven days, one month and three months. Criteria of success were complete closure of the tympanic membrane, absence of lateralization of the tympanic membrane and no audiometric impairment. RESULTS Treatment was successful in 920f patients with at least two years follow-up. The failures occurred in patients with contraindications such as myringosclerosis, myringitis and perforation size greater than 500f the tympanic surface. CONCLUSION Endoscopic-guided myringoplasty using an adipose tissue graft is a rapid, safe, reliable and efficient procedure that should be performed in first intention for selected indications.
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Affiliation(s)
- J-M Thomassin
- Service d'Oto-rhino-laryngologie et Chirurgie Cervico-faciale, Fédération O.R.L., Hôpital Universitaire de la Timone, 264, rue Saint Pierre, 13385 Marseille Cedex 05.
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