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Lou Z, Lou Z, Lv T, Chen Z. Additional cartilage reinforcement of the annulus in myringoplasty for subtotal perforation. Am J Otolaryngol 2024; 45:104232. [PMID: 38417260 DOI: 10.1016/j.amjoto.2024.104232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/03/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE In this study, graft success, hearing outcome, and complications were compared following the repair of subtotal perforation using a cartilage reinforcement underlay technique (CRUT) versus the traditional cartilage underlay technique (TCUT). STUDY DESIGN Randomized controlled trial. MATERIALS AND METHODS Seventy-six patients with subtotal perforations were prospectively randomized to the CRUT (n = 38) or TCUT (n = 38) group. The graft success rate, hearing outcome, and complications were compared at 12 months. RESULTS The mean operation time was 32.9 ± 4.2 (range: 26-47) min in the CRUT group and 51.8 ± 6.3 (range: 48-73) min in the TCUT group (P < 0.001). At 12 months postoperatively, no residual perforation was seen in either group. The graft success rate was 94.7 % (36/38) in the CRUT group and 92.1 % (35/38) in the TCUT group; the difference was not significant (P = 0.643). The postoperative air bone gap (ABG) was significantly improved compared to the preoperative value in both groups, without significant between-group differences in either the preoperative (P = 0.741) or postoperative (P = 0.865) ABG or the mean ABG gain (P = 0.812). Additionally, there were no significant between-group differences in the preoperative (P = 0.887) or postoperative (P = 0.753) mean bone-conduction pure tone average. In the TCUT group, seven (18.4 %) patients developed temporary hypogeusia and two (5.3 %) had external auditory canal scarring. Graft cholesteatoma was not observed in either group. CONCLUSION In the treatment of subtotal perforations, lateral reinforcement of the annulus with additional cartilage is simpler than traditional cartilage underlay for achieving graft and hearing success. The technique also does not involve raising the tympanomeatal flap or removing perforation margins.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang province, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang province, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Liu Y, Wei R, Ding Y, Li Y, Xin Y, Li D. Endoscopic Perichondrium-Cartilage Myringoplasty With Preserving of Anterior Margins and Tuck Grafts for Repairing Anterior Perforation With 3 year Followup. Ann Otol Rhinol Laryngol 2024; 133:190-195. [PMID: 37592410 DOI: 10.1177/00034894231194387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the graft outcomes of endoscopic perichondrium-cartilage myringoplasty with preserving of anterior margins for repairing anterior perforation with 3 year followup. STUDY DESIGN Prospective case series. SETTING Tertiary university hospital. MATERIALS AND METHODS We performed a prospective study in 47 patients with anterior perforation who underwent perichondrium-cartilage myringoplasty with preserving of anterior margins and tuck grafts. The operation time, graft success rate, hearing outcome, and complications were evaluated at 6 months and 3 years after surgery. RESULTS A total of 47 ears with anterior marginal perforation were included in the study. The perforation size was subtotal in 2 (4.3%) eras, large in 11 (23.4%) ears, medium in 27 (57.4%) ears, and small in 7 (14.9%). The mean operation time was 41.2 ± 5.4 minutes. All patients completed 6 months of follow-up. Residual perforation was observed in 2 patients with medium perforations, the graft success rate was 95.7% (45/47). The mean preoperative and postoperative AC PTAs were 38.1 ± 7.3 dB and 25.4 ± 4.6 dB (P < .05), while the mean preoperative and postoperative BC PTAs were 9.0 ± 4.6 dB and 9.6 ± 1.9 dB (P = .672). The functional success was 91.5% (43/47). None of the patients reported sensorineural hearing loss, altered taste, facial nerve palsy, vertigo, or tinnitus during the follow-up period. In addition, 34 (72.3%) patients completed 3 years followup and performed temporal bone CT examination, the mean followup time was 39.1 ± 2.7 months, CT revealed the well pneumatization of mastoids and middle ear. CONCLUSIONS Endoscopic perichondrium-cartilage myringoplasty with preserving of anterior margins and tuck grafts is a safe, suitable, and reliable method for repair of anterior perforation with few risk of anterior blunting and lateralization.
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Affiliation(s)
- Yachao Liu
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Ruili Wei
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Yongqing Ding
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Yanping Li
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Yunchao Xin
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Dong Li
- Department of Otolaryngol Head & Neck Surg, the First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
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Sun J. Comparison of perichondrium-cartilage button technique and traditional over-underlay technique for repairing large perforations. J Laryngol Otol 2024; 138:148-152. [PMID: 37681272 DOI: 10.1017/s0022215123000968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE This study was performed to compare the operation time, graft outcomes and complications between the endoscopic cartilage-perichondrium button technique and over-under technique for repairing large perforations. METHODS A total of 52 chronic large perforations were randomly allocated to receive treatment using the endoscopic cartilage-perichondrium button technique (n = 26) or over-under technique (n = 26). The graft outcomes, mean operation time and post-operative complications were compared between the two groups at 12 months. RESULTS The study population consisted of 52 patients with unilateral chronic large perforations. All patients completed 12 months of follow up. The mean operation time was 32.3 ± 4.2 minutes in the button technique group and 51.6 ± 2.8 minutes in the over-underlay technique group (p < 0.01). The graft success rate at 12 months was 92.3 per cent (24 out of 26) in the button technique group and 96.2 per cent (25 out of 26) in the over-underlay group (p = 0.552). CONCLUSION The endoscopic cartilage-perichondrium button technique had similar graft success rates and hearing outcomes for large chronic perforations to the over-under technique, but significantly shortened the mean operation time.
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Affiliation(s)
- J Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, China
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Lou Z, Lou Z, Chen Z. Cartilage-Perichondrium Myringoplasty for Managing Intratympanic Membrane Cholesteatomas With Chronic Otitis Media in Adults. EAR, NOSE & THROAT JOURNAL 2024:1455613241227714. [PMID: 38279828 DOI: 10.1177/01455613241227714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
Objective: This study evaluated the surgical outcomes and complications of the endoscopic cartilage-perichondrium graft technique for treating intratympanic membrane cholesteatomas (ITMCs) with tympanic membrane (TM) perforation or an atrophic TM in adults. Methods and Materials: Clinical data on 11 adult ITMCs were analyzed retrospectively. The graft success and cholesteatoma recurrence were evaluated 12 months postoperatively. Results: Of the 11 patients with ITMC, TM perforation had occurred in 2 (18.2%) and an atrophic TM or TM scar healing occurred in 9 (81.8%). In endoscopy, keratin debris accumulation was seen at the superior edge of the perforation or atrophic TM. Computed tomography revealed that the cholesteatoma was confined to the TM. Intraoperatively, the epithelial invasion of the cholesteatoma was limited to the fibrous layer within the TM. Cartilage-perichondrium grafting was performed after removing the cholesteatoma. All the grafts were successful, and the perforations achieved complete closure by the final 12 month follow-up. Endoscopy revealed no recurrent cholesteatoma. Of the 9 patients with preoperative tinnitus, the tinnitus disappeared in 3 (33.3%), was relieved in 4 (44.4%), and was unchanged in 2 (22.2%). Of the 7 patients with an ear fullness preoperatively, the ear fullness disappeared in 6 (85.7%) and was relieved in 1 (14.3%). The mean air-bone gap improved from 28.6 dB preoperatively to 16.2 dB postoperatively. Conclusions: Endoscopic complete excision of an ITMC and cartilage-perichondrium graft without raising a tympanomeatal flap can lead to successful graft intake and improve the symptoms for the patients with ITMC combined with perforation or atrophic TM.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, Yiwu, Zhejiang, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
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Wu M, Lou Z. Local Anesthesia-Based Modified Cartilage "Inlay" Graft Myringoplasty for Repairing Large Perforation. EAR, NOSE & THROAT JOURNAL 2023:1455613231200821. [PMID: 37743761 DOI: 10.1177/01455613231200821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the graft success rate and hearing outcome of modified cartilage inlay graft technique for repairing large perforations under local anesthesia. STUDY DESIGN Prospective case series. METHODS AND MATERIALS We performed a prospective study in 31 patients with large perforations who underwent endoscopic local anesthesia-based modified cartilage inlay graft technique with no raising of the squamous epithelium and no rimming of the perforation margins. The graft outcomes and complications were evaluated at 6 and 24 months postoperatively. RESULTS Thirty-one patients (31 ears) were included in this study. The mean operation time was 42.3 ± 2.6 (ranged 36-51) minutes. The visual analog scale pain scores at intraoperative and 2 and 48 hours postoperatively were, respectively, 2.6 ± 0.6, 1.4 ± 0.2, and 0.6 ± 0.1. The graft success rate was 100.0% (31/31) at 6 months after surgery. However, only 25 (80.6%, 25/31) patients completed a 2-year follow-up and performed a temporal bone CT examination; re-perforation was seen in 2 patients, the graft success rate was 92.0% (23/25). CT revealed the well-developed pneumatization of the mastoids and middle ear in all the patients. Nevertheless, 1 (1/25, 8.0%) patient developed a graft epithelial inclusion cyst, which was removed by endoscope in the outpatient setting. The mean preoperative air bone gap (ABG) was 23.1 ± 4.3 dB, while the mean postoperative ABG after 6 months was 14.9 ± 2.6 dB; the difference between these values was significant (P < .05; Wilcoxon's signed-rank test), and the functional success rate was 93.5% (29/31). CONCLUSION Endoscopic modified cartilage "inlay" graft technique with no raising the squamous epithelium and no rimming the perforation is a minimally invasive technique with a short operative time and satisfying success rate for closure of large perforations under local anesthesia.
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Affiliation(s)
- Meixia Wu
- Central Sterile Supply Department, Yiwu Central Hospital, Jinhua, Zhejiang, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, Yiwu, Zhejiang, China
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Lou Z, Lou Z, Wang J, Zhang B, Hu Y, Chen Z. Comparison of Cartilage Reinforcement and Push-Through Techniques for the Treatment of Large Perforations. EAR, NOSE & THROAT JOURNAL 2023:1455613231182661. [PMID: 37341102 DOI: 10.1177/01455613231182661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Objective: To compare the graft success rate and hearing outcomes of endoscopic cartilage reinforcement perichondrium-cartilage composite graft and push-through techniques for the treatment of large marginal perforations. Study Design: Randomized controlled trial. Materials and Methods: A total of 57 large marginal perforations were prospectively randomized to cartilage reinforcement (n = 29) and cartilage push-through technique (n = 28) groups. The graft success rate, audiometric outcomes, and complications were compared between the 2 groups at 6 months. Results: All patients completed 6 months of follow-up. The graft success rate in the cartilage reinforcement group was significantly higher compared to that in the push-through group (100.0% vs 78.6%, P < .01). Residual perforation was observed in 5 (17.9%) patients, and re-perforation in 1 (3.6%) patient, in the push-through group. The preoperative air-bone gap (ABG) was 17.6 ± 3.5 dB in the cartilage reinforcement group and 16.8 ± 8.4 dB in the push-through group (P > .05). Postoperatively, although the postoperative ABG in the cartilage reinforcement group was higher than that in the push-through group, no significant difference was observed (11.8 ± 4.3 dB vs 8.9 ± 2.5 dB, P > .05). Additionally, no significant difference was found in ABG closure between the 2 groups (6.6 ± 1.9 dB vs 7.9 ± 4.7 dB, P > .05). Conclusion: Cartilage reinforcement myringoplasty is a simpler and more useful technique to achieve graft success compared to cartilage-perichondrium push-through for the treatment of large marginal perforations, and it does not affect hearing levels.
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Affiliation(s)
- Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, Yiwu, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Boya Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Yibing Hu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
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Zhao C. Perichondrium-Cartilage Inlay Butterfly Myringoplasty: An Office-Based Procedure for Closing Small- to Medium-Sized Tympanic Membrane Perforations. EAR, NOSE & THROAT JOURNAL 2023:1455613231178113. [PMID: 37246397 DOI: 10.1177/01455613231178113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Objective: The objective of this study was to assess the graft and functional outcomes of inlay butterfly cartilage-perichondrium graft myringoplasty in an office setting. Material and Methods: Adult patients with chronic perforations underwent inlay butterfly cartilage-perichondrium graft myringoplasty under local and topical anesthesia. The graft and functional outcomes, intraoperative pain score, and complications were evaluated at 6 months postoperatively. Results: A total of 39 patients (39 ears) were included in this study. All patients completed 6 months of follow-up. The mean operation time was 26.5 ± 3.2 (ranged from 21 to 32) minutes. The intraoperative mean pain score was 0.61 ± 0.28. The graft success rate was 97.4% (38/39) at 6 months postoperatively. The mean preoperative air-bone gap (ABG) was 19.18 ± 4.01 dB, while the mean postoperative ABG at 6 months was 10.56 ± 2.27 dB (P < .05; Paired-Samples T Test). The functional success rate was 100.0% (38/38). Endoscopic examination showed that the transplanted perichondrium graft gradually atrophied, flattened, and became indistinguishable from the surrounding tympanic membrane 2 to 3 months following surgery, the superficial layer of perichondrium graft formed the crust and migrated into the external auditory canal at 3 to 6 months postoperatively. Conclusions: Perichondrium-cartilage inlay butterfly myringoplasty is a highly successful and minimally invasive procedure well tolerated by adults for closure of small- and medium-sized perforations in an office setting.
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Affiliation(s)
- Chaowei Zhao
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu, Zhejiang, China
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Lou J, Liu Y, Lou Z, Lou Z, Chen Z. Endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforations with 3 years of follow-up. Am J Otolaryngol 2023; 44:103902. [PMID: 37150123 DOI: 10.1016/j.amjoto.2023.103902] [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: 03/08/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate graft outcomes and complications of endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforation with 3 years of follow-up. MATERIAL AND METHODS Adult patients with chronic kidney-shaped perforation underwent endoscopic perichondrium-cartilage H type technique. The graft outcomes and complications were evaluated at 36 months after surgery. RESULTS The total of 51 ears were included in this study. The mean operation time was 31.5 ± 4.1 min. Residual perforation was seen in 2 patients, the graft success rate was 96.1 % (49/51) at postoperative 12 months. Granular myringitis was noted in 8.2 % (4/49) patients in 49 patients with graft success. The mean preoperative ABG was 23.6 ± 3.7 dB, while the mean postoperative ABG postoperatively 12 months was 12.9 ± 5.2 dB (P < 0.05), the functional success rate was 94.1 % (48/51). At postoperative 36 months, only 32 (62.7 %, 32/51) patients were followed up, while 19 (37.3 %, 19/51) patients lost followup. Of the 32 patients with followup of 36 months, the mean follow-up time was 38.2 ± 7.1 (37-46) months, re-perforation was seen in one. All 32 patients performed the postoperative CT examination at last followup, CT revealed the well pneumatization of mastoids and middle ear. CONCLUSIONS Endoscopic cartilage-perichondrium H type technique is an alternative method for repairing chronic kidney-shaped perforations, with a highly successful, short operation time, minimally invasive procedure, and no cholesteatoma.
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Affiliation(s)
- Jianhua Lou
- Department of Operating Theater, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China
| | - Yachao Liu
- Department of Otolaryngol Head & Neck Surgery, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China.
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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