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Al-Arman AM, Moneir W, Amer HE, Ebada HA. Platelet rich fibrin augmented tympanoplasty versus cartilage tympanoplasty: a randomized clinical trial. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08819-2. [PMID: 39042174 DOI: 10.1007/s00405-024-08819-2] [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: 04/21/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. METHODS This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. RESULTS Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. CONCLUSION Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts.
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Affiliation(s)
| | - Waleed Moneir
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Hazem Emam Amer
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
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Lou Z, Lou Z, Lv T, Chen Z. Comparison of temporalis fascia and cartilage graft over-under myringoplasty for repairing large perforations. Am J Otolaryngol 2024; 45:104101. [PMID: 37948821 DOI: 10.1016/j.amjoto.2023.104101] [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: 07/28/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The objective of this study was to compare the operation time, graft success, audiometric outcomes and complications of over-under technique using a temporalis fascia (TMF) and cartilage grafts for the repair of large perforations. STUDY DESIGN Randomized controlled trial. MATERIALS AND METHODS 80 large perforations >2 quadrants of eardrum were prospectively randomized to undergo TMF over-under technique group (TFON, n = 40) or cartilage-perichondrium over-under technique group (CPON, n = 40). The graft success rate, audiometric outcomes, and complications were compared among two groups at 12 months. RESULTS The mean operation time was 56.8 ± 4.2 (range:52-71) min in the TFON group and 37.9 ± 2.8 (range: 31-47) min in the CPON group (P < 0.001). The lost follow-up rate was 3 (7.5 %) patients in the TFON group and 2 (5.0 %) patient in the CPON group (P = 0.644). Finally, 37 patients in the TFON group and 38 patients in the CPON group were included in this study. The graft infection rate was 2 (5.4 %) patients in the TFON group and 2 (5.3 %) patient in the CPON group (P = 0.626), all the graft infection resulted in the residual perforation. The remaining residual perforation was 2 (5.4 %) patients in the TFON group and 1 (2.6 %) patient in the CPON group; the re-perforation was 3 (8.1 %) patients in the TFON group and 0 (0.0 %) patient in the CPON group. The graft success rate was 81.1 % (30/37) patients in the TFON group and 92.1 % (35/38) patient in the CPON group. The mean preoperative and 12-month postoperative ABGs were significantly different in any group (P < 0.01). However, there were no significant difference among two groups regardless of pre-or post-ABGs or ABG closure. No lateralization of the graft or blunting was noted in any group. Four (10.8 %)patients developed atelectasis and one (2.7 %) developed the EAC scarring in the TFON group. Graft cholesteatomas was found in 2 (5.4 %) patients in the TFON group and in 5 (13.2 %) patients in the CPON group (P = 0.449). Three (8.1 %) patients had temporary hypogeusia in the TFON group. CONCLUSION Although temporalis fascia graft over-under technique obtained similar graft success rates and hearing outcomes for large chronic perforations to the cartilage-perichondrium over-under technique, temporalis fascia graft technique prolonged the operation time and increased the re-perforation and graft atelectasis. Nevertheless, the graft cholesteatomas were comparable among two techniques.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou medical university affiliated Yiwu 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, Wenzhou medical university affiliated Yiwu 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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Dhoke PR, Dhote KS, Khadakkar S, Harkare V, Deosthale N, Singh A. Paediatric Type 1 Tympanoplasty: Comparison of Full Thickness Tragal Cartilage Versus Temporalis Fascia Graft-A Randomised Controlled Trial. Indian J Otolaryngol Head Neck Surg 2023; 75:470-475. [PMID: 37206811 PMCID: PMC10188737 DOI: 10.1007/s12070-022-03262-3] [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: 12/14/2021] [Accepted: 10/23/2022] [Indexed: 02/26/2023] Open
Abstract
Tympanic membrane perforation in children usually appears as a sequel of middle ear infection. This study was conducted to compare the anatomical and functional outcomes of cartilage and temporalis fascia graft in type 1 tympanoplasty in Paediatric population. DESIGN A hospital based randomized controlled trial. SETTING A tertiary care institute of central India. SUBJECTS All consecutive paediatric patients between 5 and 18 years of either sex attending ENT OPD and Paediatric OPD fulfilling inclusion criteria were included in the study. Anatomical and functional results of total 90 patients who underwent tympanoplasty were analyzed. These patients were divided into two groups depending on the graft material used. The cartilage group and the temporalis fascia group each comprising of 45 patients respectively. METHODS All patients underwent Type I tympanoplasty under general anaesthesia and with a post auricular approach. The surgeries were performed by senior surgeons. The graft success rate of the cartilage group (91.1%) was higher than the fascia group (84.44%) but the difference was not statistically significant (p = 0.449). The air bone gap closure was slightly better with temporalis fascia group than with cartilage group but the overall functional success rate in both the groups was not statistically significant.Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in paediatric tympanoplasty.
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Affiliation(s)
- Priti R. Dhoke
- Department of ENT, NKPSIMS & LMH, Nagpur, Maharashtra 440019 India
| | - Kanchan S. Dhote
- Department of ENT, NKPSIMS & LMH, Nagpur, Maharashtra 440019 India
| | - Sonali Khadakkar
- Department of ENT, NKPSIMS & LMH, Nagpur, Maharashtra 440019 India
| | - Vivek Harkare
- Department of ENT, NKPSIMS & LMH, Nagpur, Maharashtra 440019 India
| | - Nitin Deosthale
- Department of ENT, NKPSIMS & LMH, Nagpur, Maharashtra 440019 India
| | - Ankit Singh
- Department of ENT, NKPSIMS & LMH, Nagpur, Maharashtra 440019 India
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Mucha S, Bugnait G, Suri GS, Vibhuti V, Prakash S, Akash A, Tiwari V. Comparative Study on Temporalis Fascia Graft Versus Tragal Cartilage in Type-1 Tympanoplasty in Paediatric Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:396-402. [PMID: 37206827 PMCID: PMC10188822 DOI: 10.1007/s12070-023-03490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to compare anatomical and functional outcomes of temporalis fascia graft versus tragal cartilage graft in type 1 tympanoplasty in paediatric patients. A prospective, comparative and randomised study. A detailed history was taken from all the patients visiting the ENT OP dept after fulfilling the inclusion and exclusion criterion patients were enrolled for the study. Written and informed consent was taken for all the patients from legally acceptable guardians. Preoperative assessment was done and the patients were subjected to type1 tympanoplasty with Temporalis fascia graft or tragal cartilage graft. All the patients were followed up on the third, sixth postoperative months to assess hearing improvement. All the patients were followed up on the first and third,sixth postoperative months for graft status with otoscopic examination. In the present study out of 80 patients, 40 patients underwent type 1 tympanoplasty with temporalis fascia and the remaining 40 patients with tragal cartilage. Both groups were assessed postoperatively for anatomical and functional success with maximum follow up of six months. There was no statistical significance between the outcome and the age or site and size of tympanic membrane perforation. Both groups had comparable graft success rate and hearing improvement. The cartilage group had a higher anatomical success rate. The functional outcome was similar. However, there was no statistically significant difference found in the outcome of two groups. Tympanoplasty can be performed in a paediatric age group with a good success rate in suitable patients. It can be done at an early age,safely with good anatomical and functional outcomes. The age group, site or size of perforation, the type of graft used for tympanoplasty does not alter the anatomical or functional outcome significantly. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03490-1.
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Nicholas Jungbauer W, Jeong S, Nguyen SA, Lambert PR. Comparing Myringoplasty to Type I Tympanoplasty in Tympanic Membrane Repair: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:922-934. [PMID: 36939595 DOI: 10.1002/ohn.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To compare the anatomic success rates of type I tympanoplasty (tympanoplasty) versus myringoplasty. By our definition, tympanoplasty involves entering the middle ear via elevation of a tympanomeatal flap, while myringoplasty involves surgery to the drumhead without middle ear exposure. DATA SOURCES PubMed, Scopus, CINAHL, Cochrane. REVIEW METHODS To be included, studies must have documented surgical technique, tympanic membrane (TM) perforation size (as % of TM), and success rate using tissue or alloplastic grafts. Exclusion criteria included series with more than 10% of patients with cholesteatoma or middle ear pathology. A meta-analysis of weighted summary proportions under the random effects model was performed, and proportion differences (PD) were calculated. A secondary analysis of hearing outcomes was performed. RESULTS Eighty-five studies met inclusion, with a tympanoplasty cohort of n = 7966 and n = 1759 for myringoplasty. For perforations, less than 50% of the TM, the success rate for tympanoplasty and myringoplasty was 90.2% and 91.4%, respectively (PD: 1.2%, p = .19). In perforations greater than 50%, tympanoplasty and myringoplasty success rates were 82.8% and 85.3%, respectively (PD: 2.5%, p = .29). For both procedures, perforations less than 50% of the TM had higher success rates than perforations greater than 50% of the TM (p < .01). Both techniques endorsed significant improvements to air-bone gap (ABG) metrics. CONCLUSION Our analysis suggests that the anatomic success rate is similar for tympanoplasty and myringoplasty, regardless of perforation size, and that smaller perforations experience higher success rates in both techniques. ABG outcomes were also similar between procedure techniques.
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Affiliation(s)
- Walter Nicholas Jungbauer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Erdem D, Baklaci D, Elicora SS, Bilgin E, Say MA. Postoperative Anatomical and Functional Success Rates of Pediatric Patients with Chronic Otitis Media: Our Experiences. Indian J Otolaryngol Head Neck Surg 2022; 74:6477-6482. [PMID: 36742623 PMCID: PMC9895649 DOI: 10.1007/s12070-021-02657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
The preoperative and postoperative pure-tone hearing thresholds and anatomical graft success of pediatric patients who underwent chronic otitis mediasurgery with various indications were evaluated and the factors affecting success were examined.Pediatric patients aged 6 to 18 years, who underwent ear surgery for various reasons between January 1, 2013 and January 1, 2020 were included in the study. All patients included in the sample were assessed in terms of age (< 13 and ≥ 13 years), disease type (cholesteatoma, tympanosclerosis, adhesive otitis media, chronic suppurative otitis media, isolated or traumatic tympanic membrane perforation), surgery performed (type 1 tympanoplasty, canal wall-up mastoidectomy, and exploratory tympanotomy), condition of the contralateral ear (unilateral/bilateral disease), graft material (temporal muscle fascia/tragal cartilage), preoperative and postoperative pure-tone audiometry thresholds and hearing gains, and postoperative sixth-month functional and anatomical graft success. Anatomical graft success and functional success were also evaluated according to the type of surgery performed, type of disease, type of fascia used in surgery, condition of the contralateral ear, and age. No statistically significant difference was found between the groups in terms of anatomical graft success and functional success according to the type of surgery performed (p = 0.414 and p = 0.123, respectively) and type of disease (p = 0.454 and p = 0.097, respectively). There was also no statistically significant difference between the anatomical and functional success of temporal muscle fascia and conchal cartilage grafts (p = 0.833 and p = 0.565, respectively). While no statistically significant difference was observed in graft success between the patients with and without contralateral ear disease, there was a statistically significant difference in functional success (p = 0.188 and p = 0.014, respectively). Although not statistically significant, it was observed that the anatomical graft success rates were decreased in patients with contralateral ear disease compared to those without bilateral disease (p = 0.188). There was no significant difference between age and anatomical graft success (p = 0.865) or functional success (p = 0.956). The type of disease in the diagnosed ear, presence of disease in the contralateral ear, and graft material used affect functional and anatomical graft success rates. Therefore, we believe that pediatric patients should be evaluated considering these factors in the preoperative period and the parents of these patients should be well informed about possible postoperative conditions.
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Affiliation(s)
- Duygu Erdem
- School of Medicine, Department of Otorhinolaryngology, Bulent Ecevit University, 931st Avenue 945 Street No:5/3, Ilker, Ankara Zonguldak, Turkey
| | - Deniz Baklaci
- School of Medicine, Department of Otorhinolaryngology, Bulent Ecevit University, 931st Avenue 945 Street No:5/3, Ilker, Ankara Zonguldak, Turkey
| | - Sultan Sevik Elicora
- School of Medicine, Department of Otorhinolaryngology, Bulent Ecevit University, 931st Avenue 945 Street No:5/3, Ilker, Ankara Zonguldak, Turkey
| | - Ergin Bilgin
- School of Medicine, Department of Otorhinolaryngology, Bulent Ecevit University, 931st Avenue 945 Street No:5/3, Ilker, Ankara Zonguldak, Turkey
| | - Mehmet Ali Say
- Department of Otorhinolaryngology, Cerkezkoy State Hospital, Tekirdag, Turkey
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Chen K, Zhao R. Comparison of cartilage and temporalis fascia grafts in type 1 tympanoplasty: A meta-analysis. EAR, NOSE & THROAT JOURNAL 2022:1455613221137122. [PMID: 36300279 DOI: 10.1177/01455613221137122] [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: 12/22/2023] Open
Abstract
OBJECTIVE To systematically review the results of type 1 tympanoplasties with temporalis fascia (TF) vs cartilage grafts in patients with chronic otitis media. METHODS Eligible studies were identified from PubMed, Ovid, and EMBASE databases prior to November 2021. We analyzed the pure tone audiometry (PTA) and air-bone gap (ABG) data as continuous variables, and the success rate was analyzed as a dichotomous variable. RESULTS Forty-four studies, including 4582 patients, were eligible. The cartilage graft overall morphologic success rate was higher than that of the TF grafts (P < .001). In the palisade (P < .004) and island grafts (P < .001) subgroups, the analysis was significantly different. However, there was no significant difference in the inlay butterfly grafts subgroup. For hearing outcomes, the analysis revealed that TF grafts had a smaller mean post-operative ABG (P = .009). However, the subgroup analysis showed no significant difference in the mean post-operative ABG. For PTA, there was no significant difference in hearing improvement. However, the palisade cartilage graft subgroup resulted in a better hearing outcome than the TF graft subgroup in terms of the mean post-operative PTA (P = .007). There was no significant difference in the functional success rate or mean ABG gain. CONCLUSION Cartilage grafts have a better success rate than TF grafts in tympanoplasty. Both cartilage and TF tympanoplasty provided similar improvements in hearing outcome, while TF grafts generated a better outcome in post-operative ABG and palisade cartilage grafts in post-operative PTA. This may be related to the biological characteristics of the grafts. Further thorough studies need to be conducted.
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Affiliation(s)
- Kai Chen
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Zhao
- Otorhinolaryngology-Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Hearing Results in Patients With No Ossicular Chain Reconstruction and Factors Influencing the Outcome. Otol Neurotol 2022; 43:1041-1048. [PMID: 36047689 DOI: 10.1097/mao.0000000000003666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ossiculoplasty is aimed at improving or maintaining the conductive portion of hearing in patients subjected to otologic surgery. However, satisfying hearing is frequently observed after tympanoplasty even in the absence of ossicular chain reconstruction. Aims of this article would be to evaluate hearing outcomes, in terms of pure tone average air-bone gap (PTA-ABG), in patients subjected to tympanoplasty for middle ear disease whose ossicular chain has not been reconstructed, and then to investigate factors influencing those outcomes. MATERIALS AND METHODS Retrospective chart review of patients who underwent ear surgery from year 2003 to 2021 at the Otolaryngology-Head and Neck surgery department of the University Hospital of Modena was performed. Audiometric test results from patients who did not receive any ossicular chain reconstruction were collected and analyzed. SETTING Tertiary University referral center. RESULTS The mean patients' follow-up was 34.1 months. Overall, mean PTA-ABG in the study population was 23.5 dB. Integrity of stapes superstructure, malleus handle and malleus head, together with the use of tragal cartilage graft over autologous temporalis fascia to reconstruct the tympanic membrane were found to be significantly associated with better hearing outcomes, as demonstrated by lower PTA-ABG values. Stapes superstructure was found to be associated with more favorable outcomes in multivariate analysis, net of confounding factors. CONCLUSION Good hearing performance can be obtained in patients subjected to middle ear surgery, even if the ossicular chain is not reconstructed. Presence of ossicular chain remnants and the use of a rigid material for tympanic membrane reconstruction are the factors that seem to most favorably influence hearing outcomes after surgery for middle ear disease.
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Cass ND, Hebbe AL, Meier MR, Kaizer AM, Kalmanson OA, Stevens C, Tholen KE, Haville S, Handley E, Francom CR, Herrmann BW. Pediatric Primary Tympanoplasty Outcomes With Autologous and Non-autologous Grafts. Otol Neurotol 2022; 43:94-100. [PMID: 34510118 DOI: 10.1097/mao.0000000000003344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare rates of successful tympanic membrane (TM) closure in primary pediatric tympanoplasty between various autologous and non-autologous tissues. METHODS A retrospective chart review was performed examining all primary pediatric tympanoplasties over a 20-year period at a single institution. RESULTS In 564 pediatric tympanoplasties, no statistically significant difference existed between success rates of autologous and non-autologous grafts (p = 0.083). Compared with fascia, the hazard ratios (and 95% confidence intervals [CI]) for failure for each graft were as follows: human pericardial collagen (HR 0.90, CI 0.54-1.50, p = 0.680), porcine submucosal collagen (HR 1.07, CI 0.56-2.05, p = 0.830), human acellular dermal collagen (HR 1.66, CI 0.95-2.87, p = 0.073), and "multiple grafts" (HR 0.72, CI 0.26-1.98, p = 0.520). Survival curves demonstrated that 75% of graft failures occurred by 6 months after surgery, the rest occurring between 6 and 12 months postoperatively. Larger perforations encompassing more than or equal to 50% of the TM had lower success rates (HR 1.50, CI 1.02-2.21, p = 0.041) than smaller perforations encompassing less than 50% of the TM. Age was not correlated with success (HR 0.98, CI 0.93-1.03, p = 0.390). CONCLUSION This study found that non-autologous collagen grafts provide equivalent rates of healing when compared with autologous tissue in primary pediatric tympanoplasty. In addition to the potential for reduced operative time and donor site morbidity, these materials provide a viable graft alternative in fascia-depleted ears.Level of Evidence: Level 4.
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Affiliation(s)
- Nathan D Cass
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
| | - Annika L Hebbe
- Department of Biostatistics and Informatics, Colorado School of Public Health
| | | | - Alexander M Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health
- Center for Research Outcomes for Children's Surgery
| | - Olivia A Kalmanson
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
| | | | - Kaitlyn E Tholen
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
| | - Salina Haville
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
| | - Elyse Handley
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
| | - Christian R Francom
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
| | - Brian W Herrmann
- Department of Otolaryngology
- Department of Pediatric Otolaryngology, Children's Hospital Colorado
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Kaya İ, Şahin FF, Tanrıverdi O H, Kirazlı T. The new "cubism" graft technique in tympanoplasty: A randomized controlled trial. Laryngoscope Investig Otolaryngol 2021; 6:503-511. [PMID: 34195372 PMCID: PMC8223469 DOI: 10.1002/lio2.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this prospective, randomized-controlled study is to analyze the outcomes of a new graft technique in tympanoplasty and compare its outcomes with cartilage island graft plus extra perichondrium. METHODS A total of 44 patients with noncomplicated chronic otitis media were included in this prospective randomized-controlled clinical trial. Patients were randomly divided into 2 double-layer graft groups: The cartilage island graft + cubism graft (study group) and the cartilage island graft + extra perichondrium (control group). The main outcome measures of the study were the air-bone gap (ABG), ABG gain, and graft status. RESULTS Graft success rate was 100% and 95.5% in the study group and the control group, respectively. There were statistically significant differences in the postoperative first month ABG and ABG gain between study and control groups (P < .05). ABG and ABG gain showed no significant differences in the postoperative sixth month between groups (P > .05). CONCLUSION This study revealed that both graft techniques have satisfactory functional and morphological results compared to preoperative findings. The use of cubism graft with cartilage island graft has significantly better auditory outcomes in short-term and similar results in long-term compared to double-layered cartilage island graft with extra perichondrium. Cubism graft is a highly promising graft technique with its many advantages. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- İsa Kaya
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
| | - Fetih Furkan Şahin
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
| | - Hasan Tanrıverdi O
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
| | - Tayfun Kirazlı
- Department of OtorhinolaryngologyEge University School of MedicineIzmirTurkey
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Torre Carlos DL, Carolina V, Perla V. Middle ear risk index (MERI) as a prognostic factor for tympanoplasty success in children. Int J Pediatr Otorhinolaryngol 2021; 144:110695. [PMID: 33813100 DOI: 10.1016/j.ijporl.2021.110695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/25/2021] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
Tympanoplasty performed in childhood has been controversial over the years because there is no clarity in determining what prognostic factors lead to surgical success. The objective of this study was to evaluate the effect of the Middle Ear Risk Index (MERI) score on the success of pediatric tympanoplasty. A retrospective case-control study was performed at a tertiary pediatric referral center. A database was created with surgical and clinical records of pediatric patients (<18 years of age) with tympanic membrane perforation, assessed and surgically managed by the same surgical team from January 2012 through March 2018. Mild MERI before tympanoplasty was found to be a protective factor against surgical failure, with an odds ratio of 0.24 (p: 0.002). The odds ratio for severe MERI in unsuccessful tympanoplasty was 5.87, with a p: 0.003, standing out as a risk factor for surgical failure. Presurgical MERI in children may be a useful tool to determine if patients are candidates for tympanoplasty, more aggressive interventions, or if medical treatment before tympanoplasty is necessary to improve prognosis. When facing a high MERI score, parents and family should be advised before surgery about the possibility of tympanoplasty failure.
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Affiliation(s)
- de la Torre Carlos
- Department of Pediatric Otolaryngology. Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Vasquez Carolina
- Department of Pediatric Otolaryngology. Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Villamor Perla
- Department of Pediatric Otolaryngology. Hospital Infantil Napoleon Franco Pareja, Cartagena, Colombia.
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Kaya İ, Şahin FF, Tanrıverdi O H, Kirazlı T. A novel graft-harvesting technique in tympanoplasty: the cubism graft. Eur Arch Otorhinolaryngol 2021; 278:1289-1292. [PMID: 33566177 DOI: 10.1007/s00405-021-06646-3] [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: 12/13/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The slicing method that is used for thinning the cartilage graft may cause forming complications in tympanoplasty. Besides, double-layered grafting techniques may be required when graft medialization is observed. METHOD This article presents a new and controlled graft cartilage thinning and the cubism graft-harvesting technique in tympanoplasty. CONCLUSION Thanks to this new technique, over-curling and undesirable fractures of the cartilage island graft can be prevented and the obtained cartilaginous dust can be mixed with platelet-rich fibrin to form the cubism graft. This combined cartilage thinning and cubism graft technique provided 100% graft success and an average air-bone gap gain of 16.3 ± 2.9 dB (10.7-22.3 dB) in our series of 22 patients. In conclusion, 100% graft success, successful tympanic membrane re-epithelialization and significant auditory improvement can be achieved with this method.
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Affiliation(s)
- İsa Kaya
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Fetih Furkan Şahin
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey.
| | - Hasan Tanrıverdi O
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Tayfun Kirazlı
- Department of Otorhinolaryngology, Ege University School of Medicine, İzmir, Turkey
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Verma B, Dawat N, Dabholkar Y, Patil S. Prospective study of use of Island of tragal cartilage in revision tympanoplasty. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_224_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Lou Z. Endoscopic myringoplasty in pediatric patients: a comparison of cartilage graft push-through and underlay fascia graft techniques. Acta Otolaryngol 2020; 140:893-898. [PMID: 32650682 DOI: 10.1080/00016489.2020.1787510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although myringoplasty is performed in pediatric patients, there is still no consensus on the graft material and surgerical procedure. OBJECTIVE To compare the short-and long- term graft take rates of the cartilage push-through and fascia graft techniques employed during pediatric myringoplasty. MATERIALS AND METHODS 93 pediatric patients with perforation who underwent myringoplasty were randomized into the cartilage push-through and underlay fascia graft group. The outcomes evaluated were hearing gains, and graft success rates at 12 and 24 months. RESULTS The graft success rate was similar between two groups (95.7% vs 91.3%, p = .653) at postoperative 12th months, however, the graft success rate was significantly higher 91.5% for the cartilage graft group compared with 73.9% for the fascia group at postoperative 24th months. No significant between-group differences were observed pre- (p = .694) or post- (p = .812) operative ABG values or mean ABG gain (p = .745).The re-perforation rate in fascia group was significantly higher than that in push through group (19.05 vs. 4.44%). No middle ear cholesteatoma formation was found in either group. CONCLUSION Endoscopic cartilage push-through and underlay fascia graft myringoplasty afforded comparable hearing results in pediatric patients; however, the push-through technique without the elevation of a tympanomeatal flap exhibited better long-term graft success rate compared to underlay fascia graft.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, China
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15
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Naina P, Pokharel A, Syed KA, John M, Varghese AM, Kurien M. A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis. Int Arch Otorhinolaryngol 2020; 24:e438-e443. [PMID: 33101508 PMCID: PMC7575394 DOI: 10.1055/s-0039-3402432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/15/2019] [Indexed: 10/31/2022] Open
Abstract
Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake ( p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Apar Pokharel
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kamran Asif Syed
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mary John
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Mary Kurien
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India.,Department of ENT, Pondicherry Institute of Medical Sciences, Puduchery, India
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Erbele ID, Fink MR, Mankekar G, Son LS, Mehta R, Arriaga MA. Over-under cartilage tympanoplasty: technique, results and a call for improved reporting. J Laryngol Otol 2020; 1:1-7. [PMID: 33019948 DOI: 10.1097/ono.0000000000000005] [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] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. METHOD This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. RESULTS Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. CONCLUSION Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
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Affiliation(s)
- I D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M R Fink
- Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
| | - G Mankekar
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - L S Son
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - R Mehta
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
| | - M A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
- Culicchia Neurological Clinic, New Orleans, USA
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Bayram A, Bayar Muluk N, Cingi C, Bafaqeeh SA. Success rates for various graft materials in tympanoplasty - A review. J Otol 2020; 15:107-111. [PMID: 32884562 PMCID: PMC7451680 DOI: 10.1016/j.joto.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this paper is to review how successful each type of grafts is in tympanoplasty. Methods Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “graft”, “success” “tympanoplasty”, “success rate” with the search limited to the period 1955 to 2017. Results Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are significant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is. Conclusion Although temporal fascia is the most commonly used graft material for tympanoplasty, poor graft stability may cause failure. This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia. Cartilage grafts offer better ability to resist infection, pressure, and cope with insufficient vascular supply. This means that cartilage grafts are suitable for use in revision cases.
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Affiliation(s)
- Ali Bayram
- Kayseri Training and Research Hospital, Department of Otorhinolaryngology, Kayseri, Turkey
| | - Nuray Bayar Muluk
- Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey
| | - Sameer Ali Bafaqeeh
- King Saud University, Department of Otorhinolaryngology, Riyadh, Saudi Arabia
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A Comparative Study of Type-I Underlay Tympanoplasty with Temporalis Fascia Graft Alone and with Conchal Cartilage. Indian J Otolaryngol Head Neck Surg 2019; 71:1320-1326. [PMID: 31750172 DOI: 10.1007/s12070-018-1397-1] [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: 03/23/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022] Open
Abstract
Tympanoplasty which is the repair of the tympanic membrane using temporalis fascia, has been done worldwide and has stood the test of time. However in cases of reperforation or large/subtotal perforations, we are often left in need of some sturdy material for grafting. To compare the graft uptake and hearing improvement in patients undergoing type I tympanoplasty using temporalis fascia alone and temporalis fascia along with conchal cartilage. The current research is a prospective study of 60 patients with chronic suppurative otitis media (Tubo tympanic type), undergoing type I tympanoplasty, using temporalis fascia alone and temporalis fascia along with conchal cartilage. The graft uptake and hearing improvement was much better using temporalis fascia along with conchal cartilage graft as compared to cartilage alone. The use of temporalis fascia along with conchal cartilage graft is beneficial for patients with chronic suppurative otitis media (tubotympanic type) undergoing type I tympanoplasty than using temporalis fascia alone.
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Mathur NN, Manimaran V, Deka A. A Short Term Comparison of Cartilage with Temporalis Fascia Graft Tympanoplasty in Paediatric and Adolescent Population. Indian J Otolaryngol Head Neck Surg 2019; 71:1069-1074. [PMID: 31750128 PMCID: PMC6841860 DOI: 10.1007/s12070-017-1140-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022] Open
Abstract
To compare the anatomic and functional outcomes of the cartilage and temporalis fascia graft materials in type 1 tympanoplasty in paediatric and adolescent population. A total of 55 patients aged <18 years who required type 1 tympanoplasty were selected. 30 patients underwent cartilage palisade tympanoplasty and 25 using temporalis fascia grafts. The age, the side of the operated ear, the operative technique, pre- and post operative pure tone and impedance audiological results, and the status of the graft were noted. Graft was considered taken up if there was successful closure of tympanic membrane perforation. At the end of 6 months, the graft take rate for cartilage was 90% and for temporalis fascia it was 80% (p > 0.05). ABG closure ratio in cartilage group was 58.54 ± 23.10% and in temporalis fascia group was 56.46 ± 27.4% (p > 0.05). Pre operatively all patients had type B tympanogram in both the groups. While post operatively either type A or C curve was seen in 80% patients of cartilage and 68% patients of temporalis fascia group. Hearing outcomes and graft success rates were high in both fascia and cartilage graft groups but not significantly different.
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Affiliation(s)
- Neeraj Narayan Mathur
- Department of Otolaryngology and Head and Neck Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anupal Deka
- Department of Otolaryngology and Head and Neck Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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GÜLER İSMAİL, BAKLACI DENİZ, KUZUCU İHSAN, KUM RAUFOĞUZHAN, ÖZCAN MÜGE. Miringoplastilerde Temporal Kas Fasyası ve Konkal Kıkırdak Greftlerinin Erken ve Geç Dönem Sonuçların Karşılaştırılması. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.559523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Çayir S, Kayabaşi S. Type 1 tympanoplasty in pediatric patients: Comparison of fascia and perichondrium grafts. Int J Pediatr Otorhinolaryngol 2019; 121:95-98. [PMID: 30878559 DOI: 10.1016/j.ijporl.2019.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/17/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of this study was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and to evaluate the prognostic factors that may affect its success. MATERIALS AND METHODS A retrospective study of 42 pediatric patients who were younger than 18 years and underwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia from January 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and 18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type (central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia, perichondrium), length of follow up and surgical outcomes were collected. RESULTS The overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantly higher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group(p = 0.023). The functional success rate (postoperative air-bone gap<20 dB) obtained in the perichondrium group was 90.4% (19/21) and 85.7% (18/21) in the fascia group, respectively. After a mean follow-up of 27.5 ± 11.55 months, the mean hearing improvement was 11.26 ± 7.53 dBHL for overall the group. Presence of contralateral otitis media with effusion (OME) was found a risk for reperforation and bilateral perforations were negatively affected graft success rate (p < 0.01). Graft success did not affected by age, gender and type and location of perforation (p > 0.05). CONCLUSION Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatric tympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be the first choice of graft material due to its high success rates. There were no significant differences between the fascia and perichondrium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations and contralateral OME, and should be treated with perichondrium or cartilage graft.
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Affiliation(s)
- Serkan Çayir
- Aksaray University Faculty of Medicine, Department of Ear Nose and Throat and Head and Neck Surgery, Turkey.
| | - Serkan Kayabaşi
- Aksaray University Faculty of Medicine, Department of Ear Nose and Throat and Head and Neck Surgery, Turkey.
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Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients. Auris Nasus Larynx 2019; 46:319-323. [DOI: 10.1016/j.anl.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/21/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
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Shrestha B, Dhakal A, Kiran KCA, Shrestha K, Pradhan A. Long-term hearing results in endoscopic sandwich myringoplasty: An innovative Dhulikhel hospital technique. INDIAN JOURNAL OF OTOLOGY 2019. [DOI: 10.4103/indianjotol.indianjotol_22_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Surgical treatment of chronic ear disease in remote or resource-constrained environments. The Journal of Laryngology & Otology 2018; 133:49-58. [DOI: 10.1017/s0022215118002165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackgroundSurgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal.Results and conclusionExtensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.
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Baklaci D, Guler I, Kuzucu I, Kum RO, Ozcan M. Type 1 tympanoplasty in pediatric patients: a review of 102 cases. BMC Pediatr 2018; 18:345. [PMID: 30400861 PMCID: PMC6220466 DOI: 10.1186/s12887-018-1326-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the success of type 1 tympanoplasty in pediatric patients with chronic otitis media, and to evaluate the prognostic factors that may influence its success. Materials and methods Medical records of 102 children aged between 8 and 18 years (46 female, 56 male) who underwent type 1 tympanoplasty for chronic tympanic membrane perforation between January 2010 and July 2017 were reviewed. Age, gender, condition of contralateral ear (unilateral, bilateral), type (central, marginal) and location of perforation (anterior, posterior, inferior), graft material (fascia, cartilage), pre- and post-operative hearing levels, mean air-bone gap (ABG), surgical approach (postauricular, endaural) and length of follow up were recorded. Results Anatomical and functional success (ABG < 20 dBHL) rates were 86.3% (88 patients) and 74.5% (76 patients) after a mean follow-up of 32 ± 16.55 months, respectively. The mean hearing improvement was 10.77 ± 10.45 dBHL. The graft success rates were significantly higher in tragal cartilage group (95.1%) than in temporalis fascia group (80.3%) (p = 0.033). Graft success was negatively affected by contralateral perforation (p = 0.003). All patients with bilateral perforations and graft failure were in temporalis fascia group. Age, type and location of perforation and surgical approach did not influence graft success (p > 0.05). Conclusion Our results showed that type 1 tympanoplasty can be performed effectively in pediatric population regardless of age, location and type of perforation and surgical approach. Bilateral perforations are prone to reperforation, and should be treated with cartilage graft.
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Affiliation(s)
- Deniz Baklaci
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey.
| | - Ismail Guler
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
| | - Ihsan Kuzucu
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
| | - Rauf Oguzhan Kum
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
| | - Muge Ozcan
- Numune Training and Research Hospital, Department of Otolaryngology, 931st Avenue 945st Street No:5/3 Çankaya, Ankara, Turkey
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Özbay C, Soy FK, Kulduk E, Dundar R, Yükkaldiran A, Güler OK, Koç E. Boomerang-shaped vs. shield-shaped chondroperichondrial cartilage grafts for type 1 tympanoplasty in children: A study of 121 patients. EAR, NOSE & THROAT JOURNAL 2018; 96:419-432. [PMID: 29121374 DOI: 10.1177/0145561317096010-1121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many techniques and graft materials have been used for the reconstruction of the tympanic membrane. We conducted a retrospective study to compare anatomic and functional outcomes of type 1 tympanoplasty that we performed with boomerang-shaped chondroperichondrial cartilage grafts (BSGs) and shield-shaped chondroperichondrial cartilage grafts (SSGs) in pediatric patients. Our study population was made up 121 patients-61 boys and 60 girls, aged 7 to 16 years (mean: 12.4)-who had undergone a type 1 tympanoplasty. Patients were divided into two groups according to the grafting technique used; there were 59 patients in the BSG group and 62 patients in the SSG group. Ear examinations were performed at postoperative months 3, 6, 12, and 24, and pure-tone average (PTA) for air-conduction threshold values and air-bone gaps (ABGs) were evaluated at 0.5, 1.0, 2.0, and 4.0 kHz at the same visits. We also investigated the impact of the graft material on functional graft success and intergroup differences (if any) in surgical success. Mean postoperative follow-up periods were 30.5 and 30.2 months in the BSG and SSG groups, respectively. We found that the success rates for tympanic membrane reconstruction were not significantly different in the two groups (91.5 and 88.7%). Postoperatively, the mean PTA and ABG values in both groups at 3, 6, 12, and 24 months were significantly lower than the preoperative values (p < 0.05). There were no significant differences in mean PTA values between the two groups at 3, 6, 12, and 24 months. However, the extent of the decrease in PTA values in the BSG group at 3 months was significantly greater than that of the SSG group (p < 0.05). There were no significant differences in mean ABG values between the two groups at 3, 6, and 12 months, but at 24 months, the value was significantly higher in the BSG group (p < 0.05). Finally, the extent of the decrease in ABG in the BSG group at both 3 and 6 months was significantly greater than that of the SSG group (p < 0.05). We conclude that the BSG procedure is a reliable and safe method of performing pediatric tympanoplasty.
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Affiliation(s)
- Can Özbay
- Department of Otorhinolaryngology, Acıbadem Eskişehir Hospital, Hosnudiye Mah. 26170, Tepebasi/Eskişehir, Turkey
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Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty. The Journal of Laryngology & Otology 2018; 132:497-504. [PMID: 29888699 DOI: 10.1017/s0022215118000762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To validate a newly introduced cartilage rim augmented temporalis fascia tympanoplasty technique by statistically comparing it with the morphological and audiological outcomes of traditional temporalis fascia tympanoplasty. METHODS A retrospective comparative study was conducted on 115 patients who underwent tympanoplasty during 2013 and 2015. Fifty-eight patients underwent temporalis fascia tympanoplasty and 57 underwent cartilage rim augmented fascia tympanoplasty. RESULTS In the cartilage fascia group, graft healing was achieved in 94.7 per cent of cases; in the temporalis fascia group, the graft take-up rate was 70 per cent. In those with a normal ossicular chain, the post-operative air-bone gap was within 20 dB in 92.6 per cent of cartilage fascia group cases and in 69.7 per cent of the temporalis fascia group cases, which was a statistically significant difference. Among the defective ossicular chain cases, the post-operative air-bone gap was within 20 dB in 76.9 per cent in the cartilage fascia group, as against 57.1 per cent in the temporalis fascia group. CONCLUSION Cartilage rim augmented temporalis fascia tympanoplasty has a definite advantage over the temporalis fascia technique in terms of superior graft take up and statistically significant hearing gain in those with normal ossicular mobility.
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Farinetti A, Farah C, Triglia JM. Myringoplasty in Children for Tympanic Membrane Perforation: Indications, Techniques, Results, Pre- and Post-Operative Care, and Prognostic Factors. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Do the Angle and Length of the Eustachian Tube Affect the Success Rate of Pediatric Cartilage Type 1 Tympanoplasty? J Craniofac Surg 2018; 28:e227-e231. [PMID: 28468197 DOI: 10.1097/scs.0000000000003434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To investigate the relationships between the angle and length of the Eustachian tube (ET) (the ETa and the ETl) and the success rates of pediatric type 1 tympanoplasty. STUDY DESIGN A retrospective clinical chart review. METHODS In total, 51 children (31 females and 20 males; average age, 11.92 ± 3.46 years; age range: 7-18 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. RESULTS The ETa values of diseased ears of males and females were, respectively, 26.60 ± 6.42° and 23.29 ± 6.51°, compared to 27.25 ± 5.23° and 23.32 ± 4.61° for normal male and female ears, respectively. In group A, the ETa was 26.46 ± 6.82° in males and 22.95 ± 7.50° in females. In group B, the ETa was 26.85 ± 6.12° in males and 23.90 ± 4.45° in females. In group A, the mean ETl was 41.0 mm (29.6-45.3 mm) in males and 37.9 mm (32.0-44.5 mm) in females. In group B, the mean ETl was 40.5 mm (30.5-47.1 mm) in males and 38.0 mm (32.8-45.0 mm) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears, the ETa was higher in males than females (P = 0.020 and P < 0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P > 0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P > 0.05). CONCLUSIONS Neither the ETa nor the ETl affected the success rate of pediatric cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of pediatric tympanoplasty.
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Assessment of multiple factors is necessary when evaluating the success rate of myringoplasty. The Journal of Laryngology & Otology 2016; 131:90-91. [PMID: 27991405 DOI: 10.1017/s0022215116009440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies. Laryngoscope 2016; 127:2139-2148. [PMID: 27933630 DOI: 10.1002/lary.26451] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement. DATA SOURCES The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar. REVIEW METHODS A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I2 statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated. RESULTS A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P < 0.001). Although there was no significant difference in the air-bone gap (ABG) closure of < 10 dB between the two groups, the subanalysis of prospective studies showed that patients in the TF group had less mean postoperative ABG (P = 0.02). Subgroup analysis of palisade grafts compared with that of TF graft revealed a significant difference in the graft integration rate favoring cartilage tympanoplasty (P = 0.01). CONCLUSION Cartilage grafting seemed to show a higher graft integration rate compared with TF grafting. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2139-2148, 2017.
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Affiliation(s)
- Mir Mohammad Jalali
- Nose and Sinus Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Motasaddi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kouhi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Soleimani
- Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Rozendorn N, Wolf M, Yakirevich A, Shapira Y, Carmel E. Myringoplasty in children. Int J Pediatr Otorhinolaryngol 2016; 90:245-250. [PMID: 27729143 DOI: 10.1016/j.ijporl.2016.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tympanic membrane perforation (TMP) may be caused by acute and chronic otitis media, trauma and iatrogenic reasons. The goal of myringoplasty is to achieve a dry, self-cleansing ear with intact TM while preserving hearing. Literature review of myringoplasty outcome demonstrates results with different success rates and affecting factors. OBJECTIVES The aim of this study was to evaluate TMP closure (TMPC) rate and hearing improvement and to assess the effect of clinical and surgical parameters on residual and recurrent perforation. MATERIALS AND METHODS Retrospective chart analysis of pediatric patients who underwent myringoplasty between the years 2000-2015. Closure success rate and hearing improvement were evaluated. The influence of age and clinical and surgical variables over TMPC rate and recurrent perforation were examined. RESULTS Our study cohort consisted of 165 myringoplasties in 151 children, with a mean age of 11.7 years (R = 4.8-17.9, Me = 12.0). At one month follow-up (FU) TMPC rate was 88% (145/165). Among patients with successful TMPC a mean improvement of air bone gap (ABG) and speech reception threshold (SRT) were 9.9 dB, p < 0.001 and 9.4 dB, p < 0.001, respectively. 58/145 (40%) patients with initial closure had a minimum FU of 6 months (Me = 12.0), during which time 8/58(13.8%) had a recurrent perforation. Surgery before 9 years of age was the only factor correlated with failed initial closure (p = 0.03) and recurrent perforation (p = 0.02). CONCLUSIONS Pediatric myringoplasty is associated with high TMPC rate. Hearing improvement is to be expected in most hearing impaired patients. Age under 9 years is associated with significantly higher rates of persistent and recurrent perforation.
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Affiliation(s)
- Noa Rozendorn
- Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Michael Wolf
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Arkadi Yakirevich
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Yisgav Shapira
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Eldar Carmel
- Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
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Yang T, Wu X, Peng X, Zhang Y, Xie S, Sun H. Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis. Acta Otolaryngol 2016; 136:1085-1090. [PMID: 27310768 DOI: 10.1080/00016489.2016.1195013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSIONS Tympanoplasty using cartilage grafts has a better graft take rate than that using temporalis fascia grafts. There are no significant differences between cartilage grafts and temporalis fascia grafts for hearing outcomes. Contrary to the sliced cartilage sub-group, full-thickness cartilage grafts generate better hearing outcomes than temporalis fascia grafts. OBJECTIVE Tympanic membrane perforation can cause middle ear relapsing infection and lead to hearing damage. Various techniques have been applied in order to reconstruct the tympanic membrane. Recently, cartilage grafts and temporalis fascia grafts have been widely used for tympanic membrane closure. A systemic review and meta-analysis was carried out based on published retrospective trials that investigated the efficacy of cartilage grafts and temporalis fascia grafts in type 1 tympanoplasty. Both graft take rates and mean AIR-BONE-GAP gains were analyzed. METHODS Cochrane Library, PubMed, and Embase were systematically searched. After a scientific investigation, we extracted the relevant data following our selection criteria. Odds ratio (OR) of graft take rates and mean difference (MD) of AIR-BONE-GAP gains were calculated within 95% confidence intervals. RESULTS Eight eligible articles with 915 patients were reviewed. The pooled OR for graft take rate was 3.11 (95% CI =1.94-5.00; p = 0.43) and the difference between the two groups was significant, which means that the cartilage grafts group got a better graft take rate than the temporalis fascia grafts group. The pooled MD for mean AIR-BONE-GAP gain was 1.92 (95% CI = -0.12-3.95; p < 0.000 01) and the difference was not significant. However, in the full thickness cartilage grafts sub-group, the pooled MD for mean AIR-BONE-GAP gains was 2.56 (95% CI =1.02-4.10; p = 0.14) and the difference was significant, which means that the full thickness cartilage grafts sub-group got a better hearing outcome than the temporalis fascia grafts group. On the contrary, the pooled MD of sliced cartilage grafts sub-group was 0.12 (95% CI = -0.44-0.69; p = 0.61) and there was no significant difference between the sliced cartilage grafts and temporalis fascia group.
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Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol 2016; 82:695-701. [PMID: 27068884 PMCID: PMC9444745 DOI: 10.1016/j.bjorl.2015.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. Objective To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. Methods In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7–18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant. Results The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females. Conclusions Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.
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Affiliation(s)
- Yakup Yegin
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Mustafa Çelik
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
| | - Arzu Karaman Koç
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Levent Küfeciler
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Mustafa Suphi Elbistanlı
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Fatma Tülin Kayhan
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
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Akyigit A, Karlidag T, Keles E, Kaygusuz I, Yalcın S, Polat C, Eroglu O. Endoscopic cartilage butterfly myringoplasty in children. Auris Nasus Larynx 2016; 44:152-155. [PMID: 27262221 DOI: 10.1016/j.anl.2016.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/14/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study evaluated the results of the graft success rate and hearing gain of children who underwent endoscopic inlay butterfly myringoplasty due to chronic otitis media. METHODS The study included 32 pediatric patients aged between 8 and 17, who had endoscopic inlay butterfly myringoplasty with the diagnosis of chronic otitis media between September 2012 and January 2015 in Elazig Training and Research Hospital Otorhinolaryngology Clinic and Firat University Otorhinolaryngology Clinic. All patients' demographics, perforation size, and hearing status were examined. RESULTS Tympanic membrane perforation was ≤3mm in 12 patients and between 3 and 6mm in 20 patients. The air-bone gap (ABG) of the patients was 18.5±6.29dB preoperatively, 8.81±3.53dB postoperatively second month, 8.09±3.55dB postoperatively sixth month, and 7.96±3.32dB postoperatively 12th month. Two (6.3%) of the patients had postoperative myringitis. Two (6.3%) patients had recurrent perforation in the postoperative follow-ups. CONCLUSION In children, endoscopic inlay butterfly tympanoplasty is a surgical technique with short duration, high graft success, effective hearing reconstruction, and high levels of postoperative patient comfort.
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Affiliation(s)
| | - Turgut Karlidag
- Firat University, Faculty of Medicine, Department of ENT, Elazig, Turkey
| | - Erol Keles
- Firat University, Faculty of Medicine, Department of ENT, Elazig, Turkey
| | - Irfan Kaygusuz
- Firat University, Faculty of Medicine, Department of ENT, Elazig, Turkey
| | - Sinasi Yalcın
- Firat University, Faculty of Medicine, Department of ENT, Elazig, Turkey
| | - Cahit Polat
- Elazığ Education and Research Hospital, Clinic of ENT, Elazig, Turkey
| | - Orkun Eroglu
- Firat University, Faculty of Medicine, Department of ENT, Elazig, Turkey
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Yeh CF, Wu CS, Huang CY, Tang CH, Kuo TY, Tu TY. Chronic otitis media surgery and re-operation risk factor analysis: A nationwide retrospective cohort study of 18 895 patients. Acta Otolaryngol 2015; 136:259-65. [PMID: 26623993 DOI: 10.3109/00016489.2015.1115550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Patients with risk factors including younger age, mastoiditis, external ear disease, treatment by older surgeons, and concomitant mastoidectomy should receive detailed management to minimize the probability of re-operation for chronic otitis media (COM). OBJECTIVES Although COM remains a common ear disease requiring surgical intervention, its re-operation risks are less well-documented. This study aimed to compare patients with COM who underwent re-operation and those patients with no re-operation, and identify the risks of re-operation. METHOD This retrospective cohort study analyzed the trend of COM surgery from 1999-2009, and identified the re-operation risks of 18 895 patients with COM who underwent surgery from 2002-2006 using the National Health Insurance Research Database in Taiwan. RESULTS Among the study population, 129 patients underwent revision surgery during a 5.5 ± 1.5 year follow-up period. A univariate logistic regression analysis showed that the re-operation rate was significantly higher in patients under 18 years of age, those with mastoiditis, disorders of external ear, treatment by surgeons of 50-64 years of age, use of a very high volume surgeon, and combined surgery with mastoidectomy. A multivariate analysis further limited the re-operation risk factors to younger patients, those with mastoiditis, external ear disorders, treatment by older surgeons, and concomitant mastoidectomy.
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Affiliation(s)
- Chien-Fu Yeh
- a Department of Otolaryngology Head & Neck Surgery , Taipei Veterans General Hospital , Taipei , Taiwan
- b Department of Otolaryngology , National Yang-Ming University School of Medicine , Taipei , Taiwan
| | - Chuan-Song Wu
- c Department of Otolaryngology , Taipei City Hospital , Taipei , Taiwan
| | - Chii-Yuan Huang
- a Department of Otolaryngology Head & Neck Surgery , Taipei Veterans General Hospital , Taipei , Taiwan
- b Department of Otolaryngology , National Yang-Ming University School of Medicine , Taipei , Taiwan
| | - Chao-Hsiun Tang
- d School of Health Care Administration, Taipei Medical University , Taipei , Taiwan
| | - Ting-Yu Kuo
- a Department of Otolaryngology Head & Neck Surgery , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Tzong-Yang Tu
- a Department of Otolaryngology Head & Neck Surgery , Taipei Veterans General Hospital , Taipei , Taiwan
- b Department of Otolaryngology , National Yang-Ming University School of Medicine , Taipei , Taiwan
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Tripathi P, Guragain RP, Bhusal CL, Karna SL, Borgstein J. A comparison of two myringoplasty techniques in Nepalese children: a prospective randomized trial. Int J Pediatr Otorhinolaryngol 2015; 79:1556-60. [PMID: 26231742 DOI: 10.1016/j.ijporl.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/13/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND In children, the success of myringoplastywith temporalis fascia is lower compared to adults and cartilage as an alternative graft material has shown higher success rate. OBJECTIVE To compare results of myringoplasty using tragal cartilage palisades with the use of temporalis fascia in children with large tympanic membrane perforations. MATERIALS AND METHODS This is a prospective and randomized study conducted in children of age 6-14 years with large tympanic membrane perforation of more than two quadrants. Status of graft at or around 6 weeks after surgery was used as morphological outcome measure. Pre- and postoperative audiograms were compared to evaluate audiological outcome in two groups. RESULTS Forty seven out of 55 patients completed follow-up. The graft uptake rate in the cartilage palisades and temporalis fascia myringoplasty group was 91.3% (21/23) and 83.33% (20/24), respectively; the difference was not statistically significant (P=0.666). The mean preoperative air-bone gaps (ABG) in cartilage palisades and temporalis fascia group were 36.2±8.9dB and 33.8±7.5dB, the difference was not statistically significant (P=0.412). Similarly, the postoperative ABG in cartilage palisades and temporalis fascia group were 25.1±12.2dB and 17.2±9.2dB, respectively, the difference was statistically significant (P=0.040). The gap closure was 11.0dB in palisades group and 16.8dB in fascia group, but it was not significant (P=0.133). CONCLUSION In our study of pediatric myringoplasty, the morphological and functional outcomes in both cartilage palisades and temporalis fascia groups were comparable.
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Affiliation(s)
- Prashant Tripathi
- Children's Hospital for Eye, ENT and Rehabilitation Services (CHEERS), BP Eye Foundation, Manohara, Bhaktapur, Nepal.
| | | | - Chop Lal Bhusal
- Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal
| | - Sureshwar Lal Karna
- Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal
| | - Johannes Borgstein
- Department of Otolaryngology, Tergooi Hospital, Rijksstraatweg 1, 1261AN, Blaricum, Netherlands
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Comparative study of sliced tragal cartilage and temporalis fascia in type I tympanoplasty. The Journal of Laryngology & Otology 2015; 129:16-22. [PMID: 25602596 DOI: 10.1017/s0022215114003132] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare anatomical and audiological results using sliced tragal cartilage and temporalis fascia in type I tympanoplasty. METHOD A retrospective review was undertaken of primary tympanoplasties using sliced tragal cartilage and temporalis fascia from May 2005 to January 2008. In total, 223 ears were operated on using sliced tragal cartilage graft and 167 using temporalis fascia. Statistical analysis of the outcome data was performed. RESULTS At the two-year and four-year follow ups, successful closure of the tympanic membrane was achieved in 98.20 per cent and 97.75 per cent, respectively, of the cartilage group compared with 87.42 per cent and 82.63 per cent, respectively, of the temporalis fascia group. At the four-year follow up, the average air-bone gap was 7.10 ± 3.01 dB in the cartilage group and 8.05 ± 3.22 dB in the temporalis fascia group. CONCLUSION The overall success rate for primary cartilage tympanoplasty is higher when using sliced cartilage than with temporalis fascia grafting.
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Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
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Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
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Comparison of temporal muscle fascia and cartilage grafts in pediatric tympanoplasties. Am J Otolaryngol 2014; 35:796-9. [PMID: 25115537 DOI: 10.1016/j.amjoto.2014.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare anatomic and functional outcomes of the different graft materials used in pediatric tympanoplasty. MATERIALS AND METHODS The patients younger than 18 years of age and who had tympanoplasty between 2010 and 2012 were included in the study. Temporal muscle fascia or cartilage was used as the graft material. The age, gender, the side of the operated ear, the operation technique, pre- and postoperative audiological results, and the status of the graft were noted. An intact graft and an air-bone gap (ABG) ≤ 20 were regarded as surgical success in the postoperative period. Audiograms obtained before surgery and 1 year after surgery were used for the comparison. RESULTS Sixty pediatric cases were included in the study. Fascia graft was used as the graft material in 35 of them, and cartilage was used in 25 patients. The graft success rate was 82.9% in the fascia group while it was 92% in the cartilage group. In the fascia group preoperative ABG was 28.2 ± 10.1 dB, postoperative ABG was 15.1 ± 10.2dB, and postoperative gain was 13.1 ± 9.6 dB. In the cartilage group, preoperative ABG was 28.9 ± 10.2dB, and postoperative ABG was 16.8 ± 10.3 dB with a postoperative gain of 12.1 ± 6.8 dB. The differences between the fascia and the cartilage groups were not statistically significant either for hearing gain or graft success rate. CONCLUSION Cartilage and fascia grafts yield similar results for hearing gain and graft success rate in pediatric tympanoplasty.
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Type I tympanoplasty with island chondro-perichondral tragal graft: the preferred technique? The Journal of Laryngology & Otology 2013; 127:354-8. [PMID: 23433000 DOI: 10.1017/s0022215113000121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This retrospective, comparative study aimed to assess anatomical and functional results in a group of adults undergoing type I tympanoplasty for subtotal tympanic membrane perforation, using two different types of graft. SUBJECTS AND METHODS The study included 106 patients affected by chronic otitis media, who underwent underlay type I tympanoplasty, 53 using an autologous chondro-perichondral tragal graft and 53 using temporalis fascia. Anatomical and functional outcomes were evaluated over time. RESULTS Audiometric results comparing the cartilage and fascia groups at six months and one year after surgery showed no statistically significant differences. Assessment of anatomical outcomes indicated a greater number of complications in the fascia group. CONCLUSION Functional results indicate the validity of the cartilage tympanoplasty, while anatomical results indicate a slightly better outcome in terms of graft re-perforation and retraction, compared with temporalis fascia at one-year follow up. These results suggest that the cartilage technique is preferable for type I tympanoplasty.
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Iacovou E, Vlastarakos PV, Papacharalampous G, Kyrodimos E, Nikolopoulos TP. Is cartilage better than temporalis muscle fascia in type I tympanoplasty? Implications for current surgical practice. Eur Arch Otorhinolaryngol 2013; 270:2803-13. [PMID: 23321796 DOI: 10.1007/s00405-012-2329-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare the hearing results and graft integration rates in patients undergoing myringoplasty for the reconstruction of the tympanic membrane, with the use of either cartilage or temporalis muscle fascia (TMF). A systematic literature review in Medline and other database sources up to February 2012 was carried out, and the pooled data were meta-analyzed. Twelve studies were systematically analyzed. One represented level I, one level II and ten level III evidence. The total number of treated patients was 1,286. Cartilage reconstruction was used in 536, TMF in 750 cases. Two level III studies showed a significant difference between the pre- and postoperative air-bone gap closure, in favor of cartilage grafting. The mean graft integration rate was 92.4 % in the cartilage group and 84.3 % in the TMF group (p < 0.05). The rates of re-perforations were 7.6 and 15.5 %, respectively (p < 0.05). Among the other complications of type I tympanoplasty, retraction pockets, otitis media with effusion, anterior blunting, and graft lateralization were usually surgically managed, whereas most of the rest were minor and could be dealt with conservatively. The graft integration rate in myringoplasty is higher after using cartilage, in comparison with fascia reconstructions (grade C strength of recommendation), and the rate of re-perforation is significantly lower. Although cartilage is primarily used as grafting material in cases of Eustachian tube dysfunction, adhesive otitis media, and subtotal perforation in everyday surgical practice, a wider utilization for the reconstruction of the tympanic membrane in myringoplasties can be recommended.
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Affiliation(s)
- Emily Iacovou
- ENT Department, General Hospital of Larnaca, Larnaca, Cyprus
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Friedman AB, Gluth MB, Moore PC, Dornhoffer JL. Outcomes of cartilage tympanoplasty in the pediatric population. Otolaryngol Head Neck Surg 2012; 148:297-301. [PMID: 23223520 DOI: 10.1177/0194599812470434] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To justify the successful use of a patient selection algorithm based on age for primary cartilage tympanoplasty. STUDY DESIGN Case series with chart review. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS We performed a retrospective chart review of patients between ages 4 and 13 years who underwent cartilage tympanoplasty for tympanic membrane perforations from August 2005 to November 2011. Demographics, complication data, and auditory outcomes were collected. RESULTS Patients were subdivided into 3 age groups. Group 1 consisted of patients younger than 7 years (n = 43); group 2, ages 7 to 10 years (n = 40); and group 3, ages 10 to 13 years (n = 36). Mean follow-up was 595 days (range, 48-1742). Complication rates respective to the 3 groups were as follows: remnant perforation (6.97%, 5.00%, 2.78%), revision tympanoplasty (2.33%, 2.50%, 0%), and need for tympanostomy tubes (4.65%, 2.50%, 0%). Logistic regression models were used to evaluate complication rates between groups. No significant differences were found (remnant perforation, P = .710; repeat tympanoplasty, P = .998; tympanostomy tubes, P = .875). No significance was found among audiological outcomes between the 3 groups. CONCLUSION These data suggest cartilage tympanoplasty can be performed effectively in young children when appropriate conditions exist.
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Affiliation(s)
- Adva B Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Is Cartilage Tympanoplasty More Effective Than Fascia Tympanoplasty? A Systematic Review. Otol Neurotol 2012; 33:699-705. [DOI: 10.1097/mao.0b013e318254fbc2] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yung M, Vivekanandan S, Smith P. Randomized study comparing fascia and cartilage grafts in myringoplasty. Ann Otol Rhinol Laryngol 2011; 120:535-41. [PMID: 21922978 DOI: 10.1177/000348941112000808] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study compares the medium-term outcomes of myringoplasty procedures using fascia and cartilage grafts. METHODS Patients with chronic otitis media with perforations larger than 50% of the size of the tympanic membrane were included in a randomized, controlled, prospective clinical trial. The perforations were repaired with either temporalis fascia (20 ears) or cartilage (18 ears) grafts selected randomly. A search of the literature was performed to look for other randomized studies comparing fascia and cartilage. RESULTS The graft take rates of fascia and cartilage grafts at 24 months were 84.2% and 80%, respectively. The postoperative air-bone gaps and hearing gains at 24 months were 16.97 dB and 13.63 dB, respectively, in the fascia group and 20.63 dB and 12.60 dB, respectively, in the cartilage group. There was no significant difference in the graft take rates or postoperative hearing between the two groups. The literature search identified one other randomized study comparing fascia and cartilage grafts in the repair of large perforations. The pooled data from the two studies did not show a difference in the graft take rates or hearing gains between cartilage and fascia. CONCLUSIONS There was no statistical difference in the outcomes of fascia and cartilage grafts in the repair of large perforations.
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Affiliation(s)
- Matthew Yung
- Department of Otolaryngology, The Ipswich Hospital National Health Service Trust, Ipswich, England
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Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media. Auris Nasus Larynx 2010; 38:196-202. [PMID: 21035289 DOI: 10.1016/j.anl.2010.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 06/17/2010] [Accepted: 07/27/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and re-tympanoplasty using the same technique and to analyse the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome. METHODS Study included all patients, who underwent tympanoplasty (n=617) and re-tympanoplasty (n=94) for chronic otitis media without cholesteatoma in the period between September 1998 and 2007. The data of all patients on preoperative disease, perforation size and localization, middle ear status, surgical approach, graft material, adjunctive procedures, pre- and postoperative morphological (otomicroscopy) and functional (hearing examination evaluating pure-tone audiogram) results were analyzed. All operations were performed using an underlay technique and either the retroauricular or transcanal approach. The temporal fascia, perichondrium or cartilage-perichondrium composite grafts were used for the reconstruction of TM. Ossiculoplasty was performed as needed. The interrelation between multiple pre-operative parameters and post-operative morphological (closure of the perforation) and functional (hearing level) outcomes was analysed. RESULTS Successful closure rates of the TM perforation were 93.6% and 90.2% of the patients in the primary and revision tympanoplasty groups, respectively. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4% comparing to 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4% comparing to 11.4% of primary cases). Successful hearing (ABG within 20dB) for primary tympanoplasties was achieved in 81.1%, and for retympanoplasty - in 69.5% of the cases. (p<0.01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty. CONCLUSIONS There is no evidence of increased risk of graft failure in re-tympanoplasty cases when compared to primary tympanoplasty operations. Hearing results depend on structural changes in the middle ear (ossicular abnormalities and tympanoscerosis) which in revision cases are found more often. No differences were found between fascia, perichondrum or cartilage-perichondrium grafts in terms of graft healing and hearing results.
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Abstract
OBJECTIVES To calculate the efficacy (evaluating both morphologic and functional results) of cartilage palisade tympanoplasty (CPT) in comparison with tympanoplasty involving a temporalis muscle fascia (FT) graft. STUDY DESIGN Randomized controlled trial. SETTING General Hospital. PATIENTS One hundred twenty-three patients with chronic otitis media who were recruited for the study between the years 1997 and 2002. INTERVENTION(S) Sixty-four patients were randomly allocated to the group receiving CPT and the remaining 59 to the group undergoing tympanoplasty with FT. MAIN OUTCOME MEASURE The primary endpoint was defined as "morphological success," a composite variable that includes the absence of perforation, atelectasis, atrophy, lateralization, otorrhea, and blunting. The secondary endpoints were defined as functional hearing results. RESULTS Both treatment groups were homogeneous with regard to the main baseline characteristics studied. Morphologic success at 24 months in the CPT group was 51 of 62 (82.26%), whereas in the FT group, it was 38 of 58 (64.41%; p = 0.03; relative risk = 1.28; 95% confidence interval (CI) = 1.02-1.60). The relative risk for morphologic success, adjusted for a multivariate model, was 1.36 (95% CI = 1.11-1.38), whereas the adjusted NNT was 5 (95% CI = 4-15). No statistically significant differences were found between the functional results of both treatment groups. CONCLUSION Cartilage palisade tympanoplasty is a more effective technique for reconstructing the tympanic membrane than FT for the population studied.
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Nicholas BD, O'Reilly RC. Is cartilage preferable to fascia myringoplasty in children? Laryngoscope 2010; 120:2136-7. [DOI: 10.1002/lary.21006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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