1
|
Bruno C, Guidi M, Locatello LG, Gallo O, Trabalzini F. Current outcomes of myringoplasty in a European referral children's hospital. Int J Pediatr Otorhinolaryngol 2022; 160:111246. [PMID: 35863147 DOI: 10.1016/j.ijporl.2022.111246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Myringoplasty is a frequently performed procedure in children, with a heterogeneous failure rate. Our study aimed to evaluate the outcome of myringoplasty in a pediatric hospital and to identify which are risk factors for reperforation or poor hearing improvement after surgery. METHODS Preoperative and intraoperative variables between pediatric patients who had undergone myringoplasty with an intact tympanic membrane at follow-up and the cases with reperforation were compared. The same factors were investigated as potential predictors of audiological success. Pre and postoperative PTA and ABG were compared in the whole population, in structural success and failure groups and closure of ABG was calculated and used to compare the audiological outcomes between the two groups. RESULTS Parameters that affected the postoperative integrity of TM were age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure. Early perforations occurred mostly after surgeries performed by trainees, while late perforations were more frequently in autumn. Myringoplasty, regardless of the structural outcome, can improve the ABG and PTA. No preoperative and intraoperative parameters affected the audiological outcome. CONCLUSION Pediatric myringoplasty is a safe and successful procedure that can improve hearing, regardless of the structural outcome. In light of our results, parameters to consider before surgery are age, the time between diagnosis and surgery, the intraoperative status of the middle ear, and secondhand smoke exposure.
Collapse
Affiliation(s)
- Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy; Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy.
| | - Mariapaola Guidi
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Head and Neck Surgery, Meyer Children's Hospital, Florence, Italy
| |
Collapse
|
2
|
Le TT, Vo DMN, Duong TM, Nguyen N. Endoscopic transcanal myringoplasty with anterior tab flap underlay technique: An analysis of 35 cases. Ann Med Surg (Lond) 2022; 80:104135. [PMID: 35846857 PMCID: PMC9283794 DOI: 10.1016/j.amsu.2022.104135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 11/15/2022] Open
|
3
|
Arora RD, Thakur N, Kamble P, Jati M, Nagarkar NM, Thakur JS. Circumferential subannular tympanoplasty: surgical and hearing outcome in 224 ears with subtotal perforation. Acta Otolaryngol 2022; 142:254-258. [PMID: 35235490 DOI: 10.1080/00016489.2022.2042596] [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: 11/01/2022]
Abstract
BACKGROUND Subannular tympanoplasty is a newer technique with limited research articles in the literature. These articles have limitation in terms of sample data. We reviewed outcome of subannular tympanoplasty performed during last five years in our center. OBJECTIVE To determine the surgical and hearing outcome of circumferential subannular tympanoplasty. METHODS A retrospective observational study was performed in a tertiary care academic center involving 224 subjects with mucosal chronic otitis media who underwent circumferential subannular type 1 tympanoplasty. RESULTS Complete neo-tympanum was found in 213 cases (95.1%) at the end final follow period of 12 months after surgery. Eleven tympanic membranes did not take up the graft and considered failure at the end of 6 months after surgery. All of them were subjected for revision surgery and showed intact neo-tympanum after 12 months of surgery. The hearing outcome showed significant improvement in air conduction thresholds from 42.54 ± 13.04 dB to 30.48 ± 10.61 dB at the end of one year. No surgical complication was observed in the study group. CONCLUSION The circumferential subannular tympanoplasty carries good surgical success and should be preferred in large and subtotal perforations. Randomized controlled trials are warranted to overcome the limitations in the present study. SIGNIFICANCE This is the first study showing outcome of subannular tympanoplasty in large sample size of more than 200.
Collapse
Affiliation(s)
- Ripu D. Arora
- Department of Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Neha Thakur
- Department of Otolaryngology-Head and Neck Surgery, Indira Gandhi Medical College, Shimla, India
| | - Payal Kamble
- Department of Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Monalisa Jati
- Department of Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Nitin M. Nagarkar
- Department of Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Jagdeep S. Thakur
- Department of Otolaryngology-Head and Neck Surgery, Indira Gandhi Medical College, Shimla, India
| |
Collapse
|
4
|
Comparison of anterior tab flap and underlay tympanoplasty techniques in anterior tympanic membrane perforations. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.982871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
5
|
Vandenbroeck S, Kuhweide R, Lerut B. En Hamac tympanoplasty and canalplasty for optimal type 1 tympanoplasty outcomes. J Laryngol Otol 2020; 134:1-4. [PMID: 32787982 DOI: 10.1017/s0022215120001383] [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: 11/07/2022]
Abstract
OBJECTIVE Multiple tympanoplasty techniques have been developed with numerous differences in grafting and approach. This study aimed to improve type 1 tympanoplasty outcomes by using the 'en hamac' technique as well as performing a complete canalplasty for anterior perforations. METHOD A retrospective review was performed using the prospective Otology-Neurotology Database tool for otological surgery. All primary type 1 tympanoplasty cases performed for tympanic membrane perforations from 2010 to 2016 were selected for analysis, all performed by one author. Minimal clinical and audiometric follow up was 18 months. RESULTS Tympanic membrane perforation closure was achieved in 62 of the patients (96.88 per cent). None of the en hamac cases had residual or recurrent perforation (p = 0.02). The mean remaining air-bone gap was 8.50 dB. The remaining air-bone gap was less than 10 dB in 72.55 per cent, 10-20 dB in 25.49 per cent and more than 20 dB in 1.96 per cent. CONCLUSION Using the en hamac technique for anterior perforations as well as systematically performing a complete canalplasty provides multiple surgical advantages with excellent post-operative results.
Collapse
Affiliation(s)
- S Vandenbroeck
- Resident Otorhinolaryngology, AZ Sint-Jan Hospital Bruges, Belgium
| | - R Kuhweide
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Hospital Bruges, Belgium
| | - B Lerut
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Hospital Bruges, Belgium
| |
Collapse
|
6
|
The effect of anterior tab flap technique on graft success rate in large tympanic membrane perforation. Eur Arch Otorhinolaryngol 2020; 278:1765-1772. [PMID: 32719926 DOI: 10.1007/s00405-020-06222-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Questions have been raised about the effectiveness of myringoplasty techniques for the large tympanic membrane perforation. Various surgical approaches have been recommended to achieve a satisfactory graft success rate in large tympanic membrane perforations. Consequently, there is a growing body of literature that recognizes this controversial topic in otology. The aim of the present research was to investigate the graft success rate in the anterior tab flap technique in ears with large tympanic membrane perforations. METHODS In this retrospective study, we analyzed 157 ears (belong to 157 patients) which underwent tympanoplasty, intact canal wall mastoidectomy or canal wall down mastoidectomy with anterior tab flap method. Our primary outcome was graft success rate. RESULTS We achieved a graft success rate of 89.8% (141 ears from a total of 157 ears) by the usage of anterior tab flap method. CONCLUSION We suggest anterior tab flap as a safe and effective surgical technique for large tympanic membrane perforations.
Collapse
|
7
|
El-Kholy NA, Salem MA, Rakha AM. Endoscopic single versus double flap tympanoplasty: a randomized clinical trial. Eur Arch Otorhinolaryngol 2020; 278:1395-1401. [PMID: 32691232 DOI: 10.1007/s00405-020-06212-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to compare the results of endoscopic over-underlay tympanoplasty, single flap technique, with endoscopic over-underlay tympanoplasty combined with an anterior tab, double flap technique, in repair of the challenging total and subtotal tympanic membrane perforations with inadequate anterior remnant. This is to determine whether highly adequate visualization at the anterior meatal angle area offered by endoscopy can eliminate the need for anterior tab reinforcement. SUBJECTS AND METHODS A prospective randomized single-blinded study involving 104 patients with total or subtotal tympanic membrane perforations was conducted. Patients were randomized into two groups: 52 with endoscopic single flap tympanoplasty, first group, and 52 with endoscopic double flap tympanoplasty, second group, between August 2017 and February 2019. The main outcome is graft take rate. Secondary outcomes include hearing results, pain score assessment, operative time and postoperative complications. RESULTS Graft take rates were 94% and 98% for the first and second groups, respectively (P value = 0.307). Significant improvement was achieved in total air-bone gap from 21.45 ± 5.37 and 23.1 ± 4.47 preoperatively to 6.4 ± 5.46 and 6.15 ± 3.57 postoperatively for the first and second groups, respectively. Pain scores were not significantly different between the two groups. Mean operative time was significantly longer in the second group (P value = 0.010). There was no reported lateralization or anterior blunting in both groups. CONCLUSION In repair of total and subtotal tympanic membrane perforations with inadequate anterior remnant, endoscopic enrollment provides excellent visualization and good manipulation at the anterior meatal angle area with favorable results, eliminating the need for adding an anterior tab and alleviating the burden of longer operative time. CLINICAL TRIAL REGISTRY ClinicalTrials.gov (NCT03922295) "retrospectively registered" at 18/4/2019.
Collapse
Affiliation(s)
- Noha Ahmed El-Kholy
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Dakahlia Governorate, Mansoura, 35516, Egypt.
| | - Mohammed Abdelbadie Salem
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Dakahlia Governorate, Mansoura, 35516, Egypt
| | - Abdelwahab Mohamed Rakha
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, El-Gomhoria Street, Dakahlia Governorate, Mansoura, 35516, Egypt
| |
Collapse
|
8
|
Ayache S, Beltran M, Guevara N. Endoscopic transcanal myringoplasty for anterior tympanic membrane perforation. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:413-415. [DOI: 10.1016/j.anorl.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
9
|
Mohanty S, Manimaran V, Umamaheswaran P, Jeyabalakrishnan S, Chelladurai S. Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations — A prospective study in a tertiary care hospital. Auris Nasus Larynx 2018; 45:936-942. [DOI: 10.1016/j.anl.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
|
10
|
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]
|
11
|
De Zinis LOR, Berlucchi M, Nassif N. Double-handed endoscopic myringoplasty with a holding system in children: Preliminary observations. Int J Pediatr Otorhinolaryngol 2017; 96:127-130. [PMID: 28390601 DOI: 10.1016/j.ijporl.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Endoscopic transcanal myringoplasty is a newly-introduced technique for reconstruction of tympanic membrane perforation that offers the advantage to obviate postauricular incision. The objective of this study was to evaluate the feasibility of a double-handed endoscope holder transcanal myringoplasty in children. This technique permits bimanual execution of the procedure and allows the surgeon to overcome the two significant issues of single-handed endoscope surgery, i.e. easy domination of a bloody field and smooth introduction of the graft. METHODS A prospective non-randomized study of 10 consecutive primary endoscope holder-aided myringoplasties was performed; 3 mm or 4 mm 0° rigid endoscopes were used. A xenograft, biologic soft tissue, was applied in all cases. RESULTS All procedures were performed successfully. Duration of surgery was faster than with a single-handed procedure and varied between 20 and 60 min. The tympanic membrane healed successfully in all patients. CONCLUSIONS In this preliminary experience in children, a bimanual endoscopic holder-aided myringoplasty technique offers the possibility to overcome the obstacles encountered in a single-handed technique, since it can replicate the same concept of a bimanual microscopic approach and allow for easy management of a bloody field and introduction of the graft in the middle ear.
Collapse
Affiliation(s)
| | - M Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - N Nassif
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy.
| |
Collapse
|
12
|
Role of circumferential subannular tympanoplasty in anterior and subtotal perforations. The Journal of Laryngology & Otology 2017; 131:123-127. [DOI: 10.1017/s0022215116009993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations.Methods:This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement.Results:This technique had a surgical success rate of 97 per cent and led to significant hearing improvement.Conclusion:Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.
Collapse
|
13
|
A novel myringoplasty technique: the placement of a complementary graft descending from the scutum to support an anterosuperior perforation. Eur Arch Otorhinolaryngol 2016; 274:127-131. [DOI: 10.1007/s00405-016-4254-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
|
14
|
Harris JP, Wong YT, Yang TH, Miller M. How I do it: Anterior pull-through tympanoplasty for anterior eardrum perforations. Acta Otolaryngol 2016; 136:414-9. [PMID: 26988908 DOI: 10.3109/00016489.2016.1139744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusions This technique is offered as a convenient and reliable method for cases with anterior TM perforation and inadequate anterior remnant. Objectives Chronic otitis media surgery is one of the most common procedures in otology. Anterior tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rates of graft failure. It was the goal of this series to evaluate the anatomical and functional outcomes of a modified underlay myringoplasty technique-the anterior pull-through method. Materials and methods In a retrospective clinical study, 13 patients with anterior TM perforations with inadequate anterior remnants underwent tympanoplasty with anterior pull-through technique. The anterior tip of the temporalis fascia was pulled through and secured in a short incision lateral to the anterior part of the annulus. Data on graft take rate, pre-operative, and post-operative hearing status were analyzed. Results A graft success rate of 84.6% (11 out of 13) was achieved, without lateralization, blunting, atelectasia, or epithelial pearls. The air-bone gap was 21.5 ± 6.8 dB before intervention and 11.75 ± 5.7 dB after surgery (p = 0.003).
Collapse
Affiliation(s)
- Jeffrey P Harris
- a Division of Otolaryngology-Head & Neck Surgery , University of California , San Diego , CA , USA
| | - Yu-Tung Wong
- a Division of Otolaryngology-Head & Neck Surgery , University of California , San Diego , CA , USA
- b Department of Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Tzong-Hann Yang
- a Division of Otolaryngology-Head & Neck Surgery , University of California , San Diego , CA , USA
- c Department of Otorhinolaryngology-Head & Neck Surgery , Taipei City Hospital , Taipei , Taiwan
| | - Mia Miller
- a Division of Otolaryngology-Head & Neck Surgery , University of California , San Diego , CA , USA
- d House Ear Clinic , Los Angeles , CA , USA
| |
Collapse
|
15
|
Nassif N, Berlucchi M, Redaelli de Zinis LO. Tympanic membrane perforation in children: Endoscopic type I tympanoplasty, a newly technique, is it worthwhile? Int J Pediatr Otorhinolaryngol 2015; 79:1860-4. [PMID: 26337560 DOI: 10.1016/j.ijporl.2015.08.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the results of a newly introduced technique to our Department of endoscopic assisted transcanal myringoplasty applied in tympanic membrane perforation in children of any age and compare them to that of the previously standard microscopic assisted myringoplasty technique. METHODS A retrospective study of myringoplasties performed between January 2005 and June 2014 in children suffering from chronic otitis media with perforation. In microscope-assisted cases, a transcanal approach was applied when the anterior tympanic annulus was completely visible through the ear speculum, and a postauricular approach was used in all other cases. A transcanal approach was used in all endoscopic-assisted cases. RESULTS Between January 2005 and December 2010 and January 2011 and June 2014, 23 and 22 myringoplasties were performed by means of an operative microscope and an endoscope, respectively. Patient age varied from 5 to 16 years. Median duration of microscopic and endoscopic approaches was 90 min and 80 min (P=0.3), respectively. Hospital stay after surgery was significantly longer in the microscope group than the endoscope group (P<0.001). The intact graft success rate was 82.6% in microscopic and 90.9% in endoscopic approaches. Median postoperative air-bone gap of microscopic and endoscopic approaches was 6.2 dB and 6.6 dB, respectively (P=0.9). Neither intra- nor postoperative complications were observed. CONCLUSION Endoscopic transcanal myringoplasty is an alternative surgical approach to traditional technique. This surgery is more conservative than microscopic approach and can be performed in all pediatric cases independently from age. Moreover, it offers comparable anatomical and functional results to the traditional surgery, and grants better comfort for the child.
Collapse
Affiliation(s)
- Nader Nassif
- Department of Pediatric Otorhinolaryngology (N.N., M.B.), Spedali Civili, Brescia, Italy.
| | - Marco Berlucchi
- Department of Pediatric Otorhinolaryngology (N.N., M.B.), Spedali Civili, Brescia, Italy
| | - Luca Oscar Redaelli de Zinis
- Department of Pediatric Otorhinolaryngology (N.N., M.B.), Spedali Civili, Brescia, Italy; Department of Otorhinolaryngology (L.O.R.Z.), University of Brescia, Brescia, Italy
| |
Collapse
|
16
|
Ben Gamra O, Nacef I, Abid W, Hariga I, Mbarek C. Myringoplasty in children: Our results. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ejenta.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
|
18
|
|
19
|
Castro O, Pérez-Carro AM, Ibarra I, Hamdan M, Meléndez JM, Araujo A, Espiña G. Myringoplasties in children: our results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:87-91. [PMID: 23260779 DOI: 10.1016/j.otorri.2012.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/07/2012] [Accepted: 06/19/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Myringoplasty, one of the most frequent surgical techniques in otology, is the repair of tympanic membrane when the ear has only a perforation without any ossicular damage. The main objective of our work was to study the outcome of myringoplasty in patients less than 15 years of age. We also reviewed the existence of prognostic factors, such as Eustachian tube functionality, surgical technique and the hearing outcome after surgery. METHOD We present a retrospective study (1994-2010) with a total of 81 children (under 15 years of age) who had undergone myringoplasty during that period of time. For these children, we analysed age, sex, technique, approach, type of graft, type of perforation, anaesthesia, hearing gain and perforation closure. We correlated these variables with the success of the surgery. RESULTS The percentage of closure was 84% (n=68). The techniques used were underlay in 79.01% (n=64), overlay in 11.11% (n=9) and sandwich in 9.87% (n=8). The percentage of patients with hearing improvement was 88.40% (n=61). CONCLUSION Myringoplasty is a surgical technique that offers good anatomical and functional results in children. We did not find prognostic factors in our study. We found postoperative improvement of hearing but it was not statistically significant.
Collapse
Affiliation(s)
- Olalla Castro
- Servicio de Otorrinolaringología, Hospital Xeral-Cíes (CHUVI), Vigo, Pontevedra, Spain.
| | | | | | | | | | | | | |
Collapse
|
20
|
"Mucosal pocket" myringoplasty: a modification of underlay technique for anterior or subtotal perforations. Am J Otolaryngol 2012; 33:708-13. [PMID: 22901662 DOI: 10.1016/j.amjoto.2012.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/16/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE Chronic otitis media surgery is the most common procedure in otology in developing countries. Subtotal and total tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rate of graft failure. It was the goal of this study to test the anatomical and functional outcomes of a modified underlay myringoplasty technique. MATERIALS AND METHODS In a prospective clinical study, 45 patients with subtotal or total TM perforation and inadequate anterior remnant underwent tympanoplasty (+/-mastoidectomy). The anterior tip of the temporalis fascia was secured in a mucosal pocket on the lateral wall of eustachian tube orifice. Data on graft take rate, preoperative and postoperative hearing status, and intraoperative findings were analyzed. RESULTS We achieved the graft success rate of 91.1%, without lateralization, blunting, atelectasia, or epithelial pearls. Approximately 24% patients had air-bone gap within 25 dB before intervention, which increased to 71% postoperatively (P < .001). CONCLUSION We believe that this technique could be a convenient and suitable method for cases with subtotal or total TM perforation and inadequate anterior remnant.
Collapse
|
21
|
Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal-type chronic otitis media. The Journal of Laryngology & Otology 2011; 126:125-30. [PMID: 22004699 DOI: 10.1017/s0022215111002659] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the efficacy of anterior tagging of graft material with respect to graft uptake and hearing results, in type I tympanoplasty. STUDY DESIGN Prospective, randomised, cohort study. METHODS Sixty patients with chronic otitis media of the mucosal type, with pars tensa perforations, were included in the study. Patients were randomly allocated to two groups: group one underwent type one tympanoplasty with anterior tagging, while group two underwent type one tympanoplasty without anterior tagging. Follow up included evaluation of graft uptake and hearing improvement. RESULTS There were 33 patients in group one and 27 patients in group two. The overall incidence of successful graft uptake was 96.96 per cent in group one and 81.5 per cent in group two. Closure of central and posterior perforations was successful in 100 per cent of both groups. Closure of anterior and subtotal perforations was successful in 95.45 per cent of group one and 54.54 per cent of group two. CONCLUSION Type one tympanoplasty with anterior tagging of graft material is a suitable technique for anterior and subtotal perforations.
Collapse
|
22
|
|
23
|
Abstract
BACKGROUND Tympanic membrane retractions are commonly managed by ENT surgeons. There is currently no consensus as to the indications, timing and options for management of this condition. OBJECTIVES To study the effectiveness of different surgical options in the management of tympanic membrane retractions. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 1); PubMed (1950 to 2010); EMBASE (1974 to 2010); CINAHL (1982 to 2010); BIOSIS Previews; ISI Web of Science; CAB Abstracts; LILACS; KoreaMed; IndMed; PakMediNet; China National Knowledge Infrastructure; ISCTRN; UKCRN; ICTRP and Google. The date of the search was 17 March 2010. SELECTION CRITERIA Randomised controlled trials (RCTs) of the surgical management of tympanic membrane retraction pockets in adults or children. Staging of the retraction using a known system must have been performed. Studies of cholesteatoma or perforations were excluded. DATA COLLECTION AND ANALYSIS Two authors independently collected and analysed data to minimise the effects of selection and reporting bias. MAIN RESULTS Two RCTs were included, involving 71 participants. The first study showed no statistically significant benefit of cartilage graft tympanoplasty over a watch and wait policy for either disease progression or hearing outcome. The second showed no additional benefit from the insertion of ventilation tubes over cartilage tympanoplasty alone with regards to hearing outcome. AUTHORS' CONCLUSIONS No evidence currently exists to either support or refute the role of surgery in the management of tympanic membrane retractions. Higher quality studies are much needed to ascertain this.
Collapse
Affiliation(s)
- Paul C Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), University Hospitals Coventry and Warwick, Clifford Bridge Road, Coventry, UK, CV2 2DX
| | | |
Collapse
|