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Gutierrez JA, Cabrera CI, Stout A, Mowry SE. Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:1453-1466. [PMID: 36951041 DOI: 10.1177/00034894231159000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. METHODS A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. RESULTS Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. CONCLUSION Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. LEVEL OF EVIDENCE 3B.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amber Stout
- Medical Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Wong ZY, Park YS, Mann GS. Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis. Otol Neurotol 2023:00129492-990000000-00326. [PMID: 37400232 DOI: 10.1097/mao.0000000000003940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
ABSTRACT OBJECTIVES To compare postoperative tympanoplasty outcomes between active versus inactive otitis media (OM) patients with tympanic membrane perforation. DATABASES REVIEWED Medline via PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for studies published from inception to March 1, 2023. METHODS Studies of 15- to 60-year-old patients undergoing microscopic/endoscopic myringoplasty using underlay/overlay technique with reported postoperative mean hearing gain and graft uptake were included. Studies requiring simultaneous surgical procedures, reporting patients with comorbidities and with non-English full text articles were excluded. Articles were independently screened by two researchers with data extracted according to a predetermined proforma in Microsoft Excel. Cochrane risk-of-bias assessment was used for risk of bias evaluation of randomized studies and Risk of Bias in Nonrandomized Studies of Interventions for nonrandomized studies. Similar studies were pooled for meta-analysis using the inverse variance random effects model to calculate the mean difference and corresponding 95% confidence interval (CI) for mean hearing gain and DerSimonian and Laird random effects model for graft uptake. RESULTS Thirty-three studies comprising 2,373 patients met the inclusion/exclusion criteria, seven were pooled for meta-analysis. Included articles showed inactive OM patients have higher average postoperative mean hearing gain of 10.84 dB and graft uptake of 88.7% compared to active OM patients (9.15 dB and 84.2%). Meta-analysis of mean hearing gain (MD, -0.76 dB; 95% CI, -2.11 to 0.60; p = 0.27, moderate certainty) and graft uptake (OD, 0.61; 95% CI, 0.34-1.09; p = 0.10, moderate certainty) have an overall p value >0.05. CONCLUSION There were no statistically significant differences in postoperative mean hearing gain and graft uptake between active and inactive OM patients undergoing tympanoplasty. Hence, tympanoplasty procedures should not be postponed solely because of patients' preoperative ear discharge status.
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Affiliation(s)
| | - Yoon Soo Park
- School of Medicine, Imperial College London, England
| | - Gagandeep Singh Mann
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Malaysia
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Pontillo V, Cavallaro G, Barbara F, Mastrodonato M, Murri A, Quaranta N. Recurrent tympanic perforation after myringoplasty: a narrative literature review and personal experience. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S41-S47. [PMID: 37698099 PMCID: PMC10159636 DOI: 10.14639/0392-100x-suppl.1-43-2023-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/22/2023] [Indexed: 09/13/2023]
Abstract
The aim of the work is to review the current literature concerning recidivism of tympanic perforation after myringoplasty and to give some tips to improve the chance of success and manage the possible scenario of failure. An analysis of the existing literature is presented and, based on it and on our experience, an algorithm of management of tympanic perforation recidivism is proposed.
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Affiliation(s)
- Vito Pontillo
- Otorinolaringoiatria Universitaria, Dipartimento di Biomedicina Traslazionale e Neuroscienze, Università di Bari, Bari, Italy
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Waterworth CJ, Watters CTM, Sokdavy T, Annear PL, Dowell R, Grimes CE, Bhutta MF. Disparities in access to ear and hearing care in Cambodia: a mixed methods study on patient experiences. J Laryngol Otol 2023; 137:373-389. [PMID: 35698817 PMCID: PMC10040287 DOI: 10.1017/s0022215122001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Chronic suppurative otitis media is a major global disease disproportionately affecting low- and middle-income countries, but few studies have explored access to care for those with ear and hearing disorders. METHOD In a tertiary hospital in Cambodia providing specialist ear services, a mixed method study was undertaken. This study had three arms: (1) quantitative analysis of patients undergoing ear surgery, (2) a questionnaire survey and (3) semi-structured in-depth interviews. RESULTS Patients presented with advanced middle-ear disease and associated hearing loss at rates that are amongst the highest per capita levels globally. Patients reported several structural, financial and socio-cultural barriers to treatment. This study showed a significant burden of ear disease in Cambodia, which reflects a delay in receiving timely and effective treatment. CONCLUSION This study highlights the opportunity to integrate effective ear and hearing care into primary care service provision, strengthening the package of activities delivered at government facilities.
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Affiliation(s)
- C J Waterworth
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - C T M Watters
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Sokdavy
- Children's Surgical Centre, Kien Khleang Rehabilitation Centre, Phnom Penh, Cambodia
| | - P L Annear
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - R Dowell
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Australia
| | - C E Grimes
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - M F Bhutta
- Clinical and Experimental Medicine, Brighton & Sussex Medical School, Brighton, UK
- Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Immordino A, Salvago P, Sireci F, Lorusso F, Immordino P, Saguto D, Martines F, Gallina S, Dispenza F. Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature. Eur Arch Otorhinolaryngol 2023; 280:1081-1087. [PMID: 35947150 PMCID: PMC9899731 DOI: 10.1007/s00405-022-07573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature. METHODS Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines. RESULTS The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air-bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review. CONCLUSIONS Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.
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Affiliation(s)
- Angelo Immordino
- Unit of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Pietro Salvago
- Unit of Audiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, AOUP Paolo Giaccone, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Federico Sireci
- Unit of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Francesco Lorusso
- Unit of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Palmira Immordino
- Hygiene and Preventive Medicine Section, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Dario Saguto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Francesco Martines
- Unit of Audiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, AOUP Paolo Giaccone, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Salvatore Gallina
- Unit of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Francesco Dispenza
- Unit of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘‘Paolo Giaccone’’, University of Palermo, Via del Vespro, 133, 90127 Palermo, Italy
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6
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Tympanoplasty With and Without Mastoidectomy for Chronic Otitis Media Without Cholesteatoma: A Systematic Review and Meta-analysis. Otol Neurotol 2022; 43:864-873. [PMID: 35970151 DOI: 10.1097/mao.0000000000003631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to compare surgical and audiometric outcomes of tympanoplasty alone (T) to tympanoplasty and mastoidectomy (T&M) in patients without cholesteatoma. DATABASES REVIEWED According to PRISMA guidelines, English articles in PubMed, Scopus, CINAHL, and Cochrane Library databases from inception to 7/29/2021 were searched. METHODS Studies describing a comparison of patients who underwent T to patients who underwent T&M were included. Studies describing patients with cholesteatoma were excluded. Patient demographics, graft failure rates, and preoperative and postoperative audiological findings were collected. Mean differences (MD) and risk difference (RD) were calculated using RevMan 5.4. Heterogeneity was assessed using Q test and I2 statistic. Risk of bias was assessed using both version 2 of the Cochrane risk-of-bias tool for randomized trials and Risk of Bias in Non-randomized Studies of Interventions. RESULTS A total of 27 studies fulfilled eligibility with T (n = 1,711) and T&M (n = 1,186). When pooling the data, mean differences between T versus T&M for air bone gap (-0.3 dB: 95% CI = -1.9 to 1.3, p = 0.730) and pure tone average (1.9 dB: 95% CI = -0.3 to 4.2, p = 0.090) were not statistically significant. Graft failure was higher with T only (16.4% versus 14.2%) than T&M (RD = -0.04, 95% CI = -0.07 to -0.00, p = 0.030, I2 = 35%]. CONCLUSION This study endorses clinically similar audiological outcomes and a reduced risk difference of graft failure with mastoidectomy. Although these data suggest that adding a mastoidectomy could decrease the risk of graft failure, the risk reduction is minimal. More research on the cost-effectiveness and the specific patient clinical characteristics and comorbidities that would benefit from adding a mastoidectomy is warranted.
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7
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Thai A, Aaron KA, Kaufman AC, Santa Maria PL. Long-Term Health Utilization and Outcomes in Chronic Suppurative Otitis Media. Otolaryngol Head Neck Surg 2021; 167:341-349. [PMID: 34637356 DOI: 10.1177/01945998211050626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To report health utilization patterns and outcomes of medical and surgical management in patients with chronic suppurative otitis media (CSOM). STUDY DESIGN Retrospective cohort. SETTING Academic otology clinic. METHODS This study included 175 patients with CSOM with a first clinic visit at our institution between March 2011 and November 2016. All patients displayed a diagnosis of CSOM by International Classification of Diseases code, had at least 1 episode of active CSOM (defined as perforation with otorrhea), and had a documented history of chronic ear infections. The mean age was 49.5 ± 1.5 years, 53% were female, and mean follow-up time was 3.5 ± 0.3 years. RESULTS Patients had an average of 9.5 ± 0.5 otology visits, 4.7 ± 0.4 prescriptions, and 1.7 ± 0.1 surgeries, with estimated per patient cost ranging from $3927 to $20,776. Under medical management, 69% of patients displayed recurrence of disease, with a median time to recurrence of 4 months. For tympanoplasty and tympanomastoidectomy, median time to recurrence was similar at 5 and 7 years, respectively (P = .73). At the most recent visit, the prevalence of all patients with CSOM displaying moderate or worse sensorineural hearing loss (SNHL) was 41%. CONCLUSIONS CSOM represents a major public health issue with high health care utilization and associated costs. Surgery is superior to medical therapy for achieving short- to medium-term inactive disease. Patients with CSOM display a high SNHL burden.
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Affiliation(s)
- Anthony Thai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ksenia A Aaron
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Adam C Kaufman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Karunaratne D, Violaris N. Myringoplasty Outcomes From a 5-Year Single Surgeon's Experience and Important Surgical Technical Aspects. J Audiol Otol 2021; 25:224-229. [PMID: 34425653 PMCID: PMC8524120 DOI: 10.7874/jao.2021.00311] [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: 05/15/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The United Kingdom (UK) national standard for the closure rate for myringoplasty is 89.5% (90.6% and 84.2% for primary and revision surgeries, respectively). The average hearing gains for primary and revision myringoplasty are 9.14 dB and 7.86 dB, respectively. This study compared the myringoplasty outcomes for a single surgeon over 5 years. SUBJECTS AND PURPOSE Data for 68 cases were analyzed retrospectively. The outcome measures were achievement of the tympanic membrane closure and the average hearing gain or loss. RESULTS The overall and primary closure rates were 97% and 98%, respectively and significantly higher than the UK national standard (p=0.0210 and p=0.0287, respectively). The revision closure rate was 93%; however, it was not significantly higher than the national standard (p=0.1872). The average hearing gain was 5.18 dB. The gains for primary and revision surgeries were 5.15 dB and 5.25 dB, respectively. CONCLUSIONS We propose that these outcomes are a result of our surgical technique, including the simultaneous use of cortical mastoidectomy in ears with discharge.
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Affiliation(s)
- Dilhara Karunaratne
- Department of Otolaryngology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - Nick Violaris
- Department of Otolaryngology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
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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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Tympanoplasty With or Without Balloon Eustachian Tuboplasty for Chronic Suppurative Otitis Media With Obstructive Eustachian Tube Dysfunction. Otol Neurotol 2020; 41:1077-1083. [DOI: 10.1097/mao.0000000000002730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dispenza F, Mistretta A, Gullo F, Riggio F, Martines F. Surgical Management of Retraction Pockets: Does Mastoidectomy have a Role? Int Arch Otorhinolaryngol 2020; 25:e12-e17. [PMID: 33542746 PMCID: PMC7850892 DOI: 10.1055/s-0040-1709196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 02/28/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction
Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature.
Objective
To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty.
Methods
Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status.
Results
This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (
p
> 0.5).
Conclusion
Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets.
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Affiliation(s)
| | | | - Federico Gullo
- Department of Otolaryngology, University of Palermo, Palermo, PA, Italy
| | - Francesco Riggio
- Department of Otolaryngology, University of Palermo, Palermo, PA, Italy
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Onofre R, Ha SC, Yang CJ, Lee HS, Lee JY, Yoo MH, Park JW, Kang BC, Park HJ. Prognostic roles of preoperative CT findings and air-bone gaps in type 1 tympanoplasty. Acta Otolaryngol 2018; 138:795-800. [PMID: 29936881 DOI: 10.1080/00016489.2018.1478129] [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: 10/28/2022]
Abstract
BACKGROUND Although CT has been used widely, the role of preoperative CT findings including other factors in tympanoplasty has not been elucidated comprehensively. AIMS/OBJECTIVES To evaluate relationship of CT findings with other factors and audiological results in type 1 tympanoplasty. MATERIAL AND METHODS A cohort of consecutive 175 patients with type 1 tympanoplasty was enrolled. Addition of mastoidectomy was based on the presence of soft tissue in antrum on CT. Postoperative air-bone gap (ABG) and reperforation rate were analyzed. RESULTS Positive soft tissue in antrum on CT was found in 52 (29.7%) patients and showed larger preoperative ABG than the negative group. Successful ABG closure (≤20 dB) was obtained in 97% when preoperative ABG ≤20 dB, but it decreased as the preoperative ABG increased (83% with preoperative ABG of 21-30 dB, and 0% with preoperative ABG >30 dB). Postoperative reperforation rate was positively related to the preoperative ABG, but not the presence of soft tissue in the antrum, the size, or locations of preoperative perforations. CONCLUSIONS AND SIGNIFICANCE Our findings showed that temporal bone CT was helpful in determining addition of mastoidectomy and the presence of soft tissue in the antrum was associated with large ABG.
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Affiliation(s)
- Rubiliza Onofre
- Department of Otolaryngology, De Los Santos Medical Center, Quezon, Philippines
| | - Seung Cheol Ha
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Chan Joo Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanil General Hospital, Seoul, Republic of Korea
| | - Hwan Seo Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Je Yeon Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jun Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Huang J, Li Z, Wu K, Wang W. Long-Term Outcomes after Performing Tympanoplasty without Mastoidectomy for Active and Inactive Noncholesteatomatous Chronic Otitis Media. ORL J Otorhinolaryngol Relat Spec 2018; 80:277-283. [PMID: 30130763 PMCID: PMC6381864 DOI: 10.1159/000491493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to assess long-term outcomes after performing tympanoplasty without mastoidectomy (TWOM) for active and inactive noncholesteatomatous chronic otitis media (COM) and to estimate the optimal time for surgery. METHODS The patients were placed into an active ear group (group A) and an inactive ear group (group B). All patients were followed up for 5 years after TWOM. RESULTS Ninety-two cases among 113 achieved dry ears in half a month to 1 month. The tympanic pressure gradually improved 3-6 months after the operation. A total of 69/72 ears achieved dry ears in the active ear group, and 37 ears had effective hearing improvement. In all, 40/41 ears achieved dry ears in the inactive ear group, and 20 ears had effective hearing improvement. There was no difference in the recurrence rate or hearing improvement in the two groups. CONCLUSION With good quality control of the surgical treatment of TWOM, there are no differences in long-term outcomes in noncholesteatomatous COM in different chronic infection conditions.
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Affiliation(s)
- Jie Huang
- Otolaryngology Department of The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, China
| | - Zeqing Li
- Otolaryngology Department of The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, China
| | - Kunmin Wu
- Otolaryngology Department of The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, China
| | - Wuqing Wang
- NHC Key Laboratory of Hearing Medicine (Fudan University), Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China,
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14
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Therapeutic Mastoidectomy Does Not Increase Postoperative Complications in the Management of the Chronic Ear. Otol Neurotol 2018; 39:54-58. [PMID: 29076928 DOI: 10.1097/mao.0000000000001609] [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]
Abstract
OBJECTIVE Tympanoplasty with or without concurrent therapeutic mastoidectomy is a controversial topic in the management of chronic ear disease. We sought to describe whether there is a significant difference in postoperative complications. STUDY DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program public files. PATIENTS Current procedural terminology codes were used to identify patients with chronic ear disease undergoing tympanoplasty ± concurrent mastoidectomy in the 2011 to 14 American College of Surgeons National Surgical Quality Improvement Program files. INTERVENTION Therapeutic. MAIN OUTCOME MEASURES Variables were compared with χ, Fischer's exact, and Mann-Whitney U tests, as appropriate to analyze postoperative complications between tympanoplasty with or without concurrent mastoidectomy. To account for confounding factors, presence of a complication was analyzed in binary logistic regression. Analysis considered sex, hypertension, obesity, advanced age, diabetes, smoking status, American Society of Anesthesiologists Physical status, procedure. RESULTS There were 4,087 patients identified meeting criteria (tympanoplasty = 2,798, tympanomastoidectomy = 1,289). There was no statistical difference in postoperative complications (tympanoplasty n = 49 [1. 8%], tympanomastoidectomy n = 33 [2. 6%]; p = 0. 087) or return to the operating room (tympanoplasty = 4 [0. 1%], tympanomastoidectomy = 6 [0. 5%]; p = 0. 082). Binary logistic regression demonstrated smoking as a predictor of a postoperative complication (OR: 1. 758, 95% CI: 1. 084-2. 851; p = 0. 022), while concurrent mastoidectomy did not significantly increase the risk of complication (OR: 1. 440, 95% CI: 0. 915-2. 268; p = 0. 115). There was a significant difference in mean operative time between tympanoplasty and tympanomastoidectomy: 85.7 versus 154.23 min, p < 0. 001. CONCLUSION In the management of chronic ear disease, tympanoplasty with concurrent mastoidectomy increases time under anesthesia, but it is not associated with any increased postoperative complications compared with tympanoplasty alone.
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Abstract
OBJECTIVE To determine which independent variables influence the efficacy of type I tympanoplasty in adult and pediatric populations. DATA SOURCES A search of the PubMed database and Cochrane Database of Systematic Reviews using the key words "tympanoplasty OR myringoplasty" from January 1966 to July 2014 was performed. STUDY SELECTION Studies reporting outcomes of myringoplasty or Type I tympanoplasty in primary non-cholesteatomatous chronic tympanic membrane (TM) perforation were included. DATA EXTRACTION Of 4,698 abstracts reviewed, 214 studies involving 26,097 patients met our inclusion criteria and contributed to meta-analysis. DATA SYNTHESIS The primary outcome of success was defined as closure rate at 12 months. The independent variables analyzed were age, follow-up period, approach, graft material, perforation cause, size, location, ear dryness, and surgical technique. Only those studies providing data on a given parameter of interest could be included when comparing each variable. CONCLUSION The weighted average success rate of tympanic closure was 86.6%. Based on this meta-analysis, pediatric surgery has a 5.8% higher failure rate than adults and there is no correlation between follow-up period and success. Other variables associated with improved closure rates include perforation with a size less than 50% of total area (improved by 6.1%) and the use of cartilage as a graft (improved by 2.8% compared with fascia), while ears that were operated on while still discharging, those in different locations of the pars tensa, or using different surgical approaches or techniques did not have significantly different outcomes.
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16
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Trinidade A, Page JC, Dornhoffer JL. Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media. Otolaryngol Head Neck Surg 2016; 155:914-922. [DOI: 10.1177/0194599816662438] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/13/2016] [Accepted: 07/13/2016] [Indexed: 01/26/2023]
Abstract
Objective Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management. Data Sources PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science. Review Method A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic. Results From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit. Conclusions Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.
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Affiliation(s)
- Aaron Trinidade
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joshua C. Page
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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17
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Abstract
AbstractObjective:To identify factors that significantly influence myringoplasty success.Methods:A retrospective study was performed of all adults and children who underwent myringoplasty from January 2005 to January 2010 in a teaching hospital. Outcome measures were tympanic membrane perforation closure and air–bone gap closure to within 20 dB HL. The factors assessed were the surgeon grade, pre-operative condition of the ipsilateral and contralateral middle ears, perforation site, perforation size, graft material, and whether simultaneous cortical mastoidectomy was performed. Factors with statistically significant effects were determined by logistic regression analysis.Results:In the adult group, the perforation site significantly influenced tympanic membrane closure (p = 0.016): anterior (p = 0.008) and subtotal (p = 0.017) sites had the greatest influence. None of the factors proved to have a significant influence on tympanic membrane closure in the paediatric group.Conclusion:There was a significant association between perforation site and tympanic membrane perforation closure in adults. Anterior and subtotal perforations had a significantly reduced closure rate.
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18
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Bahgat M. Patency of the aditus ad antrum in tubotympanic chronic suppurative otitis media. Otolaryngol Head Neck Surg 2014; 152:331-5. [PMID: 25422281 DOI: 10.1177/0194599814559698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the patency of the aditus ad antrum in cases of tubotympanic chronic suppurative otitis media (CSOM) and to measure its dimensions. Also, to examine its mucosa histologically for the presence of granulation tissue or occult cholesteatoma. STUDY DESIGN Prospective case series. SETTING Main Alexandria University Hospital (tertiary referral center). SUBJECTS AND METHODS Fifty adult patients with tubotympanic CSOM without evidence of cholesteatoma, after adequate medical control of otorrhea, presented with mild or moderate conductive hearing loss. In all patients, tympanoplasty with cortical mastoidectomy was performed. The patency and dimensions of the aditus ad antrum were assessed using a 30° endoscope. Biopsies were obtained from unhealthy mucosa to detect the presence of granulation tissue or occult cholesteatoma. RESULTS Ten cases (20%) had a blocked aditus ad antrum by unhealthy and edematous mucosa. Biopsies revealed granulation tissue in all cases. No occult cholesteatoma was detected. The results were further analyzed in relation to multiple variables to detect any clinical clues of a blocked aditus. CONCLUSION Of the studied cases, 20% had a blocked aditus. The prevalence of an obstructed aditus was higher among older patients with a long history (>1 year) of ear discharge. Marginal and subtotal central perforations and the presence of myringosclerosis increase the probability of an obstructed aditus ad antrum.
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Affiliation(s)
- Mohammed Bahgat
- Department of Ear, Nose, and Throat and Head & Neck Surgery, Alexandria University Hospitals, Alexandria, Egypt
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19
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Mohammed Abdel Tawab H, Mahmoud Gharib F, Algarf TM, ElSharkawy LS. Myringoplasty with and without Cortical Mastoidectomy in Treatment of Non-cholesteatomatous Chronic Otitis Media: A Comparative Study. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2014; 7:19-23. [PMID: 25187749 PMCID: PMC4133034 DOI: 10.4137/cment.s17980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the outcome and success of repair of uncomplicated tympanic membrane perforations with myringoplasty alone and when combined with mastoidectomy. METHODS A prospective study where 40 patients with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited during the period of June 2013 to December 2013 from the outpatient clinic of Otorhinolaryngology department, Faculty of medicine, Cairo University. Patients were managed medically and after dryness of their perforations they were operated upon. Twenty patients underwent simple myringoplasty alone and 20 patients underwent myringoplasty with cortical mastoidectomy. Underlay technique with temporalis fascia was done for all patients. Follow-up period was at least 3 months. RESULTS Hearing improvement was comparable in both groups. There was no significant difference in graft uptake between the myringoplasty alone group (70%) and cortical mastoidectomy group (80%) (P = 0.7). There was no significant difference in ear dryness between the myringoplasty alone group (75%) and cortical mastoidectomy group (90%) (P = 0.4). CONCLUSION Mastoidectomy performed in non-cholesteatomatous CSOM in this study gives no statistically significant benefit over simple myringoplasty as regards graft success rate and dryness of the middle ear with comparable hearing outcome.
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Affiliation(s)
| | - Fadi Mahmoud Gharib
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tareq M Algarf
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Louay S ElSharkawy
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
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20
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Abstract
PURPOSE OF REVIEW This review focuses on the most recent literature pertaining to pediatric acquired cholesteatoma and aims to integrate findings into a comprehensive management approach. RECENT FINDINGS Pediatric acquired cholesteatoma has been shown to differ from the adult variety secondary to anatomy and physiologic factors. Whereas the goals of therapeutic management are ultimately similar in adult and pediatric patients, special considerations must be taken into account when deciding on a treatment plan for a child. Although avoidance of an unstable mastoid cavity is an important consideration in this population, successful management has been reported with canal wall-up, canal wall-down, and hybrid techniques. Second-look procedures are also important when concern of recurrence exists. Newer innovations include endoscopic ear surgery and diffusion-weighted imaging. SUMMARY The principal goal of pediatric cholesteatoma management is eradication of disease. An individualized approach is paramount in yielding superior results in these patients. Special consideration should be given to anatomical and social factors.
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21
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Garov EV, Sidorina NG, Zelenkova VN, Lavrova AS, Akmuldieva NR. [Analysis of the effectiveness of tympanoplasty in the patients presenting with chronic otitis media complicated by perforation]. Vestn Otorinolaringol 2014:8-11. [PMID: 25734297 DOI: 10.17116/otorino201468-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The objective of the present study was to analyse the causes behind reperforation of the tympanic membrane in the patients presenting with chronic otitis media (mesotympanitis) after type I--III intrameatal tympanoplasty. Characteristic of the patients and methods of investigation. Intrameatal type I--III tympanoplasty with the use of autotransplants was performed in 652 patients presenting with chronic otitis media complicated by perforation of the tympanic membrane (CPOM). Fifty (7.6%) of these patients suffered recurrent perforation within one year after the primary treatment. The analysis of the medical histories, the character of secondary perforations, and intraoperative findings in 50 patients provided the data for the elucidation of the causes of poor anatomical and morphological outcomes of the surgical treatment. RESULTS It was shown that the anatomical and morphological effectiveness of type I--III intrameatal tympanoplasty in the patients with CPOM amounted to 92.4%. The main causes of reperforation are an extensive defect of the tympanic membrane, tympanic cavity mucositis associated with the compromised function of the Eustachian tube, in-growth of epidermis into the structures of the tympanic membrane, and the combination of these conditions as well as technical difficulties inherent in the surgical intervention.
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Affiliation(s)
- E V Garov
- Moskovskiĭ nauchno-prakticheskiĭ tsentr otorinolaringologii im. L.I. Sverzhevskogo" Departamenta zdravookhraneniia Moskvy, Moskva, Rossiia, 117152
| | - N G Sidorina
- Moskovskiĭ nauchno-prakticheskiĭ tsentr otorinolaringologii im. L.I. Sverzhevskogo" Departamenta zdravookhraneniia Moskvy, Moskva, Rossiia, 117152
| | - V N Zelenkova
- Moskovskiĭ nauchno-prakticheskiĭ tsentr otorinolaringologii im. L.I. Sverzhevskogo" Departamenta zdravookhraneniia Moskvy, Moskva, Rossiia, 117152
| | - A S Lavrova
- Moskovskiĭ nauchno-prakticheskiĭ tsentr otorinolaringologii im. L.I. Sverzhevskogo" Departamenta zdravookhraneniia Moskvy, Moskva, Rossiia, 117152
| | - N R Akmuldieva
- Moskovskiĭ nauchno-prakticheskiĭ tsentr otorinolaringologii im. L.I. Sverzhevskogo" Departamenta zdravookhraneniia Moskvy, Moskva, Rossiia, 117152
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22
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Eliades SJ, Limb CJ. The role of mastoidectomy in outcomes following tympanic membrane repair: A review. Laryngoscope 2013; 123:1787-802. [DOI: 10.1002/lary.23752] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/03/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Steven J. Eliades
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore; Maryland; U.S.A
| | - Charles J. Limb
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore; Maryland; U.S.A
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23
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Kamath MP, Sreedharan S, Rao AR, Raj V, Raju K. Success of myringoplasty: our experience. Indian J Otolaryngol Head Neck Surg 2013; 65:358-62. [PMID: 24427599 DOI: 10.1007/s12070-013-0651-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/26/2013] [Indexed: 10/27/2022] Open
Abstract
The purpose of this study is to compare the efficacy of myringoplasty with or without cortical mastoidectomy in terms of freedom from discharge, graft take up and improvement in hearing. This is a Clinical prospective study of 120 patients from among a group of patients with chronic suppurative otitis media. A detailed history and examination was conducted including pure tone audiogram. Patients were randomly divided into two groups; group A would undergo myringoplasty only and group B would undergo cortical mastoidectomy with myringoplasty. Patients were reviewed after 3 weeks for inspection of the operated ear. Second post-operative review was at 3 months for clinicoaudiological assessment. Group B was found to have slightly more improvement as compared to the other group. No significant difference in the success rates of graft take-up in patients with unilateral or bilateral disease was found. Higher take up rates were seen in large (91.83 %) and medium perforations (90.69 %). In all our failed cases, post-operative ear discharge continued to be a persistent and troubling problem. The average audiological gain was 12.88 dB in group B, whereas it was 12.40 dB in group A. The reduction of air bone gap within each group was found to be significant. There is no statistical significant data indicating that tympanoplasty with mastoidectomy yields better results. When considering the addition of a mastoidectomy to a Tympanoplasty, the performing surgeon should consider not only the potential added benefit but also potential risks and costs to the patient.
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Affiliation(s)
- M Panduranga Kamath
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, India
| | - Suja Sreedharan
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, India
| | - A Raghavendra Rao
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, India
| | - Vinay Raj
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, India
| | - Krishnam Raju
- Department of ENT and Head & Neck Surgery, Kasturba Medical College, Manipal University, Mangalore, India
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24
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Abstract
Tympanoplasty in children poses some different challenges from the same procedure in adults. The aim of the current article is to review 10 important considerations in pediatric tympanoplasty that focus on these differences and help to optimize the chance of successful outcome.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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