1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Wang L, Han H, Wang J, Zhu Y, Liu Z, Sun Y, Wang L, Xiang S, Shi H, Ding Q. Finite element analysis of repairing tympanic membrane perforation using autologous graft material and biodegradable bionic cobweb scaffold. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107868. [PMID: 37891016 DOI: 10.1016/j.cmpb.2023.107868] [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: 06/03/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVE As for repairing the perforated tympanic membranes (TM), temporalis fascia and tragal cartilage are popular in clinics as autologous graft materials. However, there is a significant hearing loss after repairing the TM with autologous graft materials, which needs to be addressed in biomechanical engineering. METHODS The finite element model of normal middle ear is improved from two aspects: the repair method of tympanic fibrous layer and the bionic spider web tympanic scaffold. By creating the solid-shell coupling condition and strong coupling boundary condition to simulate the repair, TM umbo and stapes footplate displacement-frequency response are explored in 200-8000 Hz. RESULTS The tympanic membrane perforation (TMP) causes a significant conductive hearing loss in high frequency region, which is positively correlated with perforation area. Both temporalis fascia and tragal cartilage still perform a certain degree of high-frequency hearing loss after repairing TMP. The TM attachment the magnesium alloy scaffold (MAS) prevents appropriately the high frequency hearing loss after autologous graft repair and makes the sound transmission closer to the normal condition. Significantly, the density of graft material has a negative effect on high-frequency sound transmission without the MAS. The modal-motion of TM repaired with temporalis fascia and tragal cartilage is improved significantly after attaching the MAS. In addition, the MAS restores effectively the configuration and vibration frequency of the repaired TM, which is similar to that of the native TM. CONCLUSION The area size of TMP is studied through the finite element method, which includes autologous graft materials, the MAS, parameter sensitivity analysis, modal analysis of graft material and the MAS in biological form on the effect of middle ear sound transmission. Relevant conclusions provide some references for clinical trial protocol and the follow-up repair ideas of TM of tympanoplasty.
Collapse
Affiliation(s)
- Liang Wang
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| | - Hongge Han
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| | - Jie Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China; Beijing Engineering Research Center of Audiological Technology, Beijing 100730, China
| | - Yueting Zhu
- Department of Otolaryngology, Head and Neck Surgery, Tianjin Children's Hospital, Tianjin University, Tianjin 300400, China
| | - Zhanli Liu
- School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Yongtao Sun
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China; National Key Laboratory of Strength and Structural Integrity, Xian, Shaanxi 710065, China.
| | - Lele Wang
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| | - Shuyi Xiang
- School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Huibin Shi
- School of Aerospace Engineering, Tsinghua University, Beijing 100084, China
| | - Qian Ding
- Department of Mechanics and Tianjin Key Laboratory of Nonlinear Dynamics and Control, Tianjin University, Tianjin 300350, China
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Stefan I, Stefanescu CD, Vlad AM, Zainea V, Hainarosie R. Postoperative Outcomes of Endoscopic versus Microscopic Myringoplasty in Patients with Chronic Otitis Media-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1074. [PMID: 37374278 DOI: 10.3390/medicina59061074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope's advantages. The aim of this review is to compare the surgical outcomes of a totally endoscopic transcanal approach with a conventional microscopic approach for type 1 tympanoplasty in patients with chronic otitis media (COM) in order to establish if endoscopic myringoplasty (EM) could be a better alternative to microscopic myringoplasty (MM). A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. The selected articles were identified by searching PubMed Central, PubMed, MEDLINE and Embase databases for the relevant publications. Only studies where the same surgeon in the department performed both endoscopic and microscopic myringoplasty have been included in the review. The results suggest that with an endoscopic approach, minimally invasive myringoplasty can be achieved with a similar graft success rate and postoperative air-bone gap (ABG) improvement, a shorter operative time and less postoperative complications compared to a microscopic approach.
Collapse
Affiliation(s)
- Iemima Stefan
- Medical Center of Special Telecommunications Service, 060044 Bucharest, Romania
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Cristian Dragos Stefanescu
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Ana Maria Vlad
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Viorel Zainea
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Răzvan Hainarosie
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| |
Collapse
|
5
|
Singh A, Talda D, Bhutia CD, Aggarwal SK, Chakraborty P, Kumari S, Yadav S. A Prospective Randomised Comparative Study Between Cartilage and Fascia Tympanoplasty in a Tertiary Care Hospital to Look for Better Alternative in High Risk Cases. Indian J Otolaryngol Head Neck Surg 2023; 75:50-59. [PMID: 37206716 PMCID: PMC10188854 DOI: 10.1007/s12070-022-03175-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction CSOM patients are most commonly managed surgically by type I tympanoplasty using either cartilage shield technique or underlay grafting technique. In our study, we have compared the graft uptake and hearing results of type I tympanoplasty using temporalis fascia and cartilage shield, and also reviewed the literature regarding the results of these two methods. Materials and Methods 160 patients aged between 15 and 60 years were randomized into two groups of 80 patients each, with odd numbers subjected to conchal or tragal cartilage shield grafting in group I, while in group II with even numbers, the patients underwent temporalis fascia grafting by underlay technique. Results Three months post-surgery, the graft uptake was seen in 76 patients (95%) in the cartilage shield group as compared to 58 patients (72.5%) in the temporalis fascia group, which was statistically significant between the two groups [Fisher's exact value = 0.000]. The uptake rate was much higher in cartilage shield graft as compared to fascia graft even in complicated cases like revision tympanoplasty (TP), discharging ear, subtotal perforation and retracted/adhered TP. Also, the hearing improvement in fascia and cartilage shield group was not statistically significant comparing pre- and post-operative patients, indicating that there was not much difference in audiological outcomes between the two groups. Conclusion We advocate the use of cartilage shield graft as a substitute for fascia graft in all feasible cases as well as in complicated situations to improve the success rate of type I tympanoplasty, without compromising on the hearing improvement, as seen in our study. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03175-1.
Collapse
Affiliation(s)
- Anshuman Singh
- Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Dolly Talda
- Deptt of Gynae and Obst, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Chultim Dolma Bhutia
- Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Sushil kumar Aggarwal
- Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Priyanko Chakraborty
- Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Silky Kumari
- Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| | - Sishupal Yadav
- Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India
| |
Collapse
|
6
|
Bulut KŞ, Kutluhan A, Çetin H, Gul F, Babademez MA, Kale H, Sancak M. Single Sequence Magnetic Resonance Imaging in Serous Otitis Media. Cureus 2023; 15:e38261. [PMID: 37261153 PMCID: PMC10226835 DOI: 10.7759/cureus.38261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION We evaluated the usability of short-term (approximately 3 minutes) T2 sequence temporal bone magnetic resonance imaging (MRI) in the diagnosis of serous otitis media (SOM) in our study. METHODS A prospective study. Otoscopic examination and audiometry-tympanometry were performed on all 73 patients included in the study. All patients underwent short-term T2 sequence temporal bone MRI before the paracentesis procedure. RESULTS The mean age of 73 patients (30 female and 43 male) was 7.78 ± 3.01 (3 to 17 years). A total of 134 ear paracentesis operations were performed. As a result of the intraoperative paracentesis procedure, 107 Type B tympanogram and 13 Type C tympanogram were found out of 120 ears that had fluid in the middle ear. Out of 14 ears without fluid flow in the middle ear, five were found to be Type B tympanogram and nine to be Type C tympanogram. The sensitivity of the type B tympanogram in the diagnosis of SOM was 89.1%, the specificity was 64.2%, the positive predictive value was 95.5%, and the negative predictive value was 40.9%. The sensitivity and specificity of short-term T2 sequence MRI in diagnosing SOM were found to be 100% and 100%. CONCLUSION Among the available methods, the short-term T2 sequence temporal MRI is the most effective method for evaluating fluid in mastoid cells.
Collapse
Affiliation(s)
- Kadir Şinasi Bulut
- Department of Otolaryngology, Head and Neck Surgery, Haymana State Hospital, Ankara, TUR
| | - Ahmet Kutluhan
- Department of Otolaryngology, Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, TUR
| | - Hüseyin Çetin
- Department of Radiology, Yildirim Beyazit University Faculty of Medicine, Ankara, TUR
| | - Fatih Gul
- Department of Otolaryngology, Head and Neck Surgery, Yildirim Beyazit University Faculty of Medicine, Ankara, TUR
| | - Mehmet Ali Babademez
- Department of Otolaryngology, Head and Neck Surgery, Yildirim Beyazit University Faculty of Medicine, Ankara, TUR
| | - Hayati Kale
- Department of Otorhinolaryngology, Private Otorhinolaryngology Clinic, Istanbul, TUR
| | - Mecit Sancak
- Department of Otolaryngology, Head and Neck Surgery, Lokman Hekim Hospital, Ankara, TUR
| |
Collapse
|
7
|
Moneir W, El-Kholy NA, Ali AI, Abdeltawwab MM, El-Sharkawy AAR. Correlation of Eustachian tube function with the results of type 1 tympanoplasty: a prospective study. Eur Arch Otorhinolaryngol 2023; 280:1593-1601. [PMID: 36018358 PMCID: PMC9988816 DOI: 10.1007/s00405-022-07611-4] [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: 04/15/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aims to evaluate Eustachian tube (ET) function tests and their impact on outcomes of tympanoplasty in patients with inactive chronic suppurative otitis media. MATERIALS AND METHODS A prospective study was conducted involving patients diagnosed with chronic suppurative otitis media (CSOM) and having a central dry perforation. Assessment of the ET function was done for all included cases by three tests; pressure swallow equalization test, saccharine test and methylene blue test. The primary outcome is the graft success rate defined as intact graft without any residual perforation at 6 months postoperatively. Secondary outcomes include hearing assessment and possible associated complications. RESULTS 64 patients were included in the study with an average age of 36.59 ± 11.96 years. All patients underwent assessment of the ET function by saccharine test, methylene blue test and pressure equalization test (PET) followed by microscopic post-auricular tympanoplasty. Successful tympanoplasty is achieved in 93.75% of cases with residual perforation in four patients. Mean air-bone gap is significantly improved from 23.73 ± 2.80 preoperatively to 10.93 ± 5.46 postoperatively. Results of Methylene blue test has no statistical impact on graft take rate (p value = 0.379), while saccharine test and pressure equalization test results have statistically significant correlation with graft success (p value ≤ 0.001). CONCLUSIONS Saccharine and Pressure equalization tests have a good positive correlation with the graft healing in tympanoplasty, while methylene blue test was found to have no correlation with the success rate.
Collapse
Affiliation(s)
- Waleed Moneir
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Noha Ahmed El-Kholy
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Ismail Ali
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | |
Collapse
|
8
|
Current variations and practice patterns in tympanic membrane perforation repair. J Laryngol Otol 2023; 137:249-258. [PMID: 35307041 DOI: 10.1017/s0022215122000779] [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: 11/07/2022]
Abstract
OBJECTIVE Management of tympanic membrane perforations is varied. This study aimed to better understand current practice patterns in myringoplasty and type 1 tympanoplasty. METHODS An electronic questionnaire was distributed to American Academy of Otolaryngology - Head and Neck Surgery members. Practice patterns were compared in terms of fellowship training, practice length, practice setting, paediatric case frequency and total cases per year. RESULTS Of the 321 respondents, most were comprehensive otolaryngologists (60.4 per cent), in private practice (60.8 per cent), with a primarily adult practice (59.8 per cent). Fellowship training was the factor most associated with significant variations in management, including pre-operative antibiotic usage (p = 0.019), contraindications (p < 0.001), approach to traumatic perforations (p < 0.001), use of local anaesthesia (p < 0.001), graft material (p < 0.001), tympanoplasty technique (p = 0.003), endoscopic assistance (p < 0.001) and timing of post-operative audiology evaluation (p = 0.003). CONCLUSION Subspecialty training appears to be the main variable associated with significant differences in peri-operative decision-making for surgical repair of tympanic membrane perforations.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Mitton TJ, Killeen DE, Momin ZK, Hunter JB, Isaacson B, Lee K, Kutz JW. Endoscopic Versus Microscopic Pediatric Tympanoplasty: Is There a Difference Between Closure Rates and Hearing Outcomes? Otol Neurotol 2022; 43:1205-1211. [PMID: 36166975 DOI: 10.1097/mao.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare closure rates and hearing outcomes of microscopic and endoscopic tympanoplasty in pediatric patients. STUDY DESIGN Retrospective chart review. SETTING Tertiary university medical center. PATIENTS Pediatric patients who underwent tympanoplasty surgery by a fellowship-trained neurotologist between 2010 and 2019 with a minimum of 2 months of follow-up, a tympanic membrane perforation, and no preoperative cholesteatoma. INTERVENTIONS Transcanal endoscopic tympanoplasty or microscopic tympanoplasty (MT) surgery. MAIN OUTCOME MEASURES The primary outcome is postoperative closure of the tympanic membrane perforation, assessed using otomicroscopy at the last follow-up appointment. Secondary outcomes include operative time and changes in the air-bone gap (ABG) and pure-tone average (PTA). RESULTS Two hundred eleven tympanoplasty operations were analyzed: 121 in the transcanal endoscopic ear surgery (TEES) group and 90 in the MT group. Tympanic membrane closure rates were no different between the two groups (TEES, 82.6%; MT, 88.9%; p = 0.24), and no significant association was found on multivariable analysis (TEES: odds ratio, 0.8; p = 0.61). Both groups showed improvements in the 4-month PTA and ABG and the 12-month PTA, but the 12-month ABG only improved in the TEES group ( p < 0.01). The TEES group had a shorter average operative time (109.8 versus 123.5 min; p = 0.03) and less need for a postauricular incision (2.5% versus 93.3%; p < 0.01). CONCLUSION In pediatric tympanoplasty, TEES gives similar membrane closure and hearing outcomes as the microscopic technique, with less operative time and less need for a postauricular incision.
Collapse
Affiliation(s)
- Tanner J Mitton
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zoha K Momin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kenneth Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joe Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
11
|
Transtympanic soft tissue tympanoplasty can replace conventional techniques elevating tympanic membranes. Eur Arch Otorhinolaryngol 2022; 279:5639-5645. [PMID: 35590078 DOI: 10.1007/s00405-022-07427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Most traditional tympanoplasties require elevating the tympanic membrane (TM). These techniques are rather complicated and success rates are not perfect. Therefore, the authors developed a novel technique, transtympanic soft tissue (TST) tympanoplasty, which does not require raising eardrums, and evaluated its surgical efficiency compared to perichondrium underlay (PU) tympanoplasty. STUDY DESIGN A retrospective study was conducted in a single center. METHODS 152 cases who underwent TST tympanoplasty (n = 70) or PU tympanoplasty (n = 82) between 2011 and 2020 were included in the study. Perforation location, pure tone audiometry, complications, and closure rates were analyzed according to the size of the TM perforations: moderate perforation (25-40%, n = 100) and large perforation (≥ 40%, n = 52). RESULTS For the moderate perforations, the closure rates of the TST (n = 45) and PU (n = 55) groups were 93.3% and 89.1%, respectively (p = 0.461), and even for the large perforations, the success rates were 88.0% in the TST group (n = 25) and 81.5% in the PU group (n = 27) (p = 0.515). The mean postoperative air-bone gap (ABG) values of the TST group for moderate and large perforations were 5.3 ± 5.8 dB and 6.6 ± 5.7 dB, respectively. There was no significant difference in postoperative ABG between the two surgical procedures (p > 0.05). The total operation time for TST tympanoplasty was significantly shorter than that for PU tympanoplasty (p = 0.002). CONCLUSIONS TST tympanoplasty is considered a novel, simple technique to replace traditional tympanoplasty techniques involving raising eardrums, even for large-sized perforations.
Collapse
|
12
|
Ferlito S, Fadda G, Lechien JR, Cammaroto G, Bartel R, Borello A, Cavallo G, Piccinini F, La Mantia I, Cocuzza S, Merlino F, Achena A, Brucale C, Mat Q, Gargula S, Fakhry N, Maniaci A. Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study. J Clin Med 2022; 11:jcm11237000. [PMID: 36498572 PMCID: PMC9740685 DOI: 10.3390/jcm11237000] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.
Collapse
Affiliation(s)
- Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Gianluca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Ambroise Paré Hospital (APHP), Paris Saclay University, 75016 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1000 Brussels, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75016 Paris, France
| | - Giovanni Cammaroto
- Department of Otolaryngology-Head and Neck Surgery, Morgagni Pierantoni Hospital, 47121 Forli, Italy
| | - Ricardo Bartel
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitario Mutua Terrasa, 8080 Barcelona, Spain
| | - Andrea Borello
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Francesca Piccinini
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Andrea Achena
- U.O.C. di Otorinolaringoiatria ASST Grande Ospedale Metropolitano Niguarda, 20100 Milano, Italy
| | - Cristina Brucale
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Quentin Mat
- Department of Medicine, Neurology, CHU de Charleroi, 15022 Charleroi, Belgium
| | - Stéphane Gargula
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, 75016 Paris, France
| | - Nicolas Fakhry
- Service d’Otorhinolaryngologie et de Chirurgie Cervico-Faciale, Université Aix-Marseille, Hôpital de La Conception, 147, Boulevard Baille, 13005 Marseille, France
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-3204154576
| |
Collapse
|
13
|
Lubianca Neto JF, Koerig Schuster A, Neves Lubianca JP, Eavey RD. Comparison of Inlay Cartilage Butterfly and Underlay Temporal Fascia Tympanoplasty. OTO Open 2022; 6:2473974X221108935. [PMID: 35836497 PMCID: PMC9274429 DOI: 10.1177/2473974x221108935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To systematically review the results of inlay cartilage butterfly
tympanoplasty and standard underlay temporal fascia tympanoplasty for
anatomic and functional end points. Data Sources PubMed, Embase, MEDLINE, and Virtual Health Library (VHL/Lilacs) databases
were searched from inception through April 2, 2021. No restrictions on
language, publication year, or publication status were applied. Review Methods The meta-analysis included data from articles that met inclusion criteria and
were extracted by 2 authors independently. The PRISMA statement was
followed. Risk of Bias 2.0 and Newcastle-Ottawa Scale were used to assess
risk of bias. The primary outcome was tympanic membrane closure rate. The
secondary outcome was improvement of the air-bone gap. Results Ten studies were included, 9 cohort studies and 1 randomized clinical trial,
with 577 patients. The graft take rate was 82.8% in the butterfly cartilage
inlay tympanoplasty group and 85.2% in the temporal fascia underlay
tympanoplasty group (relative risk, 1.01; 95% CI, 0.93-1.11;
I2 = 42%, P = .08). The
air-bone gap reduction ranged from 6.1 to 11.28 in the butterfly cartilage
inlay group and from 5.2 to 12.66 in the temporal fascia underlay group,
with a mean difference between groups of −2.08 (95% CI, −3.23 to −0.94;
I2 = 58%, P = .04),
favoring temporal fascia underlay. Conclusion The 2 tympanoplasty techniques analyzed here produced similar results in
terms of successful reconstruction of the tympanic membrane and reduction in
the air-bone gap. Neither age nor follow-up length of time influenced
outcomes.
Collapse
Affiliation(s)
- José Faibes Lubianca Neto
- Medical School of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Pediatrics of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Otorhinolaryngology Service of Santa Casa de Misericórdia Hospital of Porto Alegre, Porto Alegre, Brazil
- Pediatric Otolaryngology Service of Santo Antonio Children’s Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Artur Koerig Schuster
- Medical School of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Otorhinolaryngology Service of Santa Casa de Misericórdia Hospital of Porto Alegre, Porto Alegre, Brazil
- Pediatric Otolaryngology Service of Santo Antonio Children’s Hospital of Porto Alegre, Porto Alegre, Brazil
| | | | - Roland Douglas Eavey
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
14
|
Coelho SB, Lopes WDS, Bezerra GDAM, Araújo DFD, Meira ASF, Caldas Neto SDS. Use of nasal mucosa graft in tympanoplasty. Braz J Otorhinolaryngol 2022; 88:345-350. [PMID: 32771433 PMCID: PMC9422603 DOI: 10.1016/j.bjorl.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/01/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Tympanoplasty techniques with different types of graft have been used to close tympanic perforations since the 19th century. Tragal cartilage and temporalis fascia are the most frequently used types of graft. They lead to similar functional and morphological results in most cases. Although little published evidence is present, nasal mucosa has also been shown to be a good alternative graft. OBJECTIVE Surgical and audiological outcomes at the six-month follow-up in type I tympanoplasty using nasal mucosa and temporalis fascia grafts were analyzed. METHODS A total of 40 candidates for type I tympanoplasty were randomly selected and divided into the nasal mucosa and temporalis fascia graft groups with 20 in each group. The assessed parameters included surgical success; the rate of complete closure of tympanic perforation and hearing results; the difference between post- and pre-operative mean quadritonal airway-bone gap, six months after surgery. RESULTS Complete closure of the tympanic perforation was achieved in 17 of 20 patients in both groups. The mean quadritonal airway-bone gap closures were11.9 and 11.1 dB for the nasal mucosa and temporalis fascia groups, respectively. There was no statistically significant difference between the groups. CONCLUSION The nasal mucosa graft can be considered similar to the temporal fascia when considering the surgical success rate of graft acceptance and ultimate audiological gain.
Collapse
Affiliation(s)
- Sandro Barros Coelho
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídeo, Fortaleza, CE, Brazil.
| | | | | | - Davi Farias de Araújo
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídeo, Fortaleza, CE, Brazil
| | | | | |
Collapse
|
15
|
Richard C, Baker E, Wood J. Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study. Front Surg 2022; 9:844810. [PMID: 35350139 PMCID: PMC8957792 DOI: 10.3389/fsurg.2022.844810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Although cutting-edges antineoplastic therapies increase survival in children with malignancies, the optimal surgical strategy to address associated comorbidities such as chronic tympanic membrane perforation is still poorly documented. The aim of this study is to evaluate the outcomes of type I tympanoplasty in pediatric cancer survivors who received chemo and/or radiotherapy to the skull and to identify potential associated risk factors. Methods This case-control study included medical records review of oncologic patients (age <21) treated at the same Academic medical oncologic center between March 2015 and July 2021 and referred for conductive hearing loss and chronic tympanic membrane perforation. Patients and middle ear status-related variables were analyzed, and outcomes were compared with matched peers without any history of malignancies. Results A total of seven pediatric cancer survivors and seven paired children without any history of malignancies were included in this report. The mean age at tympanoplasty type I surgery was 10.2 years (range = 4.3–19.9; median = 7.9 years) for the pediatric cancer survivors' group and 10.1 years (range = 5.5–19.2; median = 7.9 years) in the control group. Three pediatric cancer patients had received chemotherapy alone, one patient had radiotherapy to the skull base, and three patients had received chemoradiotherapy. On average, surgery was performed 3.9 years after chemo and/or radiotherapy termination, except for 1 patient for whom the tympanoplasty was performed during chemotherapy treatment. A retroauricular approach was used for one of the pediatric cancer patients, a transcanal approach was performed in one other and five patients benefited from an otoendoscopic approach. Tragal perichondrium with cartilage was used in most of the pediatric cancer survivor cases (four out seven cases) while xenograft (Biodesign) and Temporalis fascia without cartilage graft were used in five out of the seven control cases. Rate of tympanic membrane perforation recurrence was similar between groups (28.6%). Mean functional gain for air conduction Pure Tone Average (AC PTA) was 2.6 and 7.7 dB HL for the oncologic and control group, respectively. Mean postoperative air-bone gap (ABG) was 10.7 dB HL [median = 8.7; inter-quartile range (IQR) = 13.8] for the oncologic cohort and 10.1 dB HL (median = 10.7; IQR = 9.6) for the control group. Discussion Chemo- and chemoradiotherapy to the skull are associated with damages to the inner and middle ear structures with secondary eustachian tube dysfunction and chronic middle ear effusion. Although healing abilities and immunological defenses are compromised as part of the expected effects of antineoplastic therapies, type I tympanoplasty can be safe and effective in this population. While different approaches may be considered, otoendoscopy showed excellent results with less morbidity in this vulnerable population.
Collapse
Affiliation(s)
- Celine Richard
- Department of Otolaryngology, The University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
- Division of Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Emily Baker
- The University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Joshua Wood
- Department of Otolaryngology, The University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
- Division of Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, United States
- *Correspondence: Joshua Wood
| |
Collapse
|
16
|
Bhandarkar AM, Krishnan NV, Mathew NM. Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media. Indian J Otolaryngol Head Neck Surg 2022; 74:32-38. [PMID: 35070923 PMCID: PMC8743324 DOI: 10.1007/s12070-020-02150-y] [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: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022] Open
Abstract
To study the efficacy of interlay cartilage rim augmented fascia tympanoplasty in mucosal chronic otitis media. A retrospective, observational study was conducted in a tertiary care hospital including charts of patients spanning a duration of one year, where 15 patients diagnosed with chronic otitis media-mucosal disease with large and subtotal perforations (with or without ossicular erosion), and had undergone interlay cartilage rim augmented fascia tympanoplasty, were analysed for morphological and functional improvement following surgery. Pre- and post-operative otomicroscopic examination and pure tone audiometry findings were the parameters considered. 86.6% had a well-healed, non-retracted, undisplaced mobile neotympanum, 6.7% who underwent a type III (minor columella) tympanoplasty had a medialised neotympanum and 1 subject (6.7%) who underwent a type I tympanoplasty had a residual pinpoint perforation which healed with conservative management. The overall morphological success rate was 93.3%. The mean hearing gain following surgery was 20.84 dB with a minimum gain of 10 dB and a maximum gain of 30 dB. The mean air-bone gap closure gain achieved was 19.2 dB with a minimum gain of 6.4 dB and a maximum gain of 30 dB. The interlay cartilage-fascia rim augmentation tympanoplasty is a novel, effective graft model suggested for large and sub-total central perforations. Future randomized studies with a larger sample size could be performed with longer follow-up to assess the outcome of this technique.
Collapse
Affiliation(s)
- Ajay M. Bhandarkar
- Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Neethu V. Krishnan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Neethu Mary Mathew
- Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
17
|
Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, Hackell J, Hunter LL, Keppel KL, Kim AH, Kim TW, Levine JM, Maksimoski MT, Moore DJ, Preciado DA, Raol NP, Vaughan WK, Walker EA, Monjur TM. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngol Head Neck Surg 2022; 166:S1-S55. [PMID: 35138954 DOI: 10.1177/01945998211065662] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. PURPOSE The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. METHODS In developing this update, the methods outlined in the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action" were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology-head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. ACTION STATEMENTS The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude.The GUG made recommendations for the following KASs: (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes.The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.
Collapse
Affiliation(s)
| | - David E Tunkel
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Charles E Bishop
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Daniel C Chelius
- Baylor College of Medicine-Texas Children's Hospital, Houston, Texas, USA
| | - Jesse Hackell
- Pomona Pediatrics, Boston Children's Health Physicians, Pomona, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | - Tae W Kim
- University of Minnesota School of Medicine/Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Jack M Levine
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Denee J Moore
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - William K Vaughan
- Consumers United for Evidence-Based Healthcare, Falls Church, Virginia, USA
| | | | - Taskin M Monjur
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
18
|
Vadiya S, Makwana P, Khetani S, Mehta N. Comparison of tragal cartilage and conchal cartilage in tympanoplasty. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_142_21] [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]
|
19
|
Saini YK, Singhal P, Prabhu KPS, Nagaraj S, Amreen, Sharma S, Yadav R, Aeron BS, Munjal S, Sharma MP. Vertical Strut Ossiculoplasty: A Versatile Alternate to Conventional Techniques-A Randomized study. Indian J Otolaryngol Head Neck Surg 2021; 73:360-365. [PMID: 34471627 PMCID: PMC8364591 DOI: 10.1007/s12070-021-02614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Various ossicular reconstruction materials and techniques have been described in literature using autologous ossicle, cortical bone, autologous cartilage, synthetic materials and implants like total/partial ossicular replacement prosthesis (TORP/PORP) etc., but it has always been a topic of controversy in terms of the efficacy, longevity and complications of the material or method used. MATERIAL AND METHODS This is a prospective, interventional, comparative, double-blind randomized control study which was done at a tertiary care center to compare outcomes of conventional and carved conchal cartilage (vertical strut) type III Tympanoplasty in terms of graft uptake and hearing gain. A total number of 52 cases were enrolled, randomized and allocated to 2 groups (26 each) i.e. group A (conventional type III) and group B (vertical strut technique). RESULTS Graft uptake was seen in 25 (96.16%) patients in group B while it was observed in 23 (88.5%) cases in group A. Hearing gains were also better in group B. CONCLUSION This study suggests that Vertical Strut technique can be studied further as it gives better gains in Air Conduction threshold and A-B Gap along with graft uptake as it provides better middle ear space and ossicular / tympanic membrane interface resulting in better hearing.
Collapse
Affiliation(s)
- Yogendra Kumar Saini
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | | | - Sushmitha Nagaraj
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Amreen
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Shivam Sharma
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Rajeev Yadav
- Department of Preventive and Social Medicine, SMS Medical College, Jaipur, India
| | | | | | - Man Prakash Sharma
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| |
Collapse
|
20
|
Mudry A. Fascia Temporalis as Tympanic Graft: A Swedish and German Story. Surg Innov 2021; 29:295-298. [PMID: 34247550 DOI: 10.1177/15533506211031445] [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: 11/17/2022]
Abstract
Fascia temporalis is the most widely used graft for reconstruction of the tympanic membrane. Its story began at the turn of the 1960s. Some historical reports credit the American otolaryngologist Lloyd A. Storrs (1922-1989), to be the first user of this material in tympanoplasty in 1961. In fact, this is not quite exact. Based only on primary sources, this study demonstrates that Urban Örtegren (1921-1991), a Swedish otolaryngologist in Lund, began using fascia temporalis to reconstruct the tympanic membrane already in 1957. He was followed by Hans Heermann (1900-1996), a German otologist of Essen in 1958. Fascia temporalis as a tympanic graft is thus a Swedish and German story.
Collapse
Affiliation(s)
- Albert Mudry
- Department of Otolaryngology, Head & Neck Surgery, 10624Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
21
|
Xing C, Liu H, Li G, Li J, Li X. Type 1 tympanoplasty in patients with large perforations: Comparison of temporalis fascia, partial-thickness cartilage, and full-thickness cartilage. J Int Med Res 2021; 48:300060520945140. [PMID: 32790512 PMCID: PMC7543155 DOI: 10.1177/0300060520945140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to compare the results of different graft materials in type I tympanoplasty for patients with a large perforation of the tympanic membrane. Methods We performed a retrospective study on 180 patients with type I tympanoplasty. The patients were divided into three groups according to the repair materials used. Age, sex, pre- and postoperative hearing levels, mean air–bone gap, rate of graft success, hearing gain, and the postoperative graft failure rate were evaluated. We continued to follow-up the patients to 1 year after surgery. Results The air conduction threshold was significantly higher before the operation than after the operation in the temporalis fascia, partial-thickness cartilage, and full-thickness cartilage groups. Although the hearing gain in the temporalis fascia group and the partial-thickness cartilage group was higher than that in the full-thickness cartilage group, there was no significant difference in the graft success rate among the groups. Conclusions Temporalis fascia, partial-thickness cartilage, and full-thickness cartilage can be used as appropriate transplantation materials for tympanoplasty type I in patients with a large perforation. Temporalis fascia and partial-thickness cartilage may be best for improvement of hearing.
Collapse
Affiliation(s)
- Caixia Xing
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| | - Hong Liu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, P.R. China
| | - Guodong Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| | - Jianfeng Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| | - Xin Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| |
Collapse
|
22
|
Mallouk S, Khadi EB, Bijou W, Oukessou Y, Sami R, Redallah LA, Mohammed M. Specific aspects of tympanoplasty in children: A retrospective cohort study of 95 cases. Ann Med Surg (Lond) 2021; 65:102297. [PMID: 33981425 PMCID: PMC8082206 DOI: 10.1016/j.amsu.2021.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Paediatric tympanoplasty is now a common surgical procedure. The age from which it could be proposed varies regarding children specificities such as Eustachian tube dysfunction, the high incidence of upper airway infections and the immaturity of the immune system. The aim of this study is to describe the specific constitutional, epidemiological and operative aspects as well as the anatomical and functional results of tympanoplasty in children. METHODS From 2014 to 2018, a cohort of 95 patients with ages between 6 and 16 years, operated for a type I tympanoplasty, was reviewed by analysing the medical history, the epidemiological and clinical parameters, in addition to the operative features and the functional results. RESULTS The mean age at surgery was 11,7 years. The main risk factors of tympanic perforation were recurrent otitis (78,9%), auricular trauma (16,8%) and tonsillar and adenoid hypertrophy (7,4%). Good anatomical postoperative results with a closed and reinforced neo-tympanic membrane were seen in 90 (94,7%) cases, while a significant improvement of the hearing loss was observed in 87 (91.6%) patients, with a mean value of 34,23 dB HL before and 21,9 dB HL after surgery (p < 0,0001). CONCLUSIONS The indications of type I tympanoplasty in the paediatric population remain a subject of debate, but still offer good anatomical and functional results as long as it is adapted to each particular case.
Collapse
Affiliation(s)
- Sanaa Mallouk
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - El Bouhmadi Khadi
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Walid Bijou
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Youssef Oukessou
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Rouadi Sami
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Larbi Abada Redallah
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| | - Mahtar Mohammed
- ENT Department, Face and Neck Surgery, Hospital August, 20’1953, University Hospital Center IBN ROCHD, Hassan II University, Casablanca, Morocco
| |
Collapse
|
23
|
Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Aleemardani M, Bagher Z, Farhadi M, Chahsetareh H, Najafi R, Eftekhari B, Seifalian A. Can Tissue Engineering Bring Hope to the Development of Human Tympanic Membrane? TISSUE ENGINEERING PART B-REVIEWS 2021; 27:572-589. [PMID: 33164696 DOI: 10.1089/ten.teb.2020.0176] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMPs) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anesthetic risks, and high failure of graft patency. The tissue engineering strategy, which includes the applications of a three-dimensional (3D) scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches, which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, we provide an overview of the in vitro and preclinical studies of emerging products over the past 5 years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.
Collapse
Affiliation(s)
- Mina Aleemardani
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Zohreh Bagher
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Chahsetareh
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Roghayeh Najafi
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Behnaz Eftekhari
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London, United Kingdom
| |
Collapse
|
25
|
Endoscopic tympanoplasty type I for tympanic perforations: analysis of prognostic factors. Eur Arch Otorhinolaryngol 2021; 278:4715-4722. [PMID: 33438041 DOI: 10.1007/s00405-020-06588-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the anatomical and functional outcomes of endoscopic transcanal tympanoplasty type I for tympanic membrane perforations. METHODS Eight hundred thirty-five patients who underwent tympanoplasty between January 2011 and January 2019 were selected. Patients with tympanic membrane perforation treated with a transcanal endoscopic tympanoplasty type 1 and a follow-up period longer than 6 months have been retrospectively reviewed. The presence of cholesteatoma or ossicular chain dysfunctions were considered exclusion criteria. Eighty-one patients were included in the present study population. The main outcome was the rate of overall graft success. Secondary outcomes included hearing results. Prognostic factors related to both the abovementioned outcomes were assessed. RESULTS Overall, 66 patients (81.5%) had a successful graft at the last follow-up evaluation. Mean follow-up was 22.1 (range 6-104) months. The anterior quadrants were entailed by the perforation in 62 (76.5%) cases. The overall success rate with cartilage (or cartilage and perichondrium) was 91.2% (p < 0.01). The median preoperative and postoperative ABG were 18.7 (13.4-25.6) and 7.5 (2.5-12.5), respectively, revealing a significant median improvement of 11.2 (p < 0.001). The type of graft and the postoperative tympanic membrane status were significantly associated with the audiologic outcome with p = 0.01 and p = 0.02, respectively. CONCLUSIONS Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results. Tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results. Anterior eardrum perforations can be successfully and safely managed with transcanal endoscopic approach avoiding postauricular approach and canalplasty.
Collapse
|
26
|
Comparing audiometric parameters between crushed and intact cartilage tympanoplasty: a double-blinded, randomised, controlled trial study. The Journal of Laryngology & Otology 2020; 134:1060-1064. [PMID: 33272334 DOI: 10.1017/s0022215120002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate hearing and the take rate of crushed cartilage grafts in tympanoplasty. METHODS In this double-blinded, randomised, controlled trial, 46 patients with tympanic membrane perforation were enrolled. A conchal cartilage graft was used for reconstruction in both intervention and control groups. In the intervention group, crushed cartilage was used. The success rate and hearing results were ascertained every four months over a one-year follow-up period. RESULTS A total of 36 patients - 20 in the intervention group and 16 in the control group - completed one year of follow up. There were no statistically significant differences between the two groups in mean air-bone gap, bone conduction threshold, speech discrimination score or speech reception threshold. CONCLUSION The reduction in living cells after crushed cartilage tympanoplasty may decrease the rigidity and the volume of the graft, but may not necessarily improve the hearing results.
Collapse
|
27
|
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.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, China
| |
Collapse
|
28
|
Liu S, Huo Z, Zhang H, Hu Q, Ramalingam M. 3D printing‐assisted
combinatorial approach for designing mechanically‐tunable and vascular supportive nanofibrous membranes to repair perforated eardrum. J Appl Polym Sci 2020. [DOI: 10.1002/app.50132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Suihong Liu
- Rapid Manufacturing Engineering Center Shanghai University Shanghai China
| | - Zirong Huo
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center Shanghai University Shanghai China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics Shanghai University Shanghai China
| | - Qingxi Hu
- Rapid Manufacturing Engineering Center Shanghai University Shanghai China
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics Shanghai University Shanghai China
| | - Murugan Ramalingam
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular and Molecular Theranostics, School of Mechanical Engineering Vellore Institute of Technology Vellore India
| |
Collapse
|
29
|
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%.
Collapse
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
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Chen YC, Huang CY, Kuo YJ, Cheng HL, Cheng YF, Liao WH. Developing a novel meatal areolar tissue autograft for minimally invasive tympanoplasty. J Chin Med Assoc 2020; 83:956-961. [PMID: 32649410 PMCID: PMC7526586 DOI: 10.1097/jcma.0000000000000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We developed an easy and minimally invasive method of transmeatal tympanoplasty using meatal areolar tissue (MAT) grafts to achieve less postoperative morbidity or surgical scarring. We compared the functional and anatomical results of the developed method with conventional endaural tympanoplasty with a temporalis fascia (TF) graft. METHODS In this retrospective cohort study, 58 patients (59 ears) with simple chronic otitis media who underwent type I tympanoplasty between January 2016 and August 2018 were included. All surgeries were performed in a tertiary referral hospital and by the same senior surgeon. The tympanic membrane (TM) was repaired with either a TF or an MAT graft. RESULTS Healing of the perforated TM and improvement in a hearing test by air-bone gap (ABG) closure were identified. Postoperative wound conditions were also evaluated. Twenty-eight ears were grafted with MAT, and 31 ears were grafted with TF. Graft success was observed in 26 patients (92.9%) in the MAT group and 28 patients (90.3%) in the TF group. Both groups showed functional improvement compared with the preoperative measurements. The postoperative pure tone audiogram (p = 0.737), ABG closure (p = 0.547), and graft success rate (p = 0.726) were not significantly different between the two groups. Neither wound dehiscence nor keloid formation was observed in our patients. CONCLUSION Both MAT and TF grafts revealed satisfactory surgical and functional results. Compared with the conventional endaural approach with TF grafts, the new transmeatal approach method with an MAT graft causes relatively minimal trauma and results in better wound cosmetics. This method represents an easy, minimally invasive surgery and shows comparatively good results.
Collapse
Affiliation(s)
- Yen-Chi Chen
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chii-Yuan Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiu-Lien Cheng
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence: Dr. Yen-Fu Cheng and Dr Wen Huei Liao, Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (Y.-F. Cheng); (W.H. Liao)
| | - Wen Huei Liao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence: Dr. Yen-Fu Cheng and Dr Wen Huei Liao, Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (Y.-F. Cheng); (W.H. Liao)
| |
Collapse
|
32
|
Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:182-189. [PMID: 32862972 DOI: 10.1016/j.otorri.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/11/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake. MATERIAL AND METHODS Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined. RESULTS The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79). CONCLUSION Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.
Collapse
Affiliation(s)
- Pedro Salvador
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
| | - Patrícia Gomes
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Francisco Silva
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Rui Fonseca
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| |
Collapse
|
33
|
Lagos A, Villarroel P, García-Huidobro F, Delgado V, Huidobro B, Caro J, Martín JS. Tympanoplasty: factors associated with anatomical and audiometric results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
Lou Z. Is the elevation of tympanomeatal flap need for modified palisade cartilage-perichondrium graft myringoplasty. Am J Otolaryngol 2020; 41:102438. [PMID: 32122678 DOI: 10.1016/j.amjoto.2020.102438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
|
35
|
Larrosa F, de Osso JT, Dura MJ, Bernal-Sprekelsen M. Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study. Eur Arch Otorhinolaryngol 2020; 277:1955-1959. [PMID: 32253534 DOI: 10.1007/s00405-020-05947-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The endoscopic approach to tympanoplasty is gaining popularity, but its adoption for the palisade tympanoplasty technique is unstudied. The aim of the present study was to evaluate the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations. METHODS Retrospective study of 42 adult patients who underwent endoscopic tympanoplasty for a subtotal perforation in a university tertiary referral center from January 2018 to June 2019. Patients underwent transcanal tympanoplasty either with cartilage palisade grafts or with one-piece composite cartilage-perichondrium grafts. Both techniques were compared for graft take rate and audiometric results. RESULTS Twenty palisade and 22 single-piece tympanoplasties were analyzed. No statistically significant differences between groups were found in terms of tympanic membrane closure (85% vs. 86.3%, p = 0.5) or hearing improvement. CONCLUSION The results of the present study suggest that similar results can be obtained with palisade cartilage grafts compared to the one-piece composite cartilage-perichondrium technique for endoscopic tympanic membrane closure. Further studies with long-term results will be needed to confirm these findings.
Collapse
Affiliation(s)
- Francisco Larrosa
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain. .,University of Barcelona Medical School, Barcelona, Spain.
| | - Jose Tomas de Osso
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain
| | - Maria Jose Dura
- Department of Physical Medicine and Rehabilitation, Hospital Germans Trias I Pujol, Badalona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Quironsalud Valencia, Valencia, Spain.,University of Valencia Medical School, Valencia, Spain
| |
Collapse
|
36
|
Tympanoplasty: factors associated with anatomical and audiometric results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:219-224. [PMID: 32156440 DOI: 10.1016/j.otorri.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tympanoplasty is a frequent surgery in otolaryngology. Its main indication is tympanic perforation, followed by adhesive otopathy. Its main and (or) anatomic objective is to restore the tympanic membrane's integrity, preventing infections, and its secondary or audiometric objective is to preserve or improve hearing. MATERIAL AND METHOD Retrospective study of all patients submitted to tympanoplasty at our hospital. Biodemographic, ear pathology and surgery characteristics were registered, and anatomic and audiometric success rates were analyzed. RESULTS A total of 182 patients were included, most female (57.1%), with average age of 36.1 years. The main surgical indication was tympanic perforation (89.0%), followed by adhesive otopathy (7.1%). Most tympanoplasties were primary surgeries (84.1%), type I (62.6%), performed by endoaural approach (83.5%) using medial or Austin technique (90.1%). Compound cartilage-perichondrium grafts were most frequently used (87.9%). The anatomic success rate was 84.6%, and the audiometric success rate was 66.8%. Patients who underwent myringoplasty (without raising of tympanomeatal flap) presented a better audiometric result (p=.003). No factors associated with better anatomical results were identified. CONCLUSIONS Our anatomic and audiometric results are comparable to those previously published. Further prospective studies are required to define factors associated with improved anatomic and audiometric results.
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Genç S, Özel HE, Altıparmak E, Başer S, Eyisaraç Ş, Bayakır F, Özdoğan F. Rates of success in hearing and grafting in the perichondrium-preserved palisade island graft technique. Braz J Otorhinolaryngol 2019; 87:305-309. [PMID: 31753779 PMCID: PMC9422520 DOI: 10.1016/j.bjorl.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/09/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Various graft materials have been used in the tympanoplasty technique. Cartilage grafts are being used increasingly in recent years. OBJECTIVE The aim of this study was to present the comparative outcomes of the perichondrium-preserved palisade island graft technique previously defined by ourselves. METHODS We retrospectively compared the hearing and graft success rates in 108 patients with chronic otitis media, who had undergone cartilage tympanoplasty, where both island and perichondrium-preserved palisade graft techniques were used. RESULTS The success rates among the study and the control groups with regard to graft take were 97% and 93%, respectively. No significant difference was observed between the groups with regard to the postoperative mean pure tone values, improvement in air-bone gaps and reduction in air-bone gaps to under 20dB. However, better results were observed in the study group. CONCLUSION The perichondrium-preserved palisade island graft technique is an easy method with high graft success rates and hearing outcomes.
Collapse
Affiliation(s)
- Selahattin Genç
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey.
| | - Halil Erdem Özel
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Erdem Altıparmak
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Serdar Başer
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Şaban Eyisaraç
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Ferit Bayakır
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Fatih Özdoğan
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| |
Collapse
|
39
|
Varghese GM, Abdullah PH, Sabu NJ. Sutureless Tragal Cartilage Island Tympanoplasty: Our Experience. Indian J Otolaryngol Head Neck Surg 2019; 71:1377-1382. [PMID: 31750181 PMCID: PMC6841843 DOI: 10.1007/s12070-018-1438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022] Open
Abstract
To evaluate graft take up and hearing improvement using the technique of tragal cartilage island in COM-mucosal type. Prospective study. A total of 258 type 1 tympanoplasty surgeries were done using tragal cartilage island graft from December 2013, to December 2015; in Jubilee Mission Medical College and Research Institute with a follow up of 1 year. Inclusion criteria-all the patients undergoing type 1 tympanoplasty for chronic otitis media (mucosal type, inactive) with an intact ossicular chain by the senior author. The youngest patient was 6 years old and the oldest was 64 years. This pattern was selected for getting a uniform pattern even though cartilage tympanoplasty can be done in other forms of COM also. Graft take up in our study was found to be 96.12% in 1 year of follow up. Closure of tympanic membrane was achieved in 248 of 258 cases. None of the patients showed retraction pockets or cholesteatoma during follow up. The average pre-op AB gap was 21.62 dB which was lowered to 4.22 dB post op. The mean gain in hearing was 17.37 dB. It is worthwhile to consider tragal cartilage island graft as an alternative to temporalis fascia.
Collapse
Affiliation(s)
- George Mullonkal Varghese
- Department of Otorhinolaryngology Head and Neck surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala India
| | - P. Hafees Abdullah
- Department of Otorhinolaryngology Head and Neck surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala India
| | - Nelwin Jerald Sabu
- Department of Otorhinolaryngology Head and Neck surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala India
| |
Collapse
|
40
|
Eldaebes MMAS, Landry TG, Bance ML. Repair of subtotal tympanic membrane perforations: A temporal bone study of several tympanoplasty materials. PLoS One 2019; 14:e0222728. [PMID: 31536572 PMCID: PMC6752791 DOI: 10.1371/journal.pone.0222728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer.
Collapse
Affiliation(s)
- Mostafa M. A. S. Eldaebes
- Department of Surgery, Division of Otolaryngology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Thomas G. Landry
- Department of Surgery, Division of Otolaryngology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Manohar L. Bance
- Department of Surgery, Division of Otolaryngology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- * E-mail:
| |
Collapse
|
41
|
Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results. J Craniofac Surg 2019; 30:e297-e300. [PMID: 30839461 DOI: 10.1097/scs.0000000000005278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ± 6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.
Collapse
|
42
|
Shoman NM. Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting. Am J Otolaryngol 2019; 40:482-486. [PMID: 31029401 DOI: 10.1016/j.amjoto.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting. STUDY DESIGN Retrospective case series. SETTING Tertiary care facility. PATIENTS Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection. INTERVENTION In-office modified myringoplasty technique under local anesthesia without sedation. MAIN OUTCOME MEASURES Complete perforation closure rate and audiometric outcomes. RESULTS 250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04). CONCLUSION The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.
Collapse
|
43
|
Abstract
OBJECTIVE There are no direct comparisons between the success of collagen allografts versus traditional autografts for tympanic membrane (TM) repair. We sought to compare success rates in a large series of patients undergoing tympanoplasty using collagen allografts versus autologous tissues. STUDY DESIGN Retrospective review. SETTING Academic medical center. SUBJECTS AND METHODS Single institution retrospective chart review was performed for adult subjects with TM perforation undergoing tympanoplasty. Demographic, clinical, and surgical data were collected. Statistical analysis was completed using Rstudio. Each factor was examined to assess effect on graft success rate using logistic regression. RESULTS Two hundred sixty-five surgeries met criteria with four main grafting materials or combinations thereof. The overall graft success rate was 81.1% with failure rate of 18.9%. There was no significant association between failure rates and: age, sex, perforation cause, size, and location, primary or revision status, middle ear status (wet or dry), concomitant procedures (mastoidectomy or ossiculoplasty), presence of active cholesteatoma, or surgical technique. Although not statistically significant, the odds of success for perichondrium + cartilage were 7.5 times higher than collagen allografts (p = 0.07, 95% confidence interval [CI] = 0.81-69.6). The odds of success for the postauricular (odds ratio [OR] = 6.4) and transcanal approaches (OR = 24.8) were significantly greater than for endaural (p = 0.007 and p = 0.008, respectively). CONCLUSION In tympanoplasty surgeries performed on patients with TM perforation, we found no statistically significant difference in graft failure rates between collagen allograft and other grafting materials or combinations, though the higher odds ratio of success with cartilage + perichondrium may be clinically relevant.
Collapse
|
44
|
Sen A, Özdamar K. Which graft should be used for the pediatric transcanal endoscopic type 1 tympanoplasty? A comparative clinical study. Int J Pediatr Otorhinolaryngol 2019; 121:76-80. [PMID: 30877979 DOI: 10.1016/j.ijporl.2019.02.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare the functional and anatomical success rates of the fascial versus perichondrial grafts in pediatric endoscopic type 1 tympanoplasties. METHODS This retrospective clinical study was conducted on 40 pediatric patients (23 females and 17 males; mean age: 10.0 ± 1.7 years; the age range: 6-13) who were operated with a transcanal endoscopic type 1 tympanoplasty. The study participants were assigned to two groups by graft types. The patients were assigned to either the tragal cartilage perichondrium group (Group A) or the fascia of the temporal muscle (Group B). The groups were compared according to the pre- and postoperative air-bone gaps and to the status of the tympanic membrane. RESULTS There were not any statistically significant differences between the groups in terms of the distribution of age, gender, the operation sites, the duration of the operation, MERI scores or the size of the perforation (all p values > 0.05). The graft retention success rates were 94.7% and 90.5% in Group A and Group B, respectively. There were no statistically significant differences between the two groups in terms of the graft retention success rates (p = 0.609). The functional (audiological) success rate was statistically higher in Group B compared to Group A (p = 0.044). CONCLUSION Perichondrium and fascia grafts were found out to be acceptable for use in pediatric endoscopic tympanoplasties. The functional success rates were higher in the fascia group. We also recommended the fascia as a graft in pediatric transcanal endoscopic type 1 tympanoplasties.
Collapse
Affiliation(s)
- Alper Sen
- Harran University, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Şanlıurfa, Turkey.
| | - Kadir Özdamar
- Private Sanmed Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Şanlıurfa, Turkey.
| |
Collapse
|
45
|
Growth and Late Detection of Post-Operative Cholesteatoma on Long Term Follow-Up With Diffusion Weighted Magnetic Resonance Imaging (DWI MRI): A Retrospective Analysis From a Single UK Centre. Otol Neurotol 2019; 40:638-644. [DOI: 10.1097/mao.0000000000002188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
46
|
Jin KF. Commentary on topical platelet rich plasma versus hyaluronic acid during fat graft myringoplasty. Am J Otolaryngol 2019; 40:465-466. [PMID: 30803807 DOI: 10.1016/j.amjoto.2019.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Kan-Feng Jin
- Department of Otorhinolaryngology, the Affiliated Yiwu Hospital of Wenzhou Medical University, Zhejiang 322000, China
| |
Collapse
|
47
|
Balcı MK, İşlek A, Ciğer E. Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques. Eur Arch Otorhinolaryngol 2019; 276:673-677. [PMID: 30600345 DOI: 10.1007/s00405-018-5262-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels. METHODS Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed. RESULTS One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively). CONCLUSION In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.
Collapse
Affiliation(s)
- Mustafa Koray Balcı
- Department of Otorhinolaryngology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi Mh. Karabağlar, Izmir, 35170, Turkey.
| | - Akif İşlek
- Department of Otorhinolaryngology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi Mh. Karabağlar, Izmir, 35170, Turkey
| | - Ejder Ciğer
- Department of Otorhinolaryngology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi Mh. Karabağlar, Izmir, 35170, Turkey
| |
Collapse
|
48
|
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.
Collapse
|
49
|
What Effect Does Smoking Have on the Surgical Closure of Tympanic Membrane Perforations? A Review. Otol Neurotol 2018; 39:1217-1221. [DOI: 10.1097/mao.0000000000002011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Li L, Zhang W, Huang M, Li J, Chen J, Zhou M, He J. Preparation of gelatin/genipin nanofibrous membrane for tympanic member repair. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2018; 29:2154-2167. [PMID: 30295148 DOI: 10.1080/09205063.2018.1528519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Longfei Li
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Weizheng Zhang
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Mengjia Huang
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Jie Li
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Jia Chen
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mi Zhou
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Jianguo He
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|