Prognostic factors of myringoplasty: study of a 140 cases series and review of the literature

Cartilaginous Myringoplasty: Anatomical and Functional Results

INTRODUCTION

 Myringoplasty remains a topical subject. Our study aims at analyzing the anatomical and functional results of cartilaginous myringoplasty, and also determining the main factors that could influence its results.

MATERIALS AND METHODS

 A retrospective study of 51 cases of tympanic perforations operated at the ENT department of the Hassan II University Hospital of Fez between January 2018 and November 2021. Only the patients with exclusive cartilage myringoplasty were included. The anatomical and functional results of cartilage myringoplasty were evaluated and analyzed according to several variables. The statistical analysis was performed using SPSS Statistics software.

RESULTS

 The average age of our patients was 35, with a sex ratio of 2.45. The perforation was anterior in 58%, posterior in 12%, and central in 30% of the cases. The average pre-operative audiometric air bone gap (ABG) was 29.3 dB. The most commonly used graft was the conchal cartilage in 89% of cases. A complete cicatrization has been noticed in 92%, and at six months after surgery, a complete closure of the ABG has been observed in 43% of cases, a significant hearing improvement with an ABG between 11 and 20 dB in 24%, a hearing recovery with an ABG between 21 and 30 dB in 21%, and an ABG > 30 dB in 12% of the cases. A statically significant relationship (p<0.05) has been found between the functional or anatomical failure of the myringoplasty; the different predictive factors were: the young age (less than 16 years), the inflammatory state of the tympanic cavity, the anterior location, and large size of the perforation.

CONCLUSION

Cartilaginous myringoplasty provides good anatomical and auditory results. The pre-operative predictive factors, such as age, complete and sufficient drying of the ear, the size and location of the perforation, and the size of the used cartilage, should all be considered for a better anatomical and functional outcome.

Comparison of the underlay and over‐underlay tympanoplasty: A randomized, double‐blind controlled trial

Objective

We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over-underlay approaches.

Methods

This is a prospective double-blind randomized controlled clinical trial with a parallel design. Patients aged 15-75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over-underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6 months.

Results

The investigation was conducted on 84 patients in the underlay and 67 patients in the over-underlay group. Although there was a higher rate of graft failure (9%) in the over-underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant (p-value = .34). No atelectasis was seen in both group. Although, between-groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air-bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over-underlay technique, the difference was clinically negligible.

Conclusion

Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over-underlay technique after the operation.

Levels of Evidence

1b.

Tragus Perichondrium-Cartilage Island and Temporalis Muscle Fascia for Repairing Tympanic Membrane Perforation Under the Otoendoscope: A Randomized Controlled Trial

OBJECTIVE

To compare the clinical effects of repairing tympanic membrane perforation (TMP) with the tragus perichondrium-cartilage island and temporalis muscle fascia (TMF) under the otoendoscope.

METHODS

The clinical data of 84 patients (total 84 ears) with TMP repaired by otoendoscopy from March 2019 to April 2021 were analyzed. The patients were randomly divided into the control group (n = 42, TMF repair) and the experimental group (n = 42, perichondrium-cartilage island repair). The intraoperative blood loss, operation time, length of hospital stay, success rate of the TMP repair, mean air-conducted sound, and air-bone gap before and after surgery were compared between the two groups.

RESULTS

The mean air-bone gap and mean air-conducted hearing threshold in the experimental group were significantly lower after surgery at all frequencies than those of the control group (all P < .05). The reduction of the mean air-conducted hearing threshold in the experimental group was significantly higher than that of the control group (P < .001). The surgery time of the experimental group was significantly shorter than the control group (78.04 ± 2.23 vs. 84.27 ± 1.67 minutes, P < .001). The success rate of the TMP repair was 95.24% (40/42) in the experimental group and 92.86% (39/42) in the control group, indicating that there was no significant difference in the success rate of TMP repair between the two materials (risk ratio = 1.75; 95% confidence interval: .31-12.04; P = .71).

CONCLUSION

Repairs with the tragus perichondrium-cartilage island have a short operation time, high healing rate, and more significant postoperative hearing improvement, which makes it a more effective method of TMP repair.

Type I tympanoplasty in pediatric age - The results of a tertiary hospital

INTRODUCTION

The performance of pediatric tympanoplasty is a matter of controversy in the literature, varying from 35 to 94%. Several authors argue that the performance of tympanoplasty should be delayed until 6-8 years old or even after 10 years old.

OBJECTIVES

To analyze the results of type I tympanoplasty in pediatric age and to identify possible prognostic factors.

MATERIAL AND METHODS

Retrospective study of children undergoing type I tympanoplasty (Portmann's classification) between January 2012 and December 2018 in our hospital. The following variables were analyzed: age, gender, etiology, size and location of the perforation, operated ear, season of the surgery, experience of the surgeon, condition of the contralateral ear, previous otologic surgery, previous adenoidectomy, presence of tympanosclerosis, surgical approach, type of graft, tympanoplasty technique, pre and postoperative audiometric results and follow-up time. The integrity of tympanic membrane (TM) was defined as anatomical success at 6 months postoperatively and as functional success we defined a pure tone average < 20 dB (mean of 0.5-4 KHz) in postoperative tonal audiometry, performed between 3 and 6 months after surgery.

RESULTS

A total of 48 ears operated on 38 patients, aged between 8 and 17 years. Anatomical and functional success rates of 81.3% and 87.5%, respectively, were obtained. The only statistically significant poor prognostic factor was the presence of tympanosclerosis plaques in the middle ear, negatively affecting anatomical success (p = 0.007) and functional success (p = 0.008). There was an anatomical failure rate of 25% in the anterior and lower TM perforations, 14.3% in central and 7.7% in posterior perforations (p = 0.603). Perforations >50% of the TM surface showed a functional failure rate of 25% vs. 10% in perforations <50% of the TM (p = 0.242) and anatomical failure rates of 12.5% vs. 20%, respectively (p = 0.620). Regarding age, the group <12 years had an anatomical success rate of 85.7%, while the group ≥12 years had a rate of 79.4% (p = 0.611). As for the functional success rates, this was 92.9% and 85.3%, respectively (p = 0.471). Apart from the presence of tympanosclerosis, no other variable was statistically significantly associated with surgical success.

CONCLUSIONS

Our study shows that type I tympanoplasty in pediatric age is a procedure with a high rate of anatomical and functional success. The presence of tympanosclerosis plaques in the middle ear was the only factor associated with poor anatomical and functional prognosis. Contrary to what has been described in some articles in the literature, in this study, the functional and anatomical success rates did not vary according to the age group.

[Clinical study on repairing subtotal perforation of tympanic membrane with cartilage island technique combined with palisade technique under otoscope]

Objective:To investigate the healing rate of subtotal perforation of tympanic membrane repaired by cartilage island technique combined with palisade cartilage technique under otoscope. Methods:A retrospective analysis was performed on 189 patients with chronic suppurative otitis media who were admitted to the Department of Otolaryngology and Head and Neck Surgery of Hunan Provincial People's Hospital from January 2018 to January 2020. The patients were divided into twogroups, in group onethere were 100 patients treated by senior surgeon, which were divided into two subgroups, Group A （68 cases） were treated with cartilage island technique alone, and Group B （32 cases） were treated with cartilage island technique combined with palisade cartilage technique. In group two there were 89 patients treated by junior surgeons, which were divided into two subgroups. In group C, 50 cases were treated with cartilage island technique alone, and in group D, 39 cases were treated with cartilage island technique combined with palisade cartilage technique. Results:The healing rate of tympanic membrane in group 1 was 96.0% （96/100）, and in group 2 was 87.6%（78/89）.There was statistically significant in group 1 and group 2（χ²=4.504, P=0.034）.The healing rate of tympanic membrane was 94.1% （64/68） in group A, 100%（32/32）in group B, 80.0%（40/50） in group C, and 97.4% （38/39） in group D. There was no statistically significant difference between group A and group B （χ²=1.961, P=0.161）, there was statistically significant difference between group C and group D （χ²=6.149, P=0.013）, and there was statistically significant difference between group A and group C（χ²=5.492, P=0.019）There was no statistical difference between group B and group D（χ²=0.832, P=0.362）. Conclusion:For beginners of tympanoplasty, the use of cartilage island technique combined with palisade cartilage technique in otoscope can significantly improve the success rate of tympanoplasty with subtotal tympanic perforation.

Efficacy of Platelet Rich Fibrin in Myringoplasty

Objective

To determine the efficacy of usage of topical autologous platelet rich fibrin (PRF) in improving outcomes of myringoplasty regarding graft uptake and hearing improvement.

Methods

This study was conducted in the ENT department of Holy Family Hospital, Rawalpindi, over a period of six months from August 2019 to January 2020. It was designed as a prospective single blinded randomized controlled trial. The study involved a total of 50 participants in whom myringoplasty was done through post auricular approach using underlay technique. In 25 patients topical drops of PRF were used. Outcomes were compared after three months with the control group (n=25), who underwent myringoplasty without PRF.

Results

After three months follow-up, graft uptake was reported 78% and 52% in cases and controls, respectively (P=0.070). Mean hearing improvement was 18 dB and 6 dB in cases and controls, respectively (P=0.014). Postoperative infection occurred in 8% of the cases, and in 32% controls (P=0.037).

Conclusion

Topical use of Platelet-Rich Fibrin during myringoplasty results in improved graft uptake. Hence, resulting in much improved hearing, significant reduction in infection rates and decrease in perforation sizes.

Myringoplasty With an Ultrathin Cartilage-Perichondrium Complex Graft Versus Temporalis Fascia Graft: A Propensity Score-Matched Analysis

OBJECTIVE

To compare endoscopic myringoplasty using the cartilage-perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group).

STUDY DESIGN

A retrospective cohort study.

SETTING

Department of Otorhinolaryngology in a tertiary Chinese hospital.

METHODS

Data were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score-matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed.

RESULTS

In the control and test groups, 90.90% and 86.36% of patients had a mean air-bone gap ≤20 dB after the surgery, respectively (P = .843). The air conduction (AC) threshold gain at each frequency was similar in the 2 groups (P > .05). The closure rates were 95.45% and 93.18%, respectively (P = .645). The air-bone gap improved significantly after surgery, F(1, 61) = 6.729, P = .012. Age, group, middle ear mucosal status, and location of the perforation did not affect the change in air-bone gap or the drum closure rate (P > .05). However, there was an interaction between the change in air-bone gap and the size of the perforation, F(1, 61) = 11.067, P = 0001.

CONCLUSION

Endoscopic myringoplasty using a cartilage-perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air-bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air-bone gap improvement.