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Wang PH, Huo TI. Outstanding research paper awards of the Journal of the Chinese Medical Association in 2020. J Chin Med Assoc 2021; 84:1071-1072. [PMID: 34670226 DOI: 10.1097/jcma.0000000000000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Teh-Ia Huo
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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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.
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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)
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Nishimura T, Hosoi H, Saito O, Akasaka S, Shimokura R, Yamanaka T, Kitahara T. Effect of fixation place on airborne sound in cartilage conduction. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:469. [PMID: 32872979 DOI: 10.1121/10.0001671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
When a transducer is placed on aural cartilage, relatively loud sound becomes audible in a conduction form termed cartilage conduction (CC). Previous studies have revealed the acoustical differences between CC and conventional air or bone conduction. This study elucidates the working principle of CC through measurements of threshold shifts by water injection into the ear canal under various fixation place conditions. Seven volunteers with normal hearing participated. A lightweight transducer was fixed for three CC conductions (on the tragus, antitragus, and intertragal incisure), and two non-CC conditions (on the pre-tragus and mastoid). Thresholds were measured at 500, 1000, and 2000 Hz in the 0%-, 40%-, and 80%-water injection conditions. Results for the three CC conditions revealed unique features different from those for the non-CC conditions. For the CC conditions, the thresholds increased by the 40%-water injection at all frequencies. However, with additional water injection (80%-water injection), the thresholds decreased at 500 and 1000 Hz; in particular, dramatically at 500 Hz. The results suggest that a direct vibration of the aural cartilage is important to obtaining the significant contribution of airborne sound to hearing above 1000 Hz. Fixation place results in no significant difference in acoustic features among CC conditions.
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Affiliation(s)
- Tadashi Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Hiroshi Hosoi
- President's Office, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Osamu Saito
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Sakie Akasaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Ryota Shimokura
- Graduate School of Engineering Science, Osaka University, D436, 1-3 Machikaneyama, Toyonaka, Osaka 560-8531, Japan
| | - Toshiaki Yamanaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Langston M, Grobman A, Goncalves S, Angeli SI. Animal Model of Chronic Tympanic Membrane Perforation. Anat Rec (Hoboken) 2019; 303:619-625. [PMID: 31260172 DOI: 10.1002/ar.24220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/02/2019] [Accepted: 02/28/2019] [Indexed: 01/16/2023]
Abstract
Chronic tympanic membrane perforations (TMP) can be a source of significant morbidity from hearing loss, recurrent middle ear infections, changes in lifestyle, and risk of cholesteatoma formation. Laboratory experiments of TMP have been fraught by the rapid and high rate of spontaneous healing observed in animal models. There is controversy on the minimal time that perforations in animal models must have in order to be considered chronic TMP and thus have clinical relevance, with authors suggesting time periods of perforation patency of 8-12 weeks. In this article, we sought to create a clinically significant experimental model that could yield a high rate of perforation patency for at least 8 weeks. Animals undergoing acute TMP were exposed to three different experimental situations to delay the healing of the perforation: fractionated radiation, topical lipopolysaccharide application, and a combined dexamethasone and mitomycin C (DXM/MC) solution. In our study, the use of DXM/MC reliably produced TMP lasting at least 8 weeks in 86.48% of the cases without the need to reopen the perforation, infolding the edges of the membrane, or using physical barriers to prevent TMP closure. Histologically, the resulting perforated tympanum showed hyaline changes of the remnant tympanum and hyperkeratosis of the squamous epithelia of the external auditory canal. We believe that this model is reproducible and has potential use in experiments of delayed healing of TMP. Anat Rec, 303:619-625, 2020. © 2019 American Association for Anatomy.
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Affiliation(s)
- Michael Langston
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
| | - Ariel Grobman
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
| | - Stefania Goncalves
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
| | - Simon I Angeli
- Department of Otolaryngology, Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida
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Luers JC, Hüttenbrink KB. Surgical anatomy and pathology of the middle ear. J Anat 2015; 228:338-53. [PMID: 26482007 DOI: 10.1111/joa.12389] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 11/29/2022] Open
Abstract
Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who moves between preservation or improvement of highly important functions (hearing, balance, facial motion) and eradication of diseases. Of these, perforations of the tympanic membrane, chronic otitis media, tympanosclerosis and cholesteatoma are encountered most often in clinical practice. Modern techniques for reconstruction of the ossicular chain aim for best possible hearing improvement using delicate alloplastic titanium prostheses, but a number of prosthesis-unrelated factors work against this intent. Surgery is always individualized to the case and there is no one-fits-all strategy. Above all, both middle ear diseases and surgery can be associated with a number of complications; the most important ones being hearing deterioration or deafness, dizziness, facial palsy and life-threatening intracranial complications. To minimize risks, a solid knowledge of and respect for neurootologic structures is essential for an otosurgeon who must train him- or herself intensively on temporal bones before performing surgery on a patient.
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Affiliation(s)
- Jan Christoffer Luers
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Karl-Bernd Hüttenbrink
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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Searching for a rat model of chronic tympanic membrane perforation: Healing delayed by mitomycin C/dexamethasone but not paper implantation or iterative myringotomy. Int J Pediatr Otorhinolaryngol 2015; 79:1240-7. [PMID: 26060147 DOI: 10.1016/j.ijporl.2015.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/14/2015] [Accepted: 05/16/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Surgical intervention such as myringoplasty or tympanoplasty is an option in the current clinical management of chronic tympanic membrane perforation (TMP). Animal models of chronic TMP are needed for pre-clinical testing of new materials and to improve existing techniques. We evaluated several reported animal model techniques from the literature for the creation of chronic TMPs. The aim of this study was to evaluate production of chronic TMPs in a rat model using topical mitomycin C/dexamethasone, paper insertion into middle ear cavity (MEC) or re-myringotomy. METHODS Forty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were randomly divided into 3 experimental groups: application of topical mitomycin C/dexamethasone, paper insertion into middle ear cavity, or re-myringotomy. Control perforations were allowed to close spontaneously. TMs were assessed regularly with otoscopy for 8 weeks. At the end of 8 weeks, animals were sacrificed for histology. RESULTS The closure of TMPs was significantly delayed by mitomycin C/dexamethasone (mean patency, 18.9 days; P≤0.01) compared with the control (mean patency, 7 days), but was not significantly delayed in the paper insertion group (mean patency, 9.4 days; P=0.74). Repeated myringotomy of closed perforations (mean number of myringotomies, 8.9 per ear) stimulated acceleration of closure rather than delay. Histologically, the mitomycin C/dexamethasone group had almost normal TM morphology, while the paper insertion group revealed inflammatory and granulomatous responses. The re-myringotomy group had a thickened TM fibrous layer with collagen deposition. CONCLUSIONS Mitomycin C/dexamethasone delayed TMP closure in rats but the effect was not sufficiently long-lasting to be defined as a chronic TMP. Neither paper insertion into middle ear cavity nor re-myringotomy created chronic TMP in rats.
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Nishimura T, Hosoi H, Saito O, Miyamae R, Shimokura R, Yamanaka T, Kitahara T, Levitt H. Cartilage conduction is characterized by vibrations of the cartilaginous portion of the ear canal. PLoS One 2015; 10:e0120135. [PMID: 25768088 PMCID: PMC4359134 DOI: 10.1371/journal.pone.0120135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/19/2015] [Indexed: 12/02/2022] Open
Abstract
Cartilage conduction (CC) is a new form of sound transmission which is induced by a transducer being placed on the aural cartilage. Although the conventional forms of sound transmission to the cochlea are classified into air or bone conduction (AC or BC), previous study demonstrates that CC is not classified into AC or BC (Laryngoscope 124: 1214–1219). Next interesting issue is whether CC is a hybrid of AC and BC. Seven volunteers with normal hearing participated in this experiment. The threshold-shifts by water injection in the ear canal were measured. AC, BC, and CC thresholds at 0.5–4 kHz were measured in the 0%-, 40%-, and 80%-water injection conditions. In addition, CC thresholds were also measured for the 20%-, 60%-, 100%-, and overflowing-water injection conditions. The contributions of the vibrations of the cartilaginous portion were evaluated by the threshold-shifts. For AC and BC, the threshold-shifts by the water injection were 22.6–53.3 dB and within 14.9 dB at the frequency of 0.5–4 kHz, respectively. For CC, when the water was filled within the bony portion, the thresholds were elevated to the same degree as AC. When the water was additionally injected to reach the cartilaginous portion, the thresholds at 0.5 and 1 kHz dramatically decreased by 27.4 and 27.5 dB, respectively. In addition, despite blocking AC by the injected water, the CC thresholds in force level were remarkably lower than those for BC. The vibration of the cartilaginous portion contributes to the sound transmission, particularly in the low frequency range. Although the airborne sound is radiated into the ear canal in both BC and CC, the mechanism underlying its generation is different between them. CC generates airborne sound in the canal more efficiently than BC. The current findings suggest that CC is not a hybrid of AC and BC.
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Affiliation(s)
- Tadashi Nishimura
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Japan
- * E-mail:
| | | | - Osamu Saito
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Japan
| | - Ryosuke Miyamae
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Japan
| | - Ryota Shimokura
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Japan
| | - Toshiaki Yamanaka
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Japan
| | - Harry Levitt
- The City University of New York, New York, New York, United States of America
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Shen Y, Redmond SL, Papadimitriou JM, Teh BM, Yan S, Wang Y, Atlas MD, Marano RJ, Zheng M, Dilley RJ. The biocompatibility of silk fibroin and acellular collagen scaffolds for tissue engineering in the ear. Biomed Mater 2014; 9:015015. [PMID: 24457429 DOI: 10.1088/1748-6041/9/1/015015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent experimental studies have shown the suitability of silk fibroin scaffold (SFS) and porcine-derived acellular collagen I/III scaffold (ACS) as onlay graft materials for tympanic membrane perforation repair. The aims of this study were to further characterize and evaluate the in vivo biocompatibility of SFS and ACS compared with commonly used materials such as Gelfoam and paper in a rat model. The scaffolds were implanted in subcutaneous (SC) tissue and middle ear (ME) cavity followed by histological and otoscopic evaluation for up to 26 weeks. Our results revealed that SFS and ACS were well tolerated and compatible in rat SC and ME tissues throughout the study. The tissue response adjacent to the implants evaluated by histology and otoscopy showed SFS and ACS to have a milder tissue response with minimal inflammation compared to that of paper. Gelfoam gave similar results to SFS and ACS after SC implantation, but it was found to be associated with pronounced fibrosis and osteoneogenesis after ME implantation. It is concluded that SFS and ACS both were biocompatible and could serve as potential alternative scaffolds for tissue engineering in the ear.
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Affiliation(s)
- Yi Shen
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands 6009, Western Australia, Australia. Ear Science Institute Australia, Subiaco 6008, Western Australia, Australia. Department of Otolaryngology, Head & Neck, Ningbo Lihuili Hospital (Ningbo Medical Centre), Ningbo 315041, Zhejiang, People's Republic of China
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Shen Y, Redmond SL, Teh BM, Yan S, Wang Y, Atlas MD, Dilley RJ, Zheng M, Marano RJ. Tympanic membrane repair using silk fibroin and acellular collagen scaffolds. Laryngoscope 2013; 123:1976-82. [PMID: 23536496 DOI: 10.1002/lary.23940] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/15/2012] [Accepted: 11/21/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the efficacy of silk fibroin scaffolds (SFS) and acellular collagen scaffolds (ACS) for the repair of tympanic membrane (TM) in a guinea pig acute perforation model. STUDY DESIGN Experimental animal research. METHODS Seventy-two albino guinea pigs underwent perforation of the right TM and were divided into four experimental groups (n = 18). The perforations were repaired with SFS, ACS, and paper patch using onlay myringoplasty, or they were allowed to heal spontaneously (control). An additional group of 10 guinea pigs without perforation or scaffold was allocated as a normal TM group. Guinea pigs in each experimental group (n = 6) were evaluated at 7, 14, and 28 days following surgery. TM structural healing was evaluated by otomicroscopy and histology, and functional hearing was analyzed by auditory brainstem responses (ABR). Prior to the study, mechanical properties of SFS and ACS were investigated. RESULTS Tensile strength and elasticity of SFS and ACS were within the known range for human TM. Based on otologic and histologic evaluation, TMs treated with SFS or ACS showed complete closure of the perforation at an earlier stage, with a trilaminar structure and more uniform thickness compared to paper patch and control treated groups. ABR assessment demonstrated that SFS or ACS treatment facilitated a faster restoration of hearing function compared to paper patch and control groups. CONCLUSION The results of this study show that SFS and ACS are effective graft materials and may be utilized as alternatives to current grafts for TM repair.
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Affiliation(s)
- Yi Shen
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Western Australia, Australia.
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Abstract
OBJECTIVE Evaluation of 3 different kinds of autologous substitutes for simple myringoplasty. STUDY DESIGN Retrospective review of myringoplasty cases. PATIENTS A total of 117 patients (52 women with 52 ears and 65 men with 65 ears) with an average age of 25.6 years (range, 12-51 yr) were examined. Forty-two cases exhibited large perforations, and 75 exhibited small perforations. INTERVENTION Myringoplasty with temporal fascia, tragus perichondrium, or tragus cartilage-perichondrium composite grafts were randomly used in this comparative study. All the 117 operations were performed by a single surgeon. MAIN OUTCOME MEASURES Otoscopic findings as assessed by a hearing examination using a quad-frequency pure-tone average air-bone gap. RESULTS Recurrent defects were not observed in the small perforation group repaired with autologous substitutes. The graft acceptance rate in this group was 100%. For the large perforation group, the graft acceptance rate was highest with the cartilage-perichondrium composite grafts group (p < 0.05) 1 year after the operation. Tympanic membranes repaired with temporalis fascia or perichondrium eventually perforated again or seemed invaginated and adherent. Early hearing improvements in the temporalis fascia and perichondrium groups were better than that of cartilage-perichondrium composite grafts, but there was no significant difference 1 year after surgery. CONCLUSION Temporal fascia, tragus perichondrium, and tragus cartilage-perichondrium composite grafts are all suitable for myringoplasty after a minor tympanic membrane perforation. However, cartilage-perichondrium composite graft material for myringoplasty has superior long-term benefits in regard to both hearing improvements and tympanic membrane morphology, which are especially evident in cases with large perforations.
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Farrior JB. Sandwich graft tympanoplasty: A technique for managing difficult tympanic membrane perforation. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/s1043-1810(95)80007-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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