Background:
Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether ...single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques.
Materials and Methods:
A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement.
Results:
A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques (P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant (P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure (P = .02). All 3 groups showed statistically significant hearing improvement postoperatively (P < .0001). Preoperative hearing levels (P = .179), postoperative hearing (P = .857), and decibels of hearing improvement (P = .356) were the same for all 3 groups.
Conclusion:
Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.
Background: Packing with gelatin sponge has long been widely used in myringoplasty. However, there is no research on packing with nothing.
Aims/objectives: To analyse the differences between packing ...with gelatin sponge and packing with nothing.
Material and methods: Patients with tympanic membrane perforation were randomly divided into a packing with gelatin sponge group and a packing with nothing group. Differences between the groups were compared.
Results: The operation time of group A (34.00 ± 1.05 min) was significantly shorter than that of group B (42.20 ± 1.40 min; p < .00); 1 patient (2.86%) in group A and 35 patients (100%) in group B had a dry ear time of longer than 1 week (p < .001). Ten patients (28.57%) in group A and 24 patients (68.57%) in group B had aural fullness after the operation (p < .001). The air-bone gap (ABG) in group A was smaller than that in group B at 1 week, 1 month, 2 months and 3 months after the operation (p < .05).
Conclusion and significance: Group A achieved the same good results, but it had a short operation time, an early dry ear time, a low incidence of aural fullness and early recovery of hearing.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The advent of Endoscopic Ear Surgery (EES) has allowed otologists an improved view of the surgical field compared with conventional Microscopic Ear Surgery (MES). EES presents different challenges ...for surgeons and a learning curve is necessary.
The purpose of this study was to compare the efficacy of EES and MES for trans-canal tragal cartilage myringoplasty, an entry level EES.
We retrospectively analysed patients who underwent push through trans-canal tragal cartilage myringoplasty in our institution over 5 years (2016–2020). Exclusion criteria were: patients with prior ear surgery, non-tragal cartilage tympanic membrane graft, additional procedure at time of surgery and patients with insufficient follow up. EES and MES groups were compared using outcomes such as graft success rate, changes in pure tone audiometry (PTA), operative time and complications.
Seventy-four patients met inclusion criteria (MES = 38, EES = 36). Mean age of included patients was 29.3 years with no significant demographic differences between groups. Graft success rate at 12 months was higher among the EES group versus MES (94.4% v 86.8%, p = 0.43). Mean operative time was reduced in the EES group (47.3 min v 53.8 min, p = 0.04). Hearing outcomes did not differ significantly between groups. No major operative complications occurred in either group.
Outcomes were marginally better in the cohort who underwent EES. This supports that EES offers an otologic choice to complement established practice for trans-canal myringoplasty and may be used to facilitate introduction to EES for trainees and otologists wishing to learn this technique.
•Graft uptake was similar between endoscopic and microscopic myringoplasty.•Endoscopic myringoplasty had a shorter mean operative time.•Both approaches are a suitable otologic choice for myringoplasty.•Myringoplasty is an excellent entry level procedure for endoscopic ear surgery.
Purpose
The aim of this study was to evaluate the long-term anatomical (graft success) and functional (audiological) results of endoscopic butterfly inlay myringoplasty.
Methods
The files of 56 ...patients (29 female, 27 male) who were diagnosed with noncomplicated chronic otitis media and underwent endoscopic butterfly inlay myringoplasty in 2014–2016 at a tertiary referral center were reviewed. Age, gender, follow-up time, perforation location (anterior, posterior and central), perforation size (small, medium), pre- and postoperative pure tone audiometry (PTA) thresholds, pre- and postoperative air-bone gaps (ABG) and complications were noted.
Results
Graft success rate was 98.2% in postoperative 12th month and 94.6% in postoperative 24th month. In all patients, mean PTA for air conduction was 35.2 ± 3.9 dB preoperatively and 27.5 ± 4.3 dB in postoperative 6th month, 25.1 ± 3.5 dB in postoperative 12th month and 20.4 ± 3.2 in postoperative 24th month. Preoperative mean ABG was 24.2 ± 3.8 dB, whereas 19.5 ± 4.3 dB 6 months after surgery, 17.1 ± 3.5 dB 12 months after surgery and 12.4 ± 3.1 dB 24 months after surgery. There was significant difference between pre- and postoperative PTA and ABG in all 6th, 12th, 24th month follow-up (
p
= 0.001 for all measurements). Three patients (5%) had myringitis after surgery. Two patients (3%) had total graft resorption.
Conclusion
We suggested that endoscopic butterfly inlay myringoplasty is a safe surgical method with high graft success and effective hearing reconstruction. Follow-up is necessary for at least 2 years for precise anatomical and functional evaluation of the surgery.
Objectives
The aim of this study was to determine influencing factors on tympanic membrane closure and their consequence on absolute risks of closure and hearing improvement in myringoplasties.
...Design
Retrospective cohort.
Setting
Medium-sized medical centrum.
Participants
195 patients were analysed who underwent a myringoplasty between January 2015 and February 2017 at the Jeroen Bosch Hospital in The Netherlands.
Main outcome measures
Patient-related data, descriptions of the tympanic defect, surgical data, and the most important follow-up data were collected. Primary outcome is successful closure of the tympanic membrane and the secondary outcome is the amount of air–bone gap improvement after surgery.
Results
The overall success rate of the myringoplasty graft was 74.9%. If cartilage and butterfly graft were used, higher success rates of 85.4% and 85.5% were achieved compared to temporalis fascia (61.3%). Success rate of the operation was dependent of the skills of the surgeon. Chances of success are 91.9% if the operation is performed by an experienced surgeon using cartilage and 66.7% if a less experienced surgeon uses fascia. If a postoperative complication occurs or when silastic sheets are used, this might have a negative effect on the success of the operation. The mean ABG improved 10.10 dB if the perforation was closed compared to 3.38 dB after an unsuccessful procedure.
Conclusion
The success rate of a myringoplasty is dependent of the skills of the surgeon and type of graft used and varies between 91.9 and 52.0% depending on these factors.
Purpose
Nowadays, the use of otoendoscopy is becoming increasingly popular in ear surgery. Data on endoscopic tympanoplasty are quite current but not yet sufficient. This study aims to present the ...anatomical and functional results of endoscopic butterfly inlay myringoplasty in large perforations.
Methods
The graft success rates and audiological outcomes of 26 ears of 23 patients who underwent endoscopic cartilage inlay myringoplasty due to large perforation (more than two-thirds of the area of tympanic membrane) from March 2016 to August 2018 were evaluated.
Results
The mean follow-up period was 13.3 ± 7.1 (6–32) months. Graft success rate was 96% (25/26 ears). The preoperative mean air–bone gap (ABG) was 21.4 dB and postoperative mean was 14.4 dB. Significant improvement was observed in postoperative air–bone gap values compared to preoperative period (
p
0.005).
Conclusions
Endoscopic inlay butterfly myringoplasty is a safe surgical technique and has satisfactory anatomic and audiological outcomes in large tympanic perforations.
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.
PubMed, Scopus, CINAHL, Cochrane.
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.
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.
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.
Purpose
While the use of cartilage graft for revision tympanoplasty is quite common, the data on the revision of cartilage tympanoplasty are limited. Our study aims to present the results of our ...patients who underwent endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty.
Methods
Demographic data, ear sides, perforation locations, graft success rates and hearing results of the patients who underwent endoscopic butterfly inlay myringoplasty for revision of cartilage tympanoplasty between Sep 2017 and Jan 2020 were evaluated.
Results
A total of 17 patients with 7 (41%) females and 10 (59%) males were included in our study. Eight of the ears (47%) were right and nine (53%) were left. Perforation locations included ten (59%) anterior, six (35%) inferior, and one (6%) posterior. The graft success rate of our study was 100%. No changes were observed in post-operative air conduction, bone conduction and air–bone gap values compared to the pre-operative period (
p
> 0.05).
Conclusions
Endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty is considered to be a safe surgical technique with satisfactory anatomical and hearing results.
