Allograft tympanoplasty Van Rompaey, Vincent; Caremans, Jeroen
Operative techniques in otolaryngology--head and neck surgery,
March 2024, 2024-03-00, Volume:
35, Issue:
1
Journal Article
Peer reviewed
Allograft tympanoplasty was once widely used across the world but is currently only performed by a limited number of surgeons in Belgium and Germany. Allograft tympanic membranes and ossicles are ...procured endoscopically nowadays and are processed in specific tissue banks subject to European Union regulations on human allograft tissue to ensure the receptor will receive quality-controlled tissue. The surgical procedure via retroauricular approach can teach us how we can manage difficult cases with total, subtotal and marginal perforations, but also cases of isolated pars tensa cholesteatoma.
Objective
A cholesteatoma is a mass of keratinising epithelium in the middle ear. It is a rare disorder that is associated with significant morbidity, and its causative risk factors are poorly ...understood; on a global scale, up to a million people are affected by this each year. We have conducted a systematic literature review to identify reports about the heritability of cholesteatoma or any constitutional genetic factors that may be associated with its aetiology.
Data Sources
A systematic search of MEDLINE (EBSCO) and two databases of curated genetic research (OMIM and Phenopedia) was conducted.
Study Selection
The participants and populations of interest for this review were people treated for cholesteatoma and their family members. The studies of interest reported evidence of heritability for the trait, or any association with congenital syndromes and particular genetic variants.
Data Extraction
The searches identified 449 unique studies, of which 35 were included in the final narrative synthesis.
Data Synthesis
A narrative synthesis was conducted, and data were tabulated to record characteristics, including study design, genetic data and author conclusions. Most of the studies identified in the literature search, and described here, are case reports and so represent the lowest level of evidence. In a few case reports, congenital and acquired cholesteatomas have been shown to segregate within families in the pattern typical of a monogenic or oligogenic disorder with incomplete penetrance. Evidence from syndromic cases could suggest that genes controlling ear morphology may be risk factors for cholesteatoma formation.
Conclusions
This is the first systematic review about the genetics of cholesteatoma, and we have identified a small body of relevant literature that provides evidence of a heritable component for its aetiology. Cholesteatoma is a complex and heterogeneous clinical phenotype, and it is often associated with chronic otitis media and with some rare congenital syndromes known to affect ear morphology and related pathologies.
A BSTRACT Aims: 1. To compare the outcome of tympanoplasty alone with tympanoplasty combined with cortical mastoidectomy in patients with quiescent Chronic otitis media (COM). 2. To assess gain in ...hearing in dB. Materials and Methods: Patients diagnosed with mucosal type of chronic otitis media in the quiescent stage were selected. Two groups were formed. Patients were selected randomly and alternately they were included in groups A and B. The patients underwent otomicroscopy. Pure tone audiometry would depict pure conductive hearing of hearing loss. Group A (50% patients) were subjected to tympanoplasty alone and group B (other 50% patients) were subjected to tympanoplasty combined with cortical mastoidectomy. Prior to surgery, all patients underwent routine blood and urine examination, pure tone audiometry, and B/L mastoid X-ray Schuller’s view. Results: In our study, hearing gain in decibels in the tympanoplasty group was 17.1% and in tympanoplasty combined with cortical mastoidectomy was 21.1%. Graft uptake was 94% in the tympanoplasty group and 96% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in three cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake but the difference in two groups is statistically insignificant. Conclusion: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis. Media: Clinical significance: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis media.
Objectives
Microscopic tympanoplasty has been the standard surgery for repairing perforated tympanic membranes since the 1950s, but endoscopic tympanoplasty has been increasingly practiced since the ...late 1990s. In this study, we compared the efficacies of endoscopic and microscopic tympanoplasty.
Data Sources
PubMed, Embase, MEDLINE, and the Clinical Trial Register.
Review Methods
We conducted a systematic review and meta‐analysis following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis statement. We included clinical studies that compared the efficacies of endoscopic and microscopic tympanoplasty. We assessed the risk of bias and calculated the pooled relative risk (RR) estimates with 95% confidence interval (CI).
Results
We identified four studies (involving 266 patients in total) that met the inclusion criteria. The pooled tympanic membrane closure rates and hearing results of endoscopic and microscopic tympanoplasty were comparable (85.1% vs. 86.4%, respectively; RR: 0.98; 95% CI: 0.85 to 1.11; I2 = 0) (mean difference of improvements of air‐bone gaps: −2.73; 95% CI: −6.73 to 1.28; I2 = 80%). The pooled canalplasty rate of endoscopic tympanoplasty was significantly lower than that of microscopic tympanoplasty. Patients receiving endoscopic tympanoplasty had a more desirable cosmetic result than did those receiving microscopic tympanoplasty.
Conclusions
Our up‐to‐date review evidences the comparable tympanic membrane closure rates and hearing results for endoscopic and microscopic tympanoplasty. Patients receiving endoscopic tympanoplasty have a lower canalplasty rate and more desirable cosmetic result than do those receiving microscopic tympanoplasty. Laryngoscope, 127:1890–1896, 2017
Objective
Endoscopic ear surgery is no longer a promising technique, but a well‐established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature ...evidence, in terms of their efficacy and safety characteristics.
Data Sources
We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.
Review Methods
Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS‐I and RoB‐II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.
Results
Thirty‐three studies, with 2646 patients in total, were included in the meta‐analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:−0.23; 95% CI: −0.61, 0.14, I2 = 33.42%), and air‐bone gap improvement (pooled mean difference:−0.05; 95% CI:−0.23, 0.13, I2 = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: −1.72; 95% CI: −3.39, −0.04, I2 = 0%), dysgeusia (OR: −1.47; 95% CI: −2.47, −0.47, I2 = 0%), otitis externa development (OR: −1.96; 95% CI: −3.23, −0.69, I2 = 0%), auricular numbness (OR: −2.56; 95% CI: −3.93, −1.19, I2 = 0%), as well as surgical duration (OR: −1.86; 95% CI: −2.70, −1.02, I2 = 43.95%), when compared to the postauricular microscopic approach.
Conclusion
Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.
Level of Evidence
NA Laryngoscope, 134:3466–3476, 2024
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