Introduction: Intact tympanic membrane acts as a partition between the external ear and middle ear. Tympanic membrane perforation is one of the commonest causes of conductive hearing loss. ...Perforation size is the most important determination of hearing loss. The aim of this study was to find out the prevalence of tympanic membrane perforation among patients presenting to the otorhinolaryngology department of a tertiary care hospital.
Methods: A descriptive cross-sectional study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery of a tertiary care hospital from March 2021 to August 2021. Ethical approval was taken from Institutional Review Committee (Reference number: 57112021). Convenience sampling was done and data was collected from 414 patients presenting to the department. Collected data were entered, analyzed in Statistical Package for the Social Sciences version 21.0 and documented for study. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data.
Results: Among 414 patients, tympanic membrane perforation was seen in 100 (24.15%) (20.02-28.27 at 95% Confidence Interval). Among 100 patients with a total of 153 perforated eardrums, mild hearing loss was seen in the majority of the cases. Posterior perforation had a mean hearing loss of 40.41±5.96 dB, central had 39.09±3.13 dB, and anterior had 35.15±5.88 dB.
Conclusions: Our study showed the prevalence of tympanic membrane perforation to be high when compared to other similar studies. Hearing loss was observed in all cases; the majority with mild hearing loss. The degree of hearing loss was more in larger and posterior perforation.
Introduction: Intact tympanic membrane acts as a partition between the external ear and middle ear. Tympanic membrane perforation is one of the commonest causes of conductive hearing loss. ...Perforation size is the most important determination of hearing loss. The aim of this study was to find out the prevalence of tympanic membrane perforation among patients presenting to the otorhinolaryngology department of a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery of a tertiary care hospital from March 2021 to August 2021. Ethical approval was taken from Institutional Review Committee (Reference number: 57112021). Convenience sampling was done and data was collected from 414 patients presenting to the department. Collected data were entered, analyzed in Statistical Package for the Social Sciences version 21.0 and documented for study. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 414 patients, tympanic membrane perforation was seen in 100 (24.15%) (20.02-28.27 at 95% Confidence Interval). Among 100 patients with a total of 153 perforated eardrums, mild hearing loss was seen in the majority of the cases. Posterior perforation had a mean hearing loss of 40.41±5.96 dB, central had 39.09±3.13 dB, and anterior had 35.15±5.88 dB. Conclusions: Our study showed the prevalence of tympanic membrane perforation to be high when compared to other similar studies. Hearing loss was observed in all cases; the majority with mild hearing loss. The degree of hearing loss was more in larger and posterior perforation.
Abstract Introduction Fat grafts have been in used since 1962 for small central perforations, with a success rate ranging from 86 to 100%. Platelet-rich plasma (PRP) containing platelet ...concentrations greater than 1 million platelets/μL assist the healing process by various means. Current data suggests improved healing when tympanoplasty is performed using temporalis fascia grafts if PRP is added during surgery. Objective To assess the effect of PRP on fat grafts in small and moderate-sized central perforations. Methods The present prospective observational study was conducted with 36 patients who underwent fat graft tympanoplasty with PRP under local anesthesia. Clinical and audiological observations were carried out after 4, 8, and 12 weeks, and a statistical analysis of the observations was performed. Results We assessed 23 patients with small central perforations and 11 patients with moderate central perforations. An overall success rate of 76.4% was observed, with an 82.6% success rate among patients with small central perforations and 63.6% among those with moderate central perforations. There was no statistically significant difference in the uptake regarding the location of the perforation, but a statistically significant difference was found in terms of hearing improvement following the procedure. Conclusion The morbidity of conventional tympanoplasty in cases of small-to-moderate central perforations in patients with chronic otitis media vis a vis the results of the procedure needs to be revisited, as in the present study fat grafts placed with PRP under local anesthesia could lead to surgical and audiological outcomes that are as good as those reported in the literature.
Objective
To investigate a possible correlation between the degree of conductive hearing loss (CHL) caused by an isolated tympanic membrane (TM) perforation and mastoid‐middle ear volume.
Study ...Design
Retrospective chart, audiometry, and computed tomography (CT) imaging review.
Methods
Adult patients with a diagnosis of isolated TM perforation between 2010 and 2018 were identified and their audiometric data collected. Mastoid‐middle ear volume (MMEV) was then calculated based on segmentation analysis from the patient's head or temporal bone CT. Calculated MMEV was compared to MMEV derived by tympanometry. A Student's t‐test was performed to determine a correlation between the calculated MMEV on CT imaging and the degree of conductive hearing loss as measured by the air bone gap on standard audiometry.
Results
There was a statistically significant difference between MMEV as determined by segmentation analysis compared to that determined by tympanometry (absolute average percent difference = 33.8%; range ‐49.5% to +155.2%; P = .03). Greater MMEV determined by segmentation analysis correlated with smaller air bone gap; this trend approached but did not reach statistical significance (P = .09).
Conclusions
Calculated MMEV by segmentation analysis on CT imaging may be a more accurate estimate of MMEV than tympanometry. MMEV may be correlated to the degree of conductive hearing loss in the setting of isolated TM perforation where greater volume was associated with better hearing.
Level of Evidence
4 Laryngoscope, 130:E228–E232, 2020
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.
Chitin nanofibrils (CNs) are an emerging bio-based nanomaterial. Due to nanometric size and high crystallinity, CNs lose the allergenic features of chitin and interestingly acquire anti-inflammatory ...activity. Here we investigate the possible advantageous use of CNs in tympanic membrane (TM) scaffolds, as they are usually implanted inside highly inflamed tissue environment due to underlying infectious pathologies. In this study, the applications of CNs in TM scaffolds were twofold. A nanocomposite was used, consisting of poly(ethylene oxide terephthalate)/poly(butylene terephthalate) (PEOT/PBT) copolymer loaded with CN/polyethylene glycol (PEG) pre-composite at 50/50 (w/w %) weight ratio, and electrospun into fiber scaffolds, which were coated by CNs from crustacean or fungal sources via electrospray. The degradation behavior of the scaffolds was investigated during 4 months at 37 °C in an otitis-simulating fluid. In vitro tests were performed using cell types to mimic the eardrum, i.e., human mesenchymal stem cells (hMSCs) for connective, and human dermal keratinocytes (HaCaT cells) for epithelial tissues. HMSCs were able to colonize the scaffolds and produce collagen type I. The inflammatory response of HaCaT cells in contact with the CN-coated scaffolds was investigated, revealing a marked downregulation of the pro-inflammatory cytokines. CN-coated PEOT/PBT/(CN/PEG 50:50) scaffolds showed a significant indirect antimicrobial activity.
Eardrum perforation and associated hearing loss is a global health problem. Grafting perforated eardrum with autologous tissues in clinic can restore low‐frequency hearing but often leaves poor ...recovery of high‐frequency hearing. In this study, the potential of incorporating a thin multilayered graphene membrane (MGM) into the eardrum for broadband hearing recovery in rats is examined. The MGM shows good biocompatibility and biostability to promote the growth of eardrum cells in a regulated manner with little sign of tissue rejection and inflammatory response. After three weeks of implantation, the MGM is found to be encapsulated by a thin layer of newly grown tissue on both sides without a significant folded overgrowth that is often seen in natural healing. The perforation is well sealed, and broadband hearing recovery (1–32 kHz) is enabled and maintained for at least 2 months. Mechanical simulations show that the high elastic modulus of MGM and thin thickness of the reconstructed eardrum play a critical role in the recovery of high‐frequency hearing. This work demonstrates the promise of the use of MGM as a functional graft for perforated eardrum to recover hearing in the broadband frequency region and suggests a new acoustics‐related medical application for graphene‐related 2D materials.
Multilayered reduced graphene oxide membranes, offering a combination of exceptional mechanical strength, stiffness, light weight, and biocompatibility, are demonstrated to be a unique patching material to enable the closure of the perforated eardrum of rats and complete hearing restoration at both low and high frequencies.
To evaluate the effect of adding platelet rich plasma (PRP) or Hyaluronic acid (HA) to fat graft myringoplasty (FGM) for medium sized central tympanic membrane (TM) perforations.
This is a ...retrospective study conducted on 69 patients with medium sized central TM perforations. In 21 patients, PRP was used with the FGM; and in 23 patients, HA was used with the FGM; while in 25 patients, pure FGM was performed without adding an enhancing material.
Successful TM perforation repair was achieved in 18 ears (85.7) with using PRP with FGM and in 20 ears (87%) with using HA with FGM and in 15 ears (60%) with pure FGM.
FGM with adding PRP or HA is more successful in closure of TM perforation than pure FGM in case of medium sized central TM perforation.
Although a number of methods have been attempted to improve securing the graft, packing gelfoam in the middle ear cavity cannot be avoided, which could obstruct the tympanic ostium of the Eustachian ...tube and affect inner ear function. Myringoplasty using tissue adhesive has gained traction because tissue adhesives can effectively stabilise the graft and act as scaffolding to improve the graft uptake. The aim of this prospective study was to explore myringoplasty using cyanoacrylate glue with no packing in the middle ear cavity for the repair of subtotal tympanic membrane (TM) perforations.
Between March 2014 and November 2015, 71 patients with subtotal TM perforations were randomly and prospectively divided into a glue group and a control group. Two securing techniques were performed using only cyanoacrylate glue or using only filling gelfoam in the middle ear cavity, respectively, during an anterosuperior anchoring myringoplasty operated by a single surgeon.
At a 6-month follow-up, the graft uptake rate was 87% in the glue group and 89% in the control group. A significant hearing improvement was found in both groups postoperatively when compared to the preoperative values (P<0.05 for both). There was no significant difference in the graft uptake rate and hearing improvement between the 2 groups (P>0.05). Similar complications were found in each group.
Cyanoacrylate glue is a helpful material for graft stabilisation and can substitute for filling gelfoam in the middle ear cavity during anterosuperior anchoring myringoplasty for subtotal TM perforation.
Objective
Review of the English language literature finds little documentation of the relation of otology or otolaryngology outcomes to a surgeon's age, years in practice, or numbers of cases ...previously performed. Because of one surgeon's adoption of a new tympanoplasty technique for uncomplicated tympanic membrane perforations, our institution was situated to report an example of a surgical learning curve with its outcome. Experience versus outcome is worth establishing objectively because these relationships reflect on training and certification.
Design
This retrospective review of the medical records tallied preoperative risk factors and perforation sizes for four consecutive 100‐blocks of double‐layer tympanoplasties.
Setting
An otology specialty care facility in Addis Ababa, Ethiopia.
Participants
Participants were 359 patients with tympanic membrane perforations without ossicular discontinuity or erosion who underwent 400 primary simple tympanoplasties.
Intervention
A double‐layer tympanoplasty was performed in each operation using an endaural approach.
Outcome Measures
The outcomes were closure of the perforation and change in hearing.
Results
There were no statistically significant differences between the four 100‐block case cohorts in preoperative risk factors and perforation sizes. Preoperative, postoperative, and change of hearing were also the same between the four groups; and statistically there was no significant difference between the four 100‐block cohorts. Perforation closure for each successive 100‐block increased from 74% to 98%. The closure rates of the second, third, and fourth 100‐block were each statistically significantly different from the first 100‐block, but not from each other.
Conclusion
This simple study demonstrates the surgical learning curve with increased surgeon experience, and is one of very few such documentations. With each additional 100 cases, the outcomes improved, and sheds light on the numbers of cases necessary for competency.
Level of Evidence
3
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