Influence of size and site of perforation on fat graft myringoplasty

Objectives

In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results.

Methods

The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium–large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients’ follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year.

Results

The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium–large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p > 0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p < 0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations.

Conclusion

Fat graft myringoplasty (FGM) may be used in all small and medium–large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium–large perforations; patients with small perforations had more satisfied audiological outcome than medium–large perforations.     

内外植法与内植法鼓膜成形术的近期对比分析

目的:探讨内外植法修补鼓膜的成功率和对听力的影响.方法:回顾性分析2002年以来行内植法鼓膜成形术且术后随访6个月以上的74例(77耳)患者,A组44例(45耳)采用传统的内植法,B组30例(32耳)将移植膜放置在残余鼓膜与锤骨柄之间(内外植法),比较2组患者术后3个月时的听力.结果:A组鼓膜1次修补成功40耳(89.0%),语言区平均听阈改善≥10 dB者23耳,手术成功率57.5%.B组鼓膜修补1次愈合28耳(87.5%),语言区平均听阈改善≥10 dB者23耳,手术成功率71.9%.并发症:A组再穿孔2耳(5.9%),鼓膜内陷8耳(17.8%);B组再穿孔2耳(6.25%),钝角愈合3耳(9.38%),鼓膜内陷2耳(6.25%).结论:将移植膜放置在残余鼓膜与锤骨柄之间可避免术后鼓膜和锤骨柄脱离,减少移植膜与鼓岬发生粘连.对鼓膜较大穿孔患者听力的改善明显优于移植膜放置在锤骨柄内侧者.     

耳内镜边缘性鼓膜穿孔修补术

目的探讨耳内镜下边缘性鼓膜穿孔成形的手术方法、技巧与疗效.方法依据24例单纯边缘性鼓膜穿孔的大小,9例用经穿孔缘直接内植法,15例用经外耳道皮瓣内植法修补.结果随访患者3～19月,总治愈率为100%,一次治愈率为87.5%;术后3个月,语言频率气导听阈下降＞10dB者占87.5%,气骨导差＜10dB者占91.7%.结论耳内镜下处理无残留鼓膜的边缘性穿孔,视野清晰,操作简便、精确,处理继发再穿孔亦甚方便,疗效优于显微镜.     

Endoscopic transcanal myringoplasty for anterior tympanic membrane perforation

Anterior tympanic membrane perforations constitute a surgical challenge because of the anatomy of the anterior wall of the external auditory canal and the specific physical properties of the anterior tympanic membrane. The author reports an endoscopic transcanal myringoplasty technique with anterior fixation of the graft onto the anterior wall of the external auditory canal, avoiding canaloplasty in the majority of cases, detachment of the annulus in the anterior angle and medialization of the graft in the middle ear.     

Prognostic factors in pediatric myringoplasty. A review of 90 cases

Although tympanic membrane perforations continue to be a significant source of otologic morbidity in the pediatric population, myringoplasty in children still elicits debate. The records of 76 patients under 18 who underwent 90 myringoplasties at the 12 de Octubre University Hospital (Madrid, Spain) over a recent 8-year period were reviewed. The overall short-term surgical success rate was 64.8%. The overall success rate evaluated at least one year after surgery was 58%. The audiological threshold improved in 68% per cent of successful cases. Surprisingly, females had lower graft take rates than males. The outcome of surgery was unrelated to age at operation, duration, mechanism, size, and location of the perforation, or condition of the opposite ear.     

A randomized prospective trial of a novel device for measuring perforation size during inlay ‘butterfly’ myringoplasty

Aim

This study introduces a new device to facilitate perforation size measurement during “butterfly” myringoplasty. The purpose of this study is to evaluate the use of ‘otological compass’ on short-term results of inlay cartilaginous ‘butterfly’ tympanoplasty technique in adult patients.

Study design

Prospective, randomized, controlled, blinded.

Patients and methods

This study included 25 patients who underwent inlay cartilage myringoplasty. All operations were performed under general anesthesia by the same surgeon with a microscope-assisted approach. The patients were divided randomly and consecutively into two groups: Group 1 (n = 12) had perforation dimensions and shape measured using the Otologic Compass (OC) and the control group (n = 13) had perforation measured by means of a Fisch elevator. The duration of surgery, number of trials for correct placement of the cartilage graft, results and complications of the surgery were evaluated and compared.

Results

The mean follow-up duration was 6 months. Groups were similar in terms of age and perforation diameters (p > 0.05). Average number of cartilage shaping before satisfactory graft fitting was significantly fewer in the OC group: 1.1 ± 0.3 and 2.2 ± 0.6 trials for OC and control groups, respectively (p < 0.001). Mean duration of preparation and satisfactory graft fitting was 9.6 ± 4.2 minutes in the OC group whereas it was 18.1 ± 5.2 minutes for the control group. Operative duration was significantly shorter in the OC group (p < 0.001). At the end of the follow-up period, successful closure occurred 91.7% and 84.6% patients in the OC and control groups, respectively (p > 0.05). The mean preoperative to postoperative three-tone air-bone gap improved 7.9 dB and 9.0 dB in OC and control groups, respectively (p > 0.05).

Conclusion

This study shows that OC presents as a useful tool that expedites and refines butterfly myringoplasty procedure. The number of cartilage shaping prior to satisfactory graft fitting revealed significantly better results: almost all surgeries in the OC group were complete after a single cartilage shaping attempt.     

The predictive value of eustachian tube function (measured with sonotubometry) in the successful outcome of myringoplasty

Sonotubometry, as a technique for assessing Eustachian tube function, does not rely on an intact tympanic membrane. This device has been used to study 25 patients having myringoplasty who all had preoperative testing and post-operative testing at 4 months. The overall success rate for grafting was 76%. In those who had normal preoperative tubal function the success rate was 86%, as opposed to 67% in those whose preoperative tubal function was poor. This difference was not statistically significant. In all those patients where poor preoperative function ended with successful grafting, post-operative tubal function reverted to normal. Other factors also taken into account, such as the patient's age, size of the perforation and the operative difficulty, had no bearing on the outcome of surgery.     

耳内镜分离前壁皮瓣修复鼓膜前下象限边缘性穿孔的疗效分析

目的探讨耳内镜下分离前下皮瓣修补鼓膜前下象限边缘性穿孔的临床疗效和应用价值。方法对资料完整的13例鼓膜前下象限边缘性穿孔患者的临床资料进行回顾性分析。对比患者手术前后纯音听阈和耳内镜结果,计算气骨导差及气骨导差改善值。结果术后3个月复查,耳内镜下所有患者鼓膜完整。平均气导为（16.0±15.64）dB,骨导为（12.16±11.92）dB,气骨导差为（3.83±3.73）dB,术后3个月的气骨导差明显小于术前(P<0.05)。结论耳内镜下分离前下皮瓣修补鼓膜前下象限穿孔,具有简单,微创,愈合率高的特点,值得临床推广。     

Comparison of bilateral same-day and sequential endoscopic cartilage myringoplasty for bilateral chronic tympanic membrane perforation

Abstract

Background: There is debate over the applicability of bilateral same-day myringoplasty in patients with bilateral chronic tympanic membrane perforations (TMPs) requiring ear surgery on both sides.

Objectives: To evaluate the healing and hearing outcomes of bilateral endoscopic ‘push-through’ cartilage myringoplasty in patients with bilateral chronic TMPs with mucosal chronic otitis media (COM) on the same day.

Material and methods: The medical records of 60 patients (120 ears) with bilateral chronic TMPs who underwent bilateral same-day or sequential endoscopic push-through cartilage myringoplasty between January 2014 and March 2019 were evaluated.

Results: Of the 60 patients with 120 ears, 26 patients with 52 ears were in the bilateral same-day group and 34 patients with 68 ears in the sequential group. The overall graft success rate at 3?months was 92.3% (48/52) in the same-day group and 94.1% (64/68) in the sequential group. None of the sensorineural HL and retraction pockets occurred in two groups.

Conclusions and significance: Bilateral push-through cartilage myringoplasty can be performed safely for the patients with bilateral chronic TMPs in the same day, it significantly reduced the medical costs and shortened the operation time and length of stay compared to sequential myringoplasty.     

Over-Under法鼓膜成形术在鼓膜大穿孔患者中的临床应用分析

目的 探讨Over-Under法鼓膜成形术在鼓膜大穿孔患者中的临床应用.方法 回顾性分析2000年至2006年接受Over-Under法鼓膜成形手术且术后随访半年以上的慢性化脓性中耳炎患者52例(54耳),比较手术前后的穿孔愈合率、听阈变化和随访结果 .结果 术后3个月,54耳中鼓膜穿孔愈合的49耳(90.7%),平均语言听阈(0.5、1、2 kHz)下降10 dB以上31耳,下降20 dB以上5耳,听力改善率达63.3%.手术前后气骨导差缩小≥10 dB以上的31耳,缩小≥20 dB以上4耳.随访6个月～2年,鼓膜再穿孔2耳(4.1%),钝角愈合5耳(10.2%),鼓膜内陷4耳(8.2%),无鼓室胆脂瘤发生.结论 Over-Under法鼓膜成形术适用于鼓膜大穿孔的患者,它能克服了内植法和外植法的不足.     

Benefit and predictive factors for speech perception outcomes in pediatric bilateral cochlear implant recipients

IntroductionDespite recent advancement in the prediction of cochlear implant outcome, the benefit of bilateral procedures compared to bimodal stimulation and how we predict speech perception outcomes of sequential bilateral cochlear implant based on bimodal auditory performance in children remain unclear.ObjectivesThis investigation was performed: (1) to determine the benefit of sequential bilateral cochlear implant and (2) to identify the associated factors for the outcome of sequential bilateral cochlear implant.MethodsObservational and retrospective study. We retrospectively analyzed 29 patients with sequential cochlear implant following bimodal-fitting condition. Audiological evaluations were performed; the categories of auditory performance scores, speech perception with monosyllable and disyllables words, and the Korean version of Ling. Audiological evaluations were performed before sequential cochlear implant with the bimodal fitting condition (CI1 + HA) and one year after the sequential cochlear implant with bilateral cochlear implant condition (CI1 + CI2). The good performance group (GP) was defined as follows; 90% or higher in monosyllable and bisyllable tests with auditory-only condition or 20% or higher improvement of the scores with CI1 + CI2. Age at first implantation, inter-implant interval, categories of auditory performance score, and various comorbidities were analyzed by logistic regression analysis.ResultsCompared to the CI1 + HA, CI1 + CI2 provided significant benefit in categories of auditory performance, speech perception, and Korean version of Ling results. Preoperative categories of auditory performance scores were the only associated factor for being GP (odds ratio = 4.38, 95% confidence interval – 95% = 1.07–17.93, p = 0.04).ConclusionsThe children with limited language development in bimodal condition should be considered as the sequential bilateral cochlear implant and preoperative categories of auditory performance score could be used as the predictor in speech perception after sequential cochlear implant.     

Fat graft myringoplasty with the newly developed surgical technique for chronic tympanic membrane perforation

The purpose of this prospective clinical trial was to evaluate the success rate of our newly developed surgical technique for fat graft myringoplasty (FGM). We also aimed to assess the correlations between the size of perforations and closure rates, as well as the results of re-gained hearing in successful cases with respect to sizes of perforations. Thirty consecutive patients with persistent tympanic membrane perforation were included in this study. All patients underwent fat graft myringoplasty with a newly developed technique. Treatment success was defined as an intact tympanic membrane (TM) at the 3-month follow-up visit. Bone conduction (BC) and air conduction (AC) thresholds at the frequencies of 0.5, 1, 2, 3, and 4 kHz were recorded preoperatively and at the 3rd month postoperatively. The range of perforation sizes among the 30 patients was 7 mm in 13 of the patients (43 %), 6 mm in 8 of the patients (27 %), and 5 mm in nine of the patients (30 %). Closure of tympanic membrane perforations with this new technique was achieved in 27 out of the 30 patients, with a success rate of 90 %. The average of the air-bone gap (dB) was similar in preoperative and postoperative periods for 5- and 6-mm sized perforation groups (p = 0.09 and p = 0.49). However, in the 7-mm sized perforation group, the average of the air-bone gap (dB) was higher in the preoperative period than the postoperative period (p = 0.004). The average of the air-bone gap (dB) for all patients was higher in the preoperative period than the postoperative period (p = 0.001). In conclusion, FGM performed with this technique may be used as an alternative for the closure of tympanic membrane perforations larger than 5 mm.     

夹层法鼓膜成形术治疗鼓膜穿孔53耳报告

目的：进一步探讨夹层法鼓膜成形术治疗鼓膜穿孔的疗效。方法;以夹层法鼓膜成形订治疗５３耳鼓膜穿孔,并与同时期行内植法治疗的１６８耳进行疗效比较。结果：夹层法组穿孔愈合率为９６．２％,内植法组为８５．７％;夹层法组听力恢复明显优于内植法组,且术后咽鼓管功能保持良好,在保持鼓膜前下锐角和锥形方面,夹层法亦优于内植法。结论：夹层法彭膜成形术是治疗鼓膜穿孔的较为理想的方法。     

同种异体羊膜修补外伤性鼓膜穿孔

目的探讨采用同种异体羊膜对外伤性鼓膜穿孔进行鼓膜修补术的临床疗效。方法回顾性分析2003年7月至2008年2月间在我科住院的27例外伤性鼓膜穿孔患者使用同种异体羊膜行鼓膜修补术,鼓膜穿孔愈合情况及听力提高的临床资料。结果全部患者随访时间超过6个月,鼓膜穿孔总愈合率为96.3%（26/27）,平均听力改善（12±3.7）dB。结论使用同种异体羊膜修补鼓膜,具有取材方便且量大,操作简便,组织相容性好,损伤小,疗效好的优点。     

耳内镜下生物羊膜治疗鼓膜穿孔的疗效观察

目的探讨耳内镜下利用生物羊膜移植行鼓膜穿孔修补术的临床疗效。方法选取苏州市吴中人民医院2015 年4月~2017年3月收治的38例（38耳）接受耳内镜下采用生物羊膜行鼓膜穿孔修补术患者为研究对象。对所有患者术后3、6个月鼓膜穿孔愈合情况以及术后6个月听力恢复情况进行统计学分析。结果38例患者术后3、6个月鼓膜愈合分别为36（94.7%）、35（92.1%）;术后6个月复查纯音测听气导平均听阈为（28.42±7.31）dB,较术前提高（17.19±5.31）dB;手术前后听力比较差异具有统计学意义（t=10.091,P﹤0.05）。结论耳内镜下利用生物羊膜行鼓膜修补术,避免了自体取材造成的手术切口创伤与瘢痕,且具有手术时间短,患者术中出血量少等优点,为鼓膜穿孔提供了一种微创、安全有效、相对经济的治疗方法,值得临床推广应用。     

Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function

In this series of patients, the underlay or overlay positioning of a graft achieves successful outcome for both repair of perforation and hearing function, with better hearing gain in the underlay group. In myringoplasty, the two most common techniques for positioning the graft relative to the remnant of both the tympanic membrane and the annulus are the "overlay" and the "underlay" techniques. 115 patients who underwent myringoplasty for tympanic membrane perforation secondary to chronic otitis media and/or trauma were included, and hearing function was evaluated. We prefer an overlay technique in subtotal perforations, in those involving the anterior and antero-inferior parts of the ear drum with respect to the handle of the malleus and in revision surgery. We reserve an underlay technique for smaller perforations and for those limited to the posterior part of the tympanic membrane. Of 115 cases, 63 underwent an overlay myringoplasty and 52 underlay myringoplasty. In the former group, five cases were anatomically unsuccessful, whereas in the second group there were three failures. The air bone gap improved significantly in both groups with a better hearing gain in the underlay group.     

Prognostic factors influencing anatomic and functional outcome in myringoplasty

The objectives of myringoplasty are essentially two: restore the eardrum integrity and improve hearing level. We have carried out a retrospective study of myringoplasties performed in our Department, between 1996 to 2000, corresponding to 197 surgical interventions, in 162 patients. The characteristics more frequently seen for operating ears were central localization of tympanic membrane perforation, dry ear, good eustaquian tube function and underlay technique placing fascia graft. Endaural or retroauricular approach were similar in number. We obtained 73.6% of anatomic success, though in some cases we needed to reoperate the patient. When we analysed risk factors of anatomic success, we noticed than only the tympanic perforation site had influence, with better rate in posterior perforations and lower rate in subtotal perforations. We analysed functional results in ears with anatomic success, finding 75.6% of hearing level improvement with a gap of less than 20 dB. Factors influencing hearing improvement were surgeon experience and the presence of middle ear alterations.