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。     

耳内镜下鼓膜修补术

目的探讨应用耳内镜下鼓膜修补术治疗鼓膜穿孔的疗效.方法应用单手操作行前内植后夹层法鼓膜成形术,治疗30耳鼓膜穿孔.结果有28耳愈合良好听力提高较为满意,穿孔愈合率为93.3%,与在显微镜下手术疗效无明显差异.结论应用耳内镜手术治疗鼓膜穿孔方便、灵活、视野好,为一较理想的手术方法.     

不同鼓膜成形术治疗慢性化脓性中耳炎静止期的临床分析

目的探讨慢性化脓性中耳炎静止期患者采用不同鼓膜成形术的疗效分析,为手术术式选择提供参考。方法收集2010年1月~2013年12月完成鼓膜成形术,术后随访3个月且资料完整的212例患者,其中小穿孔（<3 mm）29例,中穿孔（3~6 mm）53例,大穿孔（>6 mm）79例,完全穿孔51例。按照患者鼓膜穿孔大小选择不同鼓膜修补手术方法,其中脂肪修补10例,内植法（经耳道）13例,全翻内植法47例,内外植法48例,夹层法80例,外植法14例。术后3个月判断其临床疗效。结果一期愈合95．7％(203例),钝角愈合1.9%（4例）,未愈合2.4%（5例）;术后对鼓膜穿孔大、小、完全穿孔患者采取不同鼓膜修补方式进行比较,患者手术前后鼓膜愈合和气导PTA提高比较,差异无统计学无意义（P>0.05）;鼓膜中穿孔患者采取的3种修补手术方法中,鼓膜愈合数比较差异无统计学意义（P>0.05）,而对于采用夹层法和内外植法的气导PTA提高比较差异具有统计学意义（P<0.05）。结论术者应掌握多种不同鼓膜成形术方法,根据鼓膜穿孔的大小、位置和外耳道的宽窄、曲直,灵活选用,最大程度的恢复鼓膜的完整性和功能。     

耳内镜下内衬法与夹层法鼓膜修补术的疗效观察

目的 对耳内镜下内衬法和夹层法完成慢性化脓性中耳炎(CSOM)患者鼓膜修补术进行疗效观察.方法 回顾性分析2019年6月-2021年6月收治的经耳内镜内衬法和夹层法行鼓膜修补的CSOM患者的临床资料,共66例CSOM患者入组观察,随机分为两组由同一术者分别以内衬法(33例)和夹层法(33例)完成Ⅰ型鼓室成形术.比较其鼓...     

Fat graft myringoplasty: a cost-effective but underused procedure

OBJECTIVES: The objective of this study was to evaluate the success of fat graft myringoplasty and to discuss the utilities and advantages of a fat graft in primary versus revision myringoplasties. METHODS: Eighteen patients who had not had previous otological surgery, and twelve patients whose tympanic membrane perforations have persisted despite myringoplasty with temporalis fascia were included in this prospective clinical trial. All patients were treated by fat graft myringoplasty and followed up for one year. RESULTS: Successful closure of the perforation was obtained in 82.4 per cent of the ears at the final follow up. The success rate in the group of patients who had not had previous otological surgery was higher than those of revision cases. CONCLUSIONS: Adipose tissue provides the basic requirements for grafting of the tympanic membrane, with its own favourable characteristics. Fat graft myringoplasty is a cost-effective alternative in small perforations of the tympanic membrane, including revision cases.     

Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure

Objective

Since the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty).

Tympanoscope-assisted myringoplasty.

Thirty ears of 29 patients with different sized perforation of the tympanic membrane were operated on with the aid of rigid otoendoscopes. The technique has a significant novel feature: endoscopy of the tympanic cavity through a perforation with small tympanoscopes 1.7 mm in diameter with a 0%. The postoperative air-bone gap was less than 10 dB in 90% of the ears. It was concluded that tympanoscope-assisted myringoplasty is a reliable and simple procedure with the benefit of minimal trauma in healthy tissue and that it is a feasible approach for day-case surgery with an ordinary success rate of tympanic membrane closure and hearing results.     

Histology of the tympanic perforation and the replacement membrane

This study shows that the mucocutaneous junction of a perforation of the tympanic membrane may be located at the margin, in the middle ear, or in the ear canal. It is incumbent upon the surgeon performing myringoplasty to identify this junction in order to optimize the success of surgery. About one-third of the healed area following perforation has an intermediate fibrous layer. The membranes in 2 cases of myringoplasty evidenced thicker-than-normal intermediate layers.     

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.     

Cartilaginous myringoplasty: the endoscopic transcanal procedure

The objectives of the study are to evaluate the feasibility, results and complications of the endoscopic transcanal cartilaginous myringoplasty. Thirty patients with a tympanic membrane perforation underwent a transcanal endoscopic cartilaginous myringoplasty, between June 2008 and January 2010. Three patients had a residual perforation at 2 months after surgery. At 1 year, the perforation was closed for 29 patients (96 %). There was no case of blunting, lateralization of the tympanic membrane or ossicular injury. Two patients had an iatrogenic superficial cholesteatoma in the tympanic membrane. There was no significant postoperative worsening of sensorineural hearing loss. The preoperative Air Bone Gap (ABG) was not correlated with the size or site of TMP. The evolution of ABG postoperatively was not significant. The statistical analysis was performed by the Student’s t test. The endoscopic transcanal cartilaginous myringoplasty is a minimally invasive, effective and reliable procedure in the management of the tympanic membrane perforations.     

夹层法鼓膜成形术远期疗效的相关因素探讨

目的 探讨夹层法鼓膜成形术远期疗效的相关影响因素.方法回顾性研究1999年1月至2003年12月北京同仁医院住院行颞肌筋膜夹层法修补鼓膜穿孔的205例(223耳)患者的临床资料,年龄12～65岁,平均34.3岁;病程1个月～25年,平均16.1个月.观察指标包括年龄、性别、病因、病程、干耳时间、手术径路、穿孔部位、穿孔大小、鼓室状况、鼓膜是否有硬化斑.术后随访2年以上用SPSS 12.0软件包进行数据管理、统计方法为Logistic回归.结果 随访2～5年鼓膜愈合212耳,远期鼓膜愈合率为95.1%.其中,鼓膜色泽与形态正常、无其他并发症者186耳,远期手术成功率为83.4%.经多因素Logistic回归分析,依据OR值显示可能影响手术成功的相关因素依次为:穿孔大小(OR=1.900)、病程(OR=1.003)、干耳时间(OR=0.908).对术前纯音测听检查为传导性聋175耳分析显示:术后气骨导差(听力级)的平均值较术前降低7.0dB.结论 鼓膜穿孔越小、病程越短、在一定时间范围内干耳越久,远期发生并发症的可能性越小,对手术成功越有利.鼓膜内陷钙化常为晚期并发症,也是造成修补失败的重要原因之一.     

James Sheehy鼓膜成形术

目的 应用James Sheehy鼓膜成形术对无残边鼓膜大穿孔行鼓膜成形术并观察其疗效。方法2001年1月至2003年6月，共有60名无残边鼓膜大穿孔的患者接受．James Sheehy鼓膜成形术治疗，男36名，女24名，年龄16～64岁，平均45．23岁。术前气骨导差5—45dB，平均28．5dB。其中54名患者随访超过6个月。技术关键：①做耳道后壁带血管蒂皮瓣，切除耳道前壁皮肤；②行耳道成形术至一个显微镜视野下能够看到整个鼓环；③必要时探查听骨链；④颞肌筋膜外植修补鼓膜，上方置于残余锤骨柄下方；⑤耳道前壁游离皮肤及耳道后壁带血管蒂皮肤复位。结果52名患者一期愈合，2名患者术后3个月修补鼓膜中心部位出现2处针眼样穿孔，经明胶海绵贴补二期愈合，鼓膜形态如常；6名患者术后出现轻微颞颌关节症状，3天后消失；2名患者出现修补鼓膜外侧愈合。结论．James Sheehy鼓膜成形术为无残边鼓膜大穿孔治疗的可靠技术，鼓膜修补成功率高，术后反应轻微，新生鼓膜形态好。     

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。     

Myringoplasty

There is marked diversity in the reported success rates for achieving an intact tympanic membrane following myringoplasty. Controversy exists about the factors thought to influence surgical outcome. Both of these facts have important implications for obtaining informed consent prior to surgery.This study reviews the factors thought to determine the likelihood of achieving complete closure of the tympanic membrane following surgical closure.     

Fat graft myringoplasty after unsuccessful tympanic membrane repair

The objective of the present study was to evaluate the efficacy of fat graft myringoplasty in repairing residual or recurrent tympanic membrane perforation. A retrospective analysis was performed on 31 patients, aged 25–57 years (mean 43.3), submitted to myringoplasty revision using fat graft. Fourteen were males and 17 females. Perforation size ranged from 1 to 5 mm. Follow-up time ranged from 4 to 62 months (mean 26 months). Fat graft myringoplasty was performed under local anesthesia, using ear lobe fat in 26 patients and abdominal fat in five patients closure of tympanic membrane perforation was achieved in 87.1% of ears. No modification of the hearing level was evidenced at the statistical analysis. Fat graft myringoplasty is a safe, effective and minimally invasive procedure, suitable to repair small residual/recurrent perforations of the tympanic membrane. The angiogenic properties of the fat are ideal to overcome the poor vascular supply in the vicinity of the tympanic membrane perforation.     

Pediatric myringoplasty: a study of factors affecting outcome

Objectives

To analyze the success rates of myringoplasty in children, to assess prognostic factors and to evaluate their interactions in the evolution of myringoplasty.

Methods

Charts of patients who had undergone a myringoplasty between 1997 and 2007 were reviewed for: patient age, sex, perforation side, etiology, size, type and location of perforation, season of surgery, type of myringoplasty, surgical technique, graft material, preoperative status of the operated and contralateral ear, history of otologic surgery to the operated and/or contralateral ear, number of prior surgeries to the operated and contralateral ear, time elapsed between the last otologic procedure and this myringoplasty, history of adenoidectomy or tonsillectomy, time elapsed between the adenoidectomy or tonsillectomy and this myringoplasty. Anatomical success was defined as postoperative intact tympanic membrane(TM). Audiological success was defined as air bone gap less than 20 dB and a postoperative difference of no more than 10 dB in the mean bone conduction (BC) threshold.

Results

A total of 201 cases of myringoplasty were operated between 1997 and 2007. Anatomical success rates were 94.9%, 84.9% and 70.1% at 6, 12 and 24 months, respectively. The type of previous otologic surgery in the operated ear was found statistically significant for anatomical success. Audiological success rates were attained in 97.4%, 93.4% and 84.9% of patients at 6, 12 and 24 months, respectively. A mean reduction of 9.1 dB of the air bone gap was achieved postoperatively. No sensorineural hearing loss occurred. Children 12 years and older presented with statistically poorer preoperative BC at frequencies ≥2000 Hz when compared to their younger counterparts. These results suggest that the chronicisation of the TM perforation can result in long-term irreversible damage to the inner ear.

Conclusion

The type of previous otologic surgery in the operated ear was found to have an impact on anatomical success. The outcome for myringoplasty was more favourable when the etiology of the previous surgery was a benign one. We advocate early myringoplasty, preferably above the age of 6. Delaying surgery can cause permanent damage to the inner ear. All other factors evaluated were not found to be statistically significant for anatomical or audiological success.     

Portmann氏耳后上进路全翻内植法修补鼓膜大穿孔45例报告

目的 探讨Portmann氏耳后上进路全翻内植法修补鼓膜大穿孔的方法及疗效.方法 采用耳后上进路,自体颞肌筋膜作为移植材料,对45例鼓膜大穿孔病人进行全翻外耳道后壁皮瓣鼓膜成形术,并对其临床资料进行回顾性分析.结果 术后6个月随访,43例鼓膜穿孔愈合,2例出现鼓膜中央小穿孔,听力均有不同程度的提高.结论 本术式术野暴露...     

耳内镜下鼓耳道后径路行鼓膜修补术的疗效观察

目的探讨耳内镜下鼓耳道后径路行鼓膜修补术疗效观察。方法采用回顾性分析,对我科21例耳内镜下行鼓耳道后径路鼓膜修补患者,随访半年,针对术后鼓膜愈合率以及听力情况进行分析。结果20例患者,21耳,20例鼓膜愈合,成功率为95.2%,术后无味觉损伤,无移植物内陷及外移,无耳鸣或耳鸣加重,无听力损伤,无胆脂瘤形成;术前平均气导听阈为(49.4±8.6)dB HL,骨气导差为(31.9±4.9)dB HL,术后平均气导听阈为(24.2±5.9)dB HL,骨气导差为(12.7±6.5)dB HL,听力较术前明显提高(P<0.01)。17例(81%)骨气导差小于20db HL。结论耳内镜下利用耳屏软骨-软骨膜经鼓耳道后径路行鼓膜修补术,对不同部位鼓膜穿孔愈合率及听力恢复均获得良好疗效,临床上值得推广应用。     

Surgical outcomes of myringoplasty using platelet-rich plasma and evaluation of the outcome-associated factors

ObjectiveTympanic membrane perforations must be closed with surgery; however, most surgical procedures are considerably invasive in nature. The aim of this study was to evaluate the outcomes of minimally invasive myringoplasty using platelet-rich plasma (PRP) and an atelocollagen sponge for closure of chronic tympanic membrane perforations, as well as to identify the factors affecting the surgical outcome.MethodsThe records of 118 patients who underwent surgical closure of chronic tympanic membrane perforation at an ear–nose–throat clinic were reviewed retrospectively. After removing the margin of the perforation via a transcanal approach under local anesthesia, an atelocollagen sponge injected with PRP was inserted into the perforation as a scaffold. If the size of the perforation decreased after the surgery, the same surgical procedure was repeated. The success rate of closure after the last surgery was evaluated in terms of the size of the perforation. In addition, the relationships of the success rate with the cause and duration of perforation and patient age were also examined.ResultsThe perforation was closed after initial or repeat surgeries in 95.8% (68/71) of cases with small-sized perforations, 80.0% (32/40) of cases with middle-sized perforations, and 85.7% (6/7) of cases with large-sized perforations. Multiple surgeries (up to four times) were required for middle- and large-sized perforations, and even for some small-sized perforations. The number of re-operations required for closure significantly increased with increase in the size of the perforation (Kruskal–Wallis test, p < 0.01). The cause and duration of perforation were not predictors of the surgical outcome. However, patient age was a significant predictor of the surgical outcome; patients older than 80 years had a significantly worse success rate than younger patients (Fisher’s exact test, p < 0.01).ConclusionMinimally invasive myringoplasty using PRP has a satisfactory success rate even for large-sized tympanic membrane perforations. PRP is autologous and its use is non-toxic and safe. Although informed consent from the patient is necessary for the repetition of the surgery and for patients older than 80 years, this technique appears to be a promising office-based procedure for closure of chronic tympanic membrane perforations.     

Simultaneous miringoplasty and septoplasty,and the use of nasal septal perichondrium

To investigate the more ideal graft for optimal repair of tympanic membrane perforation, we examined the use of septal perichondrium in myringoplasty. Twenty-five patients with ages ranging between 18 and 54 were included in this study. All had a persistent, symptomatic tympanic membrane perforation, and nasal obstruction. All patients were scheduled for myringoplasty by a transmeatal approach in combination with septoplasty under general anaesthesia. Twenty-three patients had intact graft material and had more than 5 dB HL improvement in conductive hearing thresholds at least three frequencies in the follow up period. An overall success rate of 92 and 92% was recorded in terms of hearing improvement and perforation closure, respectively. Nasal septal perichondrium is easily accessible, cost-effective, time saving, sufficiently large, and patient friendly as a graft material in myringoplasty and has a good chance of postoperative survival. This study was presented as a oral presentation at the ‘8th International Conference on Cholesteatoma and Ear Surgery’. 15–20 June 2008, Antalya, Turkey.