Bilateral Tympanic Membrane Perforations Research Articles

Single Sitting Bilateral Myringoplasty: Outcomes and Complications

Abstract Background Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations. Traditionally each ear drum is taken up for grafting sequentially in two different sittings. The reluctance to deal with both sides at the same sitting has been primarily due to a theoretical risk of iatrogenic sensory-neural hearing loss, need of bilateral ear canal gauze packing and chances of graft intake failure. Chronic Suppurative Otitis Media (CSOM) is a widely prevalent public health problem presenting with discomfort, hearing loss, otorrhea and psychological trauma. CSOM is characterized by an inflammatory process of the middle ear often associated with irreversible tissue alterations. It may be further classified into safe chronic otitis media and unsafe chronic otitis media according to the absence or presence of a cholesteatoma. Aim This study aim at assessing the single stage bilateral surgical procedure in bilateral tympanic membrane perforation caused by chronic otitis media as regard the graft take and hearing improvement as outcomes. Methodology A meta-analysis study is done to assess the feasibility and the possibility of operating the bilateral perforation in tympanic membrane in chronic otitis media cases on same session rather than doing it in separate sessions. The outcomes that were selected to evaluate such approach are graft take and hearing improvement. Hospital stay, cost of the operation and time were supposed to be evaluated however, there was no sufficient data to treat such outcomes in this meta analytic study upon that these outcomes are going to be appraised and stated bases on the available data. Results The graft take was evaluated on the bases paper by ototscopic examination post operative from 3 weeks to 3 months by closure of the perforation. It was estimated in this study to be 88%. This percent is matching the result obtained by Ihsan et al 2016 “who operated on 50 patients with a graft uptake rate of 86 %”, Olusesi et al, 2017 " with a total of 38 participants underwent either bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential different-day tympanoplasty (20 patients, 40 ears). The overall graft take rate was 88 per cent (32 out of 36 ears in the same-day tympanoplasty group, 35 out of 40 ears in the different-day tympanoplasty group; p = 0.96, odds ratio = 0.984)" (88 %), and Katsura et al, 2005 who revised the SUM using a 17 patients who underwent bilateral same-day surgery with a success rate of (85%). Conclusion Simultaneous bilateral myringoplasty is safe and effective as a single-stage operation with a high success rate as regard the graft take and hearing improvement.

Does Tympanic Membrane Perforation Have a Protective Affect on the Inner Ear in Blast-Injured Patients?

Background Blast-induced hearing loss is an acoustic trauma commonly caused by high-energy explosions of improvised explosive devices, and the auditory system may be affected by blast damage. This study aims to evaluate the protective effect of tympanic membrane perforation (TMP) on the inner ear against blast injury. Methods In this study, 43 adult patients who had suffered blast injury were divided into three subgroups: intact tympanic membranes in both ears, unilateral TMP, and bilateral TMP. Each patient underwent a comprehensive audiogram, including bone conduction, in the audiology department. Results Evaluation was performed on 43 (100%) males with a mean age of 31.44±8.01 years (range, 18-52 years). When the type of hearing loss was evaluated separately for each ear, sensorineural hearing loss (SNHL) was observed in 31 (36%), high-frequency SNHL in 26 (30.2%), conductive hearing loss in eight (9.3%), and mixed type hearing loss in 21 (24.4%) ears. TMP was detected in 21 (48.8%) of 43 blast-injured patients, on the right side in four (9.3%) patients, on the left side in seven (16.3%), and bilateral in 10 (23.3%). When the type of acoustic trauma was evaluated, 15 (34.9%) patients were observed to have suffered from the explosion of an IED, 12 (30.2%) from weapon explosion, six (14%) were a vehicle bomb explosion, three (7%) were projectile missile explosion, three (7%) were mortar explosion, two (4.7%) were mine explosion, and two (4.7%) were exposed to the explosion in an armored vehicle (Table 1). Conclusion No significant difference was observed in the majority of the frequencies whether the tympanic membrane was perforated or not in the blast-injured patients and it was concluded that tympanic membrane perforation caused by blast injury had no protective effect on the inner ear.

The correlation between hearing loss and the site of eardrum perforation: about 260 cases

Introduction: Some authors have assumed that the hearing loss depends on the site and the size of the perforations, but the results were contradictory and inconclusive. The aim of this present study is to find correlation between hearing loss and the location of tympanic membrane perforation after a chronic otitis media. Materials and Methods: A retrospective study was conducted in our ENT department, university hospital Ibn Rochd Casablanca Morocco. Two hundred sixty patients were enrolled in this study with eardrum perforation and without any neurosensory hearing loss or middle/ inner ear diseases. Data processing and analysis were carried out with computer software SPSS. Results: Two hundred sixty patients (103 males, 157 females) with age range 8–67 years (mean = 35.9) were studied. Bilateral tympanic membrane perforations were seen in 84 patients (60%), unilateral perforation in 176 patients (68%). In the 260 patients, 253 eardrum perforations were caused by chronic otitis media. Only 7 cases were due to a traumatism. The tympanic perforation was posterior in 64 cases (24.6%), subtotal in 54 cases (20.8%), central in 49 cases (18.8%), anterior in 44 cases (16.9%), antero-superior in 1 case, antero-inferior in 23 cases (8.8%), postero-superior in 5 cases (1.9%), and postero-inferior in 10 cases (3.8%). The tympanic perforation was inferior in 10 cases (3.8%). Perforation’s sites on the tympanic membrane were correlated with the groups of average hearing loss. For anterior perforations the average loss was moderate in 52.3% and severe in 13.6%. For posterior perforations the average loss was moderate in 75%. For subtotal perforation, the percentage was equal for mild and moderate hearing loss. The average loss for anterior perforations was 41.93 dB. The average loss for posterior ones was 42.66 dB. Conclusion: The current study aimed to correlate the degree of hearing loss to the different site of perforation. From the present study we can tell that Hearing loss in chronic otitis media is independent of the site of eardrum perforation. Nevertheless, further studies are needed with a representative population to confirm our results. Keywords: Site of eardrum perforation; Hearing loss; Bone conduction

Effectiveness of transperforation myringoplasty in bilateral chronic otitis media patients undergoing contralateral tympanoplasty.

Bilateral tympanic membrane perforation closure is usually performed by otosurgeons in two sittings. However, in this study, transperforation myringoplasty was performed alongside contralateral tympanoplasty in a single sitting. The effectiveness of transperforation myringoplasty procedure and the benefits of single sitting bilateral surgery were evaluated. A prospective study of 50 selected patients with mucosal-type bilateral chronic otitis media was conducted. All patients underwent transperforation myringoplasty on the side that met the inclusion criteria and tympanoplasty on the contralateral side. Graft uptake and hearing improvement were evaluated after 6 months. At the 6-month follow up, the graft uptake rate was 82 per cent, the hearing gain was 11.5 dB and the air-bone gap gain was 11.6 dB. This procedure offers perforation closure in a single sitting to patients with bilateral chronic otitis media who meet the inclusion criteria.

Bilateral same-day endoscopic transcanal cartilage tympanoplasty: initial results

IntroductionSame-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications. ObjectiveTo evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations. MethodsFrom February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5cm×1.5cm cartilage seemed to be enough for tympanoplasty in both sides. ResultsNine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88dB preoperatively to 9.16dB postoperatively (p<0.05). ConclusionBilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications.

Otologic assessment of blast and nonblast injury in returning middle east‐deployed service members

To determine if tympanic membrane perforation offers any protection from inner ear damage and determine the incidence and pattern of otologic blast injury in military personnel returning from deployment. Retrospective analysis of US service members injured in Operation Iraqi Freedom and Operation Enduring Freedom from October 2006 to October 2007. One-hundred ten blast-injured patients were compared to 54 nonblast-injured patients returning from deployment. Data captured included audiogram results, presence of tympanic membrane perforation, demographic data, location and nature of injury, loss of consciousness, sleep disturbance, confusion, and symptoms of headache, dizziness, memory loss, and tinnitus. Of 110 blast-injured patients, 18 patients suffered tympanic membrane perforation (16%), of which nine patients suffered bilateral tympanic membrane perforation (8%). Blast patients suffered more hearing loss than controls as measured by pure-tone averages of varying speech reception frequencies and at 6,000 Hz. Of the blast patients who recorded an audiogram, nearly 24% suffered moderate to profound hearing loss. There was no statistically significant difference in hearing outcomes between blast-injured patients with tympanic membrane perforations and those without; however, when comparing patients with unilateral perforations with their contralateral ear, there was a difference in hearing thresholds at 6,000 Hz. There was a significantly increased risk of tinnitus, memory loss, headache, and dizziness between blast-injured patients compared to controls. Due to its violent nature, blast exposure causes greater neuro-otological manifestations and deserves prompt otologic evaluation.

Clinical analysis of bilateral same-day myringoplasty for 22 cases with bilateral tympanic membrane perforation

To investigate the feasibility of bilateral same-day myringoplasty and the indications for myringoplasty for patients with bilateral tympanic membrane perforation, and to summarize relevant experience. Twenty-two patients underwent bilateral same-day underlay myringoplasty, and all cases were consistent with the indications for myringoplasty. The preoperative hearing and postoperative hearing at three months were compared, and the postoperative symptoms and complications were observed. Forty patients underwent monaural myringoplasty as the control group over the same period. All cases were followed up for 1 - 3 years. The postoperative hearing was increased by an average of 18 dB, and the rate of closure of tympanic membrane perforation was 93.2% (41/44). There were seven patients with ear fullness after operation in the bilateral myringoplasty group and two patients in the control group (χ(2) = 4.5374, P = 0.0332). There were no differences in the postoperative hearing improvement, the rate of closure and the rates of other discomfort symptoms except for ear fullness between the two groups (P > 0.05). It was feasible and safe to perform bilateral same-day myringoplasty for bilateral tympanic membrane perforation, but the postoperative temporary discomfort of bilateral ear fullness should be informed the patients in advance.

Simultaneous bilateral myringoplasty as a single-stage operation

EnAbstract Background Myringoplasty is a common otologic procedure that results in successful closure of the perforation in most cases; however, the theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance among otosurgeons to perform bilateral myringoplasty. Objectives The aim of this study was to evaluate simultaneous bilateral myringoplasty as a single-stage operation. Patients and methods A prospective study was carried out between December 2009 and March 2012 on 30 patients (60 ears) with bilateral tympanic membrane perforations. Bilateral myringoplasty was performed in the same sitting using an underlay technique. Results Of the 60 ears operated upon, perforation closure was achieved in 56 (93.3%) ears and 51 (80%) ears gained hearing. No worsening of hearing was observed in any ear. Conclusion Simultaneous bilateral myringoplasty is safe and effective as a single-stage operation, with a high success rate.

E-005 Super-selective pre-operative embolization of juvenile angiofibromas

PurposeJuvenile angiofibromas (JNAs) are hypervascular, locally destructive tumors best treated by complete surgical resection. They occur predominantly in teenage boys and originate at the posterior pedicle of the middle turbinate...

Bilateral same-day surgery for bilateral perforated chronic otitis media: Inlay butterfly cartilage myringoplasty

ObjectiveConventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the risk of postoperative complications. Inlay butterfly cartilage myringoplasty (IBCM) has been shown effective for same-day closure of bilateral tympanic membrane perforations and is a quicker and more comfortable procedure for the patient. Immediate postoperative hearing is not compromised by packing materials because no external canal packing or middle ear support is required. We assessed the efficacy and safety of bilateral same day IBCM. Study DesignCase series with chart review. SettingTertiary referral center. Subjects and MethodsOf the 81 patients (age range, 9-64 years) who underwent conventional tympanoplasty/mastoidectomy for bilateral perforated chronic otitis media between June 2005 and September 2009, 17 with small-to-medium perforations and no history of otorrhea underwent same-day cartilage IBCM on the contralateral ear. Median follow-up duration was 13.0 months. ResultsThe graft take rate was 100 percent, with no retraction pockets or displaced grafts observed during follow-up. Mean air−bone gap was improved from 15.8 to 8.4 dB. Twelve patients had an average air−bone gap between 0 and 10 dB, three between 11 and 20 dB, and two between 21 and 30 dB. Two patients had myringitis postoperatively, but it improved with antibiotic treatment. ConclusionBilateral same-day IBCM offers favorable outcomes in selected patients.

Fatal consequences of an ear infection

In August, 2006, a 75-year-old non-diabetic, non-alcoholic man with hypertension and atrial fi brillation was ad mitted to the Internal Medicine department with low grade fever, increasing otalgia, otorrhoea, dysphagia, and hoarseness. He had suff ered from bilateral tympanic membrane perforation, intermittent otalgia, and otor rhoea for 12 years. In May, 2006, his otolaryngologist had prescribed ofl oxacin ear drops and oral ciprofl oxacin for otalgia and otorrhoea. In June, 2006, he was admitted to the Ear, Nose and Throat department with a 3-week history of left peripheral facial nerve palsy, left trigeminal sensory loss, and general discomfort. He was afebrile, with a serum C-reactive protein concentration of 72 mg/L; other laboratory tests were normal. CT and MRI of the head showed clouding of the left mastoid without intra cranial pathology or menin geal enhancement (fi gure A); chest radiography was normal. A diagnosis of mastoiditis was made, and ceftazidime and fl ucloxacillin were started. Surgical exploration of the left mastoid showed granulation tissue in the external auditory canal and around the ossicles. Microscopically this tissue showed chronic-active necrotising infl ammation; cultures (in cluding those for fungi) were negative. After 2 weeks, the patient was discharged in fair condition. In the current admission, besides earlier described cranial nerve dysfunction, a partial left glossopharyngeal and vagal nerve palsy were diagnosed by the consulting oto laryngologist. C-reactive protein was 57 mg/L with normal white cells. Culture of discharge from the ear grew Pseudomonas aeruginosa, and amoxicillin (empirically started on admission) was replaced by meropenem. 2 weeks later, still in hospital and being treated with meropenem, he developed headache, neck pain, and a left abducens nerve palsy. Repeated chest radiography and MRI of the brain were normal. Cerebrospinal fl uid (CSF) analysis showed only a mild pleocytosis (leucocytes 17×106 per L). The clinical picture suggested a chronic (basal) meningitis, but blood and CSF cultures remained negative. The patient refused meningeal biopsy and further treatment, had progressive diffi culty in swallowing, and died 3 weeks later in hospital from pneumonia. Autopsy showed a focal purulent pre pontine lepto meningeal exudate (fi gure B). Micro scopically, multiple septated and branched hyphae were detected in this exudate and in the left middle and internal ear (fi gure C), combined with chronic-active necrotising infl am mation. The infl ammation extended into the skull base and cranial nerves. A mould cultured from the exudate was characterised as Pseudallescheria boydii by sequence-analysis of parts of the β-tubulin gene. P boydii can cause a wide variety of clinical diseases and is commonly found in soil, polluted water, and manure. P boydii infections of the central nervous system (CNS), meninges, and mastoid are very rare and generally occur in immunocompromised, near drowning, and trauma patients, but have also been reported in patients without one of these risk factors. There was no suspicion of immunocompromise in our patient, and post mortem HIV PCR analysis from lymph node and heart tissues were negative. Diagnosis of CNS involvement by P boydii is often delayed because of non-specifi c clinical presentation, diffi culty in obtaining and culturing appro priate specimens, and because of histological similarity of P boydii to other fungi, such as aspergillus. In our patient the fungus most likely gained access to the ear and CNS through tympanic membrane perforation. In patients with P boydii mastoiditis, surgical intervention, adequate anti-fungal therapy, and identi fi cation and control of underlying immunological conditions are essential. Voriconazole is suggested as the treatment of choice. Awareness of P boydii as a cause of chronic mastoiditis and meningitis may allow early diagnosis and treatment, thereby increasing the chance of resolution.

Correlating the site of tympanic membrane perforation with Hearing loss

BackgroundIt is recognized that the size of tympanic membrane(TM) perforation is proportional to the magnitude of hearing loss, however, there is no clear consensus on the effect of the location (site) of the perforation on the hearing loss. Hence the study is set to investigate the relationship between the location of perforation on TM and hearing loss.MethodsA cross-sectional prospective study of consecutive adult patients with perforated TM conducted in the ENT clinic of University College Hospital Ibadan between January 1st 2005 and July 31st 2006. Instruments used for data collection/processing include questionnaires, video and micro-otoscopy, Pure tone audiometer, image J and SPSS packages.ResultsSixty-two patients (22-males, 40-females), aged 16–75 years (mean = 35.4 +/- 4) with 77 perforated ear drums were studied and 15(24.2%) had bilateral TM perforations, 21 (33.9%) right unilateral and 26(41.9%) left unilateral. The locations of the TM perforations were 60(77.9%) central, 6(9.6%) antero-inferior, 4(5.2%) postero-inferior, 4(5.2%) antero-superior and 3(3.9%) postero-superior respectively with sizes ranging from 1.51%–89.05%, and corresponding hearing levels 30 dB – 80 dB (59% conductive and 41% mixed). Fifty-nine percent had pure conductive hearing loss and the rest mixed. Hearing losses (dBHL) increased with the size of perforations (P = 0.01, r = 0.05). Correlation of location of perforations with magnitude of hearing loss in acute TM perorations was (P = 0.244, r = 0.273) and for chronic perforations (p = 0.047 & r = 0.31).ConclusionThe location of perforation on the tympanic membrane (TM) has no effect on the magnitude of hearing loss in acute TM perforations while it is significant in chronic ones.

Effect of Basic Fibroblast Growth Factor on Perforated Chinchilla Tympanic Membranes

Basic fibroblast growth factor (bFGF) is a polypeptide mitogen which stimulates proliferation of epidermal and connective tissue cells. When applied to tympanic membrane perforations it has been reported to enhance healing and produce connective tissue hyperplasia. Previous work with animal models has shown that hyperplastic alterations of the tympanic membrane play an essential role in cholesteatoma development. This study was designed to further investigate the hyperplastic effects of bFGF and to determine if it might induce cholesteatoma formation during the healing process. Ten chinchillas received bilateral tympanic membrane perforations. In each animal, three doses of bFGF (400 nanograms per dose) were applied to the perforated tympanic membrane on one side; the opposite (control) ear received saline alone. The animals were terminated at either two or four weeks and studied histologically. Although the dosage and administration schedule used were consistent with previous studies utilizing other rodent species, there was little evidence that bFGF affected tympanic membrane healing in chinchillas. In both control and bFGF-treated ears, dense connective tissue occupied the lamina propria of the tympanic membrane, providing an effective barrier against ingrowth of skin toward the middle ear. No cholesteatomas developed in any animals included in the study. The results of this work indicate that the risk of cholesteatoma formation following administration of bFGF is minimal when it is applied short-term to acute perforations.

Tympanic membrane perforation in survivors of a scud missile explosion

On February 25, 1990, an Iraqi SCUD missile exploded inside a building housing United States military personnel in Dhahran, Kingdom of Saudi Arabia. One hundred seventy-two individuals who were near the impact site at the time of the blast were interviewed and examined to determine blast injury to the ear. Tympanic membrane (TM) perforation was used as the clinical marker for aural blast injury. Thirty-four personnel had unilateral TM perforation and 28 had bilateral TM perforation. Eighty-six sustained sufficient injury to be hospitalized. Fifty-nine of hospitalized personnel (70%) had TM perforation. Of a total of 90 TM perforations, 39% were estimated to be 25% or less of the tympanic membrane surface area, 36% were 26% to 50%, 16% were 51% to 75%, and 10% were greater than 75%. Morphology of the perforations and estimated proximity to the blast were documented. Personnel distant from the blast, in open doorways or wearing headphones, had relative protection from TM perforation. Historic nuclear blast data were used to estimate the SCUD blast waveform based on measurements of the SCUD impact crater. A mathematical model based on the estimated waveform was validated against the actual field data by comparing the proximity and incidence of TM perforations in the SCUD missile explosion.

Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type

It is acknowledged that size and site of tympanic membrane perforation is proportional to degree of hearing loss but there are many studies which suggests otherwise. Persistent ear discharge is also supposed to deteriorate hearing level with passage of time. This study is carried out to find out the relation between size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. The objective of this study is to study the effect of size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. This is a cross-sectional prospective study conducted at Kathmandu Medical College, department of ear nose and throat from January till July 2009. One hundred patients aged between 8 to 60 years with pars-tensa perforations were included in the study. Detail clinical examination and history was carried out followed by hearing evaluation by audiometry was done in all cases. All the data is collected, statistical analysis is done using SPSS program and documented for study. One hundred patients with 119 perforated tympanic membrane, age ranged between 8 to 60 years, 44 males and 56 females were studied. Bilateral tympanic membrane perforation were seen in 19 patients, right sided perforation in 39 and left sided in 42 patients respectively. Large central perforation involving all four quadrants was the most common otologic findings seen in 72 ears (60.50%) whereas perforation in posterosuperior quadrant was the least common finding seen in 3 patients (2.52%). Significant relation is observed between site of perforation and degree of hearing loss; posterior placed perforations seem to have larger hearing loss. Ninety-five perforations (79.83%) showed more loss in low frequencies with larger air bone gap at low frequencies. The longer the duration of ear discharge, the more the hearing loss. The larger the perforation, the greater the decibel loss in sound perception. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss.