Central Tympanic Membrane Perforation Research Articles

Endoscopic transcanal underlay myringoplasty using a platelet-rich fibrin (PRF) membrane

BackgroundTympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty.MethodsWe conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry.ResultsSixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported.ConclusionEndoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision.

Effectiveness of trichloroacetic acid and trichloroacetic acid with gel foam for closure in patients with central perforation of tympanic membrane—a randomized controlled trial

BackgroundThe tympanic membrane (TM) forms the partition between the external auditory canal and the middle ear. Perforations occur as a result of acute otitis media or traumatic causes which undergoes healing spontaneously over 3 to 4 weeks. Non-surgical methods are successful in the closure of small to medium-sized perforations. Chemicals used for the cauterization of the margins of perforation are trichloroacetic acid and silver nitrate. This study was performed in a total of 90 patients. External auditory canal, tympanic membrane, site and size of perforation, and middle ear mucosa status were assessed followed by pure tone audiometry. One group constituting 45 subjects underwent TCA cauterization under sterile precautions. Another group of 45 subjects underwent the same procedure with TCA cautery and gel foam application for perforation closure. The procedure was repeated once a week for about 6 weeks. The effectiveness of these two procedures was compared between the two groups after a waiting period of 2 weeks.ResultsThe mean age of the study population is 41.84 ± 16.71. Of the 90 study participants, 54.4% (N = 49) were less than 40 years of age, gender, cause, and laterality of perforation were not associated with the outcome whereas the size of the perforation was significantly associated with the closure of TM perforation with chi-square value of 7.028 and P value of 0.008 (< 0.05). Overall, TM closure was achieved in 3.56 applications in TCA with gel foam patching whereas in 6.02 applications with TCA alone.ConclusionTCA cauterization with or without gel foam patching can be performed as a first-line treatment in adults with small to medium-sized perforations.

Association between Different Types of Central Tympanic Membrane Perforation with Hearing Impairment

Association between Different Types of Central Tympanic Membrane Perforation with Hearing Impairment

An Investigation on the Fibrin Glue's Impact on Myringoplasty's Success Rate: A Randomized Controlled Study

Objective: The study's goal is to evaluate the success rates of graft uptake in platelet-rich fibrin-assisted underlay myringoplasties employing temporalis fascia grafts to those in traditional underlay myringoplasties. Methods: This study was conducted in Mayo Hospital in Lahore's ENT department carried out this double-blind, randomized, controlled trial investigation. We recruited 60 individuals with dry central tympanic membrane perforations. Patients with co-morbidities such as diabetes and sensorineural hearing loss were not included. Probability basic random sampling was used. The patients were split into two groups using a lottery system. With the help of SPSS version 26, statistical analysis was carried out. The P-value was calculated using the chi-square test. Results: There were 60 patients, of whom 38 were males and 22 were women. The control group's average age was 27.53 ± 11.41 years, but the study group's average age (Fibrin) was 31.77 ± 12.43 years. At the 2-month follow-up, the grafts were successfully absorbed by every patient in the platelet-rich fibrin group. 23 out of 30 patients in the control group who underwent the conventional method successfully absorbed their grafts, however, the remaining 7 patients had different issues that led to graft rejection. Practical Implication: The tympanic membrane would mend more quickly if platelet-rich fibrin was used after ear procedures. Fibrin glue in tympanoplasty has been tried in several locations throughout the globe. [7,8] When concentrated fibrinogen solutions are combined with thrombin, fibrin glue is created. It may also be made from platelet-rich plasma. Our research compares platelet-rich fibrin-assisted underlay myringoplasties employing temporalis fascia grafts to traditional underlay myringoplasties to see which has a higher graft uptake success rate. Conclusions: The use of platelet-rich fibrin on the anterior ligament grafting line and perforation edges during underlay myringoplasty has greatly increased the success rate of the graft. Keywords: platelet-rich fibrin, temporal fascia graft, myringoplasty

Augmenting Community Diagnosis of Safe Ear Disease Through Tele-Myringoscopy with Borescope Using AIML Tecniques.

This study utilized AIML (artificial intelligence & machine learning) techniques to analyze 115 images of central perforation of tympanic membrane obtained from Telemyringoscopy through Borescope in order to establish a facilitation-model for the community ear diagnosis. The Modified VGG19 with batch normalization revealed the highest training accuracy of 85 as compared to other CNN techniques. The training accuracy started to saturate around mid-70% and the Test accuracy was around 50%. Although AIML did not reveal a high predictive value, its potential based on our observations cannot be underestimated considering many limitations (sample size, image-quality, associated pathologies, illumination-factor) in this study. Such limitations if resolved may revolutionize community ear care through a better cost effective tele-myringoscopy with innovations in AIML/ telemedicine.

Microbiology of Active Mucosal Chronic Otitis Media and Shifting Trends in Etiology in Idukki, Kerala: A Prospective Observational Study.

Active mucosal Chronic Otitis Media (COM) is an important cause of preventable hearing loss particularly in the developing world and may have long term effects on early communication, language development, school performance and social interaction. This study aimed to isolate the bacterial flora in the middle ear of patients suffering from active mucosal COM in Idukki district of Kerala and also to study the antibiotic sensitivity pattern of these organisms to commonly used antimicrobial agents. This was a clinical prospective observational study conducted over a period of 3 years involving 137 patients of all age groups, who were clinically diagnosed with active mucosal COM. The inclusion criteria were patients presenting with a central tympanic membrane perforation and ear discharge (either unilateral or bilateral) of more than 3 months duration. Microbial growth was seen in 128 (94.1%) patients with aerobic bacteria (83.5%), anaerobic bacteria (6.25%) and fungi (7%), of which Pseudomonas aeruginosa (39.8%) and Staphylococcus aureus (31.2%) were the most predominant etiological agents for active mucosal COM. Pseudomonas aeruginosa showed highest susceptibility to Piperacillin-Tazobactam combination and highest resistance to Ampicillin, while Staphylococcus aureus showed highest susceptibility to Gentamicin and highest resistance to Ampicillin and Ceftriaxone. The increasing trends in the antibiotic resistance pattern in Staphylococcus aureus over the years poses a threat to Idukki district, Kerala. Due to the irrational use of antimicrobials, multi-drug resistant bacterial strains are frequent, and so, there is need for continuous surveillance of the local microbiological profile of active mucosal COM.

Evaluation of the use of autologous platelet-rich fibrin in myringoplasty operation

BackgroundPlatelet-rich fibrin (PRF) which is considered a second-generation platelet-rich plasma having a high content of growth factors could be implied as a sealant and adjuvant to grafting materials during tympanoplasty operation. This work aimed to evaluate the role of autologous platelet-rich fibrin as an adjuvant in type 1 tympanoplasty (myringoplasty) for the closure of central tympanic membrane perforations. A prospective comparative study was conducted including one-hundred patients with chronic suppurative otitis media with dry central TM perforations. The patients were classified into two equal groups: group A (case group) was subjected to myringoplasty operation with the use of autologous PRF added to the temporalis fascia graft, and group B (control group) was subjected to myringoplasty operation using graft only without PRF. Both groups were assessed for successful closure of perforation defined as an intact eardrum, success in terms of hearing defined as closure of air-bone gap down to 10 dB or lesser, and hearing gain at 6 months postoperatively.ResultsAt 6 months postoperatively, the success rate (graft taking) in group A (90%) was significantly higher than in group B (70%). Success in terms of air-bone gap closure (< 10 dB) revealed that in group A, success was achieved in 39 patients (78%), which was significantly higher than in group B 27 patients (54 %). Air-bone gap at 6 months postoperatively was more in the graft taken cases in the case group than in the control group with a significant difference. There was a nonsignificant correlation between graft uptake and either hemoglobin or platelet concentrations in both groups. In addition, there was a nonsignificant correlation between graft uptake and the size of the perforation in both groups.ConclusionPlatelet-rich fibrin is a cheap, cost-effective, and completely autologous platelet concentrate with enriched growth factors. It improves the overall success rate of myringoplasty with no noticeable side effects.

Comparative study between temporalis fascia graft with and without addittion of cyanoacrylate glue in myringoplasty

Background: Tissue adhesives are often used in myringoplasty because they can hold the graft in place and help the graft absorb by acting as a framework. Aim of the study: The goal is to look at the temporalis fascia graft used in myringoplasty with and without cyanoacrylate glue and compare the two. Patients, and methods: Fifty patients with dry central tympanic membrane perforation were treated with type I tympanoplasty over the course of 1.5 years. In each instance, the autogenous temporalis fascia graft was spot welded and fixed to flaps and the surrounding tissue using glue. Myringoplasty was done on 50 people, and they were randomly put into two groups: those who had cyanoacrylate glue put on the temporalis fascia graft and those who didn't. Results: Each group had 25 cases, and there were no big differences between the groups in terms of age, direction, or size of the tympanic membrane hole. After 6 weeks, there wasn't much difference between the glue group and the control group. In the glue group, 72% had healed and 28% had perforated, while in the control group, 64% had healed and 36% had perforated (p-value 0.544).

Fungal otitis externa and tympanic membrane perforation.

Otomycosis is a fungus-causing superficial infection of the external auditory canal that is common in otolaryngology practice. Though it is a worldwide infection, but is more prevalent in warm and humid regions. There has been rise in the occurrence of otomycosis in the last few years because of the extensive usage of antibiotic eardrops. Other influencing reasons for the occurrence of otomycosis is swimming, an immunocompromised host (e.g.: DM, AIDs) pregnancy, post-canal wall down mastoidectomy, tympanic membrane perforation, hearing aids and self-inflicted injuries. Approval from the institutional ethics committee and penned informed agreement from all patients involved in the examination were obtained. 40 patients were included in the study, starting from 1stAugust to 30th September 2021, which emphasized on otomycosis infection with central tympanic membrane perforation. Physical findings such as whitish ear discharge and the presence of hyphae in the EAC, the ear drum, the middle ear mucosa were used to diagnose otomycosis. 20 patients of patched group and 20 patients of non-patched group did not visit for follow up. Data here is for patients who followed-up for 3 weeks. Any significant observation regarding statistical variation in the age, size of perforation, mycological analysis and pure tone audiometry among the two groups were not seen. To conclude, we state that treatment with clotrimazole solution in patched group is safe in managing otomycosis with tympanic membrane perforation. Otomycosis is a fungus causing surface infection of the external auditory canal that otolaryngologists routinely diagnose by medical examination. In acute otomycosis, overgrowth of the fungus in the external auditory canal is due to increased humidity.

Fat Myringoplasty for Small Central Perforation of Tympanic Membrane: A Prospective Study.

In fat myringoplasty, fat harvested from ear lobule is used as graft material for the closure of small size central perforation of tympanic membrane under local anaesthesia. This study was performed over a period of 5years (January 2016-December 2020) on 67 cases who underwent surgery and were willing to participate in the study at our tertiary hospital. Closure of perforation was found in 93% of cases within 2-3months of surgery. Hearing gain was 6.8dB on an average and morbidity was insignificant in successful cases. Fat myringoplasty is a successful yet simple procedure for repair of small size perforations. It is a day-care procedure under local anaesthesia requiring minimal tissue handling. It is also cost effective and has minimum post-operative morbidity. The likely cause of failure are ear infections and graft displacement due to respiratory tract infections. Results of the fat myringoplasty also depend upon the experience of the operating surgeon and cooperation of the patient.

Endoscopic versus Microscopic Myringoplasty in Anterior Central Tympanic Membrane Perforations

Endoscopic versus Microscopic Myringoplasty in Anterior Central Tympanic Membrane Perforations

Outcome of Endoscopic Transcanal Cartilage Myringoplasty performed in Janaki Medical College Teaching Hospital

Background and Objectives: Myringoplasty is a commonly performed surgical procedure usually with a microscope. Transcanal endoscopic myringoplasty is being widely used procedures nowadays and has the advantages of demanding lower operative time and minimal external incisions. The main objective of our study was to see the graft uptake rate and hearing results after endoscopic cartilage myringoplasty.&#x0D; Material and Methods: This prospective study was carried out on 50 patients from March 01, 2020 till April 30, 2021. All patients presented with central perforation of tympanic membrane which was dry for at least 3 months were subjected to preoperative clinical, endoscopic, audiological assessment. These patients were followed through a period of 6 months and assessed using pure tone audiometry and graft uptake was seen.&#x0D; Results: Out of 50 patients, male: female ratio was 1.9:1 with mean age group of 34 years. In our study the graft uptake rates is 85% (42) and 6 patient has pin hole perforation and 2 has small central re-perforation on 6 month followup. Mean preoperative air bone gap was 28.95 dB whereas mean postoperative air bone gap was 10.63 dB. The maximum number of patient i.e 20 had pre-operative air bone gap in the range of 31 – 40 and 20 has post operative air bone gap in the range of 0-10 which is normal.&#x0D; Conclusions: The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

ROLE OF FIBRIN GLUE FOR BETTER SUCCESS RATE IN MYRINGOPLASTY

Objective: To see graft uptake success rate in platelet rich fibrin aided underlay myringoplasties using temporalis fascia graft compared to conventional underlay myringoplasties.&#x0D; Study Design: Double blind randomized controlled trial study.&#x0D; Place and Duration of Study: ENT department, Pakistan Naval Ship Shifa Hospital, from Jan to Jun 2019.&#x0D; Methodology: Sixty cases with dry central tympanic membrane perforations were recruited. The patients suffering from sensori-neural hearing loss and co-morbidities like diabetes were excluded. The sampling technique was probability simple random. Patients were divided into two groups by lottery method. Statistical analysis was performed by using SPSS. The chi square test was applied to calculate p-value.&#x0D; Results: Out of total 60 patients 38 were males and 22 were females. Study group’s (Fibrin) mean age was 31.77 ± 12.43 years and Control group’s mean age was 27.53 ± 11.41 years. All the patients in platelet rich fibrin group had successful graft uptake at 2 months follow-up. In control group with conventional technique 23 out of 30 patients had successful graft uptake and rest 7 patients had different issues leading to graft rejection.&#x0D; Conclusion: In under lay myringoplasty procedure, application of platelet rich fibrin on temporalis fascia graft edge and perforation edges has significantly improved the successful uptake rate of graft.

The Effect of Topical Insulin on Healing of Small Central Tympanic Membrane Perforations and Hearing Threshold

The Effect of Topical Insulin on Healing of Small Central Tympanic Membrane Perforations and Hearing Threshold

Canalplasty in Tympanoplasty – Functional and Surgical Outcome

Background: During repair of central perforations of tympanic membrane, annulus should be visible in a single view. It helps in better placement of graft. To attain this, the bony canal is enlarged. Materials and Methods: Eighty patients with dry central perforation were selected during the period 2010–2020. Sixty patients with dry central perforation underwent tympanoplasty Type 1 with canalplasty and twenty patients were subjected to tympanoplasty Type 1 only. The method, operative procedure, and words of wisdom to give good results and prevent complications are described. Results: Patients with canalplasty had better postoperative results, and the success rate is improved as compared to only myringoplasty. The primary outcome measure of canalplasty with tympanoplasty procedure is complete re-epithelization and provision of a dry ear in 95%, whereas the final outcome without canalplasty was 90%. Conclusion: The aim of the canalplasty is to create a wide, patent, and physiological bony ear canal. Canalplasty helps to have better visualization, better postoperative care, better exposure for ossiculoplasty, time gain during graft placement, prevent lateralization, and promotes healing. It does improve the surgical outcome in tympanoplasty Type I.

Different Grafts used In Closure of Central Small Tympanic Membrane Perforations

Background: Large number of patient seek ENT consultation for central perforation of tympanic membrane. A significant portion of these cases are often found with very small central perforation. Minimyringoplasty is a very simple procedure to close such small perforations. Objective: the aim of the present study is to compare the surgical and audiological results of temporalis fascia versus more simple methods ( fat graft, fat graft wih hyaluronic acid and platelet rich plasma)in myringoplasty. Patient and Methods: a randomized prospective study concerned with 80 patients for whom myringoplasty was done. Patients were randomly assigned into four groups; in the first group fat graft was used (20patient) and fat graft with hyaluronic acid was used in the second group (20 patients).and platelet rich plasma was used in third group (20 patients) and temporalis fascia was used in fourth group (20 patients). Results: our study included 80 patients, 45 males and 35 females with a range from 18- 55 years. Surgical success rates75% , 80%, 75%and 75%for fat graft, fat graft with hyaluronic acid, platelet rich plasma and temporalis fascia respectively. There was 6.5 dB, 7db , 6 db and 5.5 db mean hearing improvement improvement in fat graft, fat graft with hyaluronic acid, platelet rich plasma and temporalis fascia respectively. Conclusions: The myringoplasty with fat graft,fat graft with hyaluronic acid and PRP is a minimally invasive effective procedure in management of the small central tympanic membrane perforations . Also it is safe and feasible procedure In this study we have achieved High success rate of repair of tympanic membrane perforation.

Treatment of tympanic membrane perforation with topical epidermal growth factor: progress towards clinical application

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is a widespread disease of developing countries, especially of the lower socio-economic group. Medical cost in hospitals associated with tympanoplasty for treating CSOM is very high. Our study investigates the efficacy of epidermal growth factor along with chemical cautery in healing of chronic tympanic membrane perforation on an outpatient department (OPD) basis. Hence providing a cheaper and cost effective treatment alternative to the patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total number of 70 patients with signs of COM attending ENT OPD were selected. The patients were randomly assigned into 2 groups each with a sample size of 35. Otoendoscopy and pure tone audiometry was performed. Group A was treated with EGF with chemical cautery and group B was treated with only chemical cautery. Both groups were followed up after 15 days, one month and second month of the procedure in ENT outpatient clinic.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The success rate of these non-healing perforation was found to be significantly higher in group A (29 [82.86%]) compared with group B (17 [65.71%]) with P value of 0.0070*.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study shows a statistically significant result with topical application of epidermal growth factor in small to medium non-healing central tympanic membrane perforation. Due to the promising result of epidermal growth factor, it could be considered as office myringoplasty. &lt;/p&gt;

Pattern of pseudomonas aeruginosa infection among Northwestern Nigerians with chronic suppurative otitis media

Background: Pseudomonas aeruginosa has been particularly blamed for the deep-seated and progressive destruction of the middle ear and mastoid structure through its toxins and enzymes. Drug-resistant P. aeruginosa has been found to increase along with its frequency. Aim: This study aimed to assess the antibiotic sensitivity pattern of P. aeruginosa and the effectiveness of ciprofloxacin in chronically discharging ears. Patients and Methods: This was a retrospective review of 180 patients who were managed for chronic suppurative otitis media between January 2009 and December 2018. Results: Out of the 180 patients, majority 67 (37%) were in the age group 1–10 years, range of 1 month to 70 years with mean age of 18 years and standard deviation of ± 16.8 years and M: F of 1.5:1. Most have had ear discharge for more than 6 months and the majority 78 (43.4%) of the patients had bilateral disease. Central tympanic membrane perforation was the predominant finding, 81 (45.0%) with a complication rate of 21.1%. Abscess formation was the most common complication seen among the patients. P. aeruginosa was the most common bacterial isolate, 43 (23.9%) followed by Staphylococcus aureus, 39 (21.7%). In the pediatric population, P. aeruginosa was most sensitive to levofloxacin, as opposed to gentamicin in the adult population. Ciprofloxacin was seen to be more effective in adults than in children. Resistance to ciprofloxacin was seen more in the children than in adults. There was a significant association between gender and occurrence of the organism. Conclusion: P. aeruginosa is most sensitive to levofloxacin and gentamicin in the pediatric and adult population, respectively. Resistance to ciprofloxacin is most common among adults.

A study on fat plug myringoplasty for small tympanic membrane perforation

Introduction: Fat plug myringoplasty is an under-used technique to repair a small central tympanic membrane perforation. It is easy, quick and cost effective way with minimal morbidity. It can be done as an OPD procedure. The fat is readily available from ear lobe, abdomen and buttocks. Fat graft myringoplasty (FGM) is a noninvasive, but underused surgery for perforations of the tympanic membrane. It is also preferable for use in children. Fat tissue has been used as an autogenous material for different surgeries and is known to have a high capacity for resistance. Our study is conducted to evaluate the effectiveness of using fat plug in small central tympanic membrane perforation.Aim: To evaluate the effectiveness of using fat plug in small central tympanic membrane perforation.Materials and Methods: This study was conducted in the ENT department of Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari district in a time period from JUNE 2020 to November 2020.The sample size was taken as 30 patients who had presented with complaints of ear discharge, and hearing loss, surgical procedure was done where a fat graft was inserted through the perforation for those patients who fulfilled the inclusion criteria. The study was conducted after obtaining the clearance from Institutional Human Ethical Committee.Study Design: Prospective descriptive study.Results and analysis: 30 patients were included in the study. Age range, 20 to 80 years with a tympanic perforation (size, up to one-quarter of the pars tensa). Out of which 24 % had graft failure due to variety of causes. Success rate was 76% in our study, where as the study conducted by Ringenberg et al. The success rate was 86.5%. Posterior perforations had an overall closure rate of 63%, and in anterior perforations, the overall closure rate was 36%.Conclusion: In conclusion it is simple, safe, quick, economical procedure done under local anesthesia with as success rate as temporalis fascia and minimal or no morbidity and complications. The failure rate in our study was 24% due to infection, detached fat graft and dehiscence due to undersized grafts. Posterior perforations had an overall closure rate of 63%, and in anterior perforations, the overall closure rate was 36%. Pure tone audiometry was used to assess average AB gap pre and post operatively. Postoperatively there was an improvement in hearing compared to preoperative hearing.

Central versus marginal tympanic membrane perforations: does it matter? An analysis of 792 patients

Background There is a lack of studies concerning chronic otitis media without cholesteatoma. Objectives To perform an analysis of tympanic membrane perforations (TMP), compare the parameters of central and marginal TMP, combining both the traditional and more recent technologies available. Material and methods 792 consecutive patients. The TMP subgroups were divided by central and marginal locations and compared based on signs suggestive of previous tympanic retraction, namely, medialized malleus, tympanic remnants over the promontory, tympanic remnants over the ossicular chain, and incus/stapes erosion. Analysis of the status of the contralateral ear (CLE). Results Central TMP was diagnosed in 79.8%. Compared with the central group, the marginal group had more reported hearing loss (95.6%), greater conductive hearing loss (pure tone average for air-conduction 43.3 dB and average air–bone gap of 28.7 dB), a larger perforated area (46.45%), more posteroinferior quadrant involvement, a greater number retraction signs prior to the TMP, and more changes in the CLE (71%). Conclusion The differences between TMP subgroups are highlighted when we use all technologies available to compare them. Marginal TMPs have more altered parameters than central TMPs. Significance There is a great possibility to enhance the knowledge of TMPs and to improve the pathogenesis-based treatment.