Complete Closure Of Perforation Research Articles

ENDOSCOPIC TRANSCANAL TRANSTYMPANIC POP THROUGH TECHNIQUE OF MYRINGOPLASTY USING TRAGAL PERICHONDRIUM GRAFT

INTRODUCTION A perforated tympanic membrane is most commonly repaired using temporalis fascia graft by microscope assisted post auricular approach and underlay technique, we present an alternative technique to repair the perforated tympanic membrane using an alternative easily accessible graft material like tragal perichondrium, by endoscope assisted trans canalicular approach, where the graft is placed medial to the tympanic membrane remnant by pop through technique. OBJECTIVE T h e u s a g e o f r i g i d 4 m m e n d o s c o p e f o r myringoplasty allows better visualization, magnification and reconstruction of perforated tympanic membrane using tragal perichondrium is minimally invasive. The purpose of the study is to put across our experience in 69 patients where endoscopic assisted myringoplasty was done using tragal perichondrium graft. The graft was placed medial to the tympanic membrane remnant by trans tympanic pop through technique and tympanomeatal flap was not raised. METHOD This study was done over a period of 3 years, 69 patients with chronic suppurative otitis media fitting into the inclusion criteria underwent endoscopic transcanal myringoplasty using tragal perichondrium as graft material by underlay pop t h r o u g h t e c h n i q u e . T h e p o s t o p e r a t i v e audiological improvement in closure of air bone gap on pure tone audiometry, success in tragal perichondrium graft uptake, and mean operative time was evaluated. RESULTS The study population was 69 with predominantly females, the post operative pure tone audiometry showed that 39.1% had closure of airbone gap of 10db, 17.4% showed air bone gap closure of 20bd and 43.5 % showed air bone closure of 15db. 85% had success of graft uptake (i.e. complete closure of perforation) at 6 weeks post op .The mean operative time was 80 minutes. CONCLUSION Endoscopic assisted trans-canalicular (pop t h r o u g h t e c h n i q u e ) o f s i m p l e u n d e r l a y myringoplasty using tragal perichondrial graft is simple, minimally invasive with good post operative improvement in hearing and can be d o n e a s a d a y c a r e p r o c e d u r e w i t h o u t complications. KEYWORDS Endoscopic myringoplasty, tragal perichondrium , pop in technique.

Interposition Technique for Septal Perforation Using a Composite Graft Made Up of Allograft Dermal Matrix and Autologous Cartilage

Background and Objectives Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach.Results The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8).Conclusion Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.

Endoscopic Tympanoplasty: The Fringed Shield Technique

Introduction: Endoscopic tympanoplasty has become popular in the past few years. To reach anterior quadrants of the middleear for adequate graft setting and complete perforation closure, most surgeons detach the remaining tympanic membrane from the umbus. This maneuver may cause elevation of the anterior tympanomeatal angle and result in blunting and worse audiometric thresholds. Objectives: Describe a tympanoplasty endoscopic technique with a modified full thickness cartilage graft that allows its positioning without the need to detach the malleus handle from the tympanic membrane. Data Synthesis: Because endoscopic ear surgery is an one-handed procedure, the graft needs to be stiff and easy to manipulate to facilitate its positioning and complete closure of the tympanic perforation. We describe a full thickness tragal cartilage graft shaped as an oval island with a wedge to accommodate the malleus handle and with the anterior and posterior edges fringed. This design allows its positioning in an underlay technique without the need to detach the malleus handle from the tympanic membrane. Thereby, without this maneuver, it is possible to prevent blunting and, consequently, reduce the odds of hearing loss. Conclusion: The fringed shield technique is a promising endoscopic approach with good hearing results. Although the hearing outcomes presented in this paper are not exclusive for the fringed shield technique, we would not expect different results since we have applied full thickness cartilage graft in most cases. Nevertheless, a larger series of patients submitted exclusively to the fringed shield graft would be necessary to confirm these data.

ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study
 Design: Descriptive study.
 Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018
 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia.
 Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

Repair of Large Nasal Septal Perforations Using the Upper Lateral Cartilage Mucosal Flap.

To describe the surgical technique and closure outcomes of larger septal perforation repair incorporating mucosa from the undersurface of the upper lateral cartilage into a superiorly positioned advancement flap. Retrospective case series. A chart review was performed for patients who underwent perforation repair utilizing bilateral nasal mucosal flaps which incorporated mucosa from the undersurface of the upper lateral cartilage into the superior flap between January 2009 and December 2020. Sixty-six patients met study criteria. Prior septal surgery was the most common (28.8%) etiology. Mean perforation length and height were 18.9 and 14.4 mm, respectively. Complete perforation closure was noted in 91.2% of patients followed for a minimum of 6 months (mean follow-up time 32.1 months). Twelve patients underwent secondary surgery for persistent nasal obstruction. Postoperative loss of dorsal height was noted in seven patients. The NOSE-perf scores were available for the last 15 repairs and demonstrated significant symptom improvement from a mean score of 26.4 (95% confidence interval [CI], 5.2) to 14.5 (95% CI, 5.2) (P < .0001). The ventral surface of the upper lateral cartilage can provide additional mucosa for incorporation into a superior advancement flap to achieve successful closure for larger septal perforations. Optimization of surgical outcomes for this challenging condition may require secondary functional or aesthetic procedures. 4 Laryngoscope, 132:973-979, 2022.

Auricular Perichondrium Graft for Septal Perforation Repair.

Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

Over-Underlay technique of myringoplasty.

Objective: To observe the success rate of Over-underlay technique of myringoplasty in patients with inactive tubo-tympanic type of CSOM. Study Design: Descriptive, Observational study. Setting: ENT Department Fauji Foundation Hospital Rawalpindi. Period: December 2018 to December 2019. Material &amp; Methods: A total of 80 patients with inactive tubo-tympanic type of CSOM, from both genders, within age range of 15-45 years, having pure conductive hearing loss with an Air-Bone gap of not less than 15 dB were selected by convenient sampling technique. Patients having an active ear disease or previous history of ear surgery, an active sinus or URT disease, or any comorbidity were excluded from the study. Complete general and head-neck examination was done after taking history. Patients’ affected ears were examined under surgical microscope to see the drum perforation, condition of middle ear mucosa and the status of the ossicles. Hearing assessment was done by Pure Tone Audiometry through both air and bone conduction. Temporalis fascia graft myringoplasty was done in all these patients by over-underlay technique, and they were discharged on 5th post-operative day, and were followed up in ENT OPD after 3 weeks. Status of graft was seen under surgical microscope after removing the BIPP. After three months the patients were reviewed for graft status and hearing assessment. Successful outcome was taken as those patients in whom graft uptake was successful with complete closure of perforation, and secondly, closure of the Air-Bone gap by at least 10 dB. Data was analyzed by SPSS 19. Results: Mean age of the patients (n = 80) was found to be 30.8 Years. Gender distribution showed 57 (71.25%) Males and 23 (28.75%) Females with a M:F ratio of 2.5:1. Success rate was found significantly better among younger aged males. Graft uptake was successful in 74 (92.5%) of the patients. With respect to closure of A-B gap, post-operative mean difference in Air-Bone gap was found to be 9.6 dB ± 3.9 SD as compared to preoperative mean A-B gap of 28.5 dB ± 4.2 SD, thus a closure of A-B gap by 18.9 dB ± 2.4 SD. Conclusion: Over-underlay technique is found to be a successful technique for myringoplasty in terms of graft uptake and improvement in hearing thresholds in the patients with inactive tubo-tympanic type of CSOM.

Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery

This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. Case series. Tertiary care center. In this institutional review board-approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.

The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration

Background/Aims: This study was conducted to evaluate the long-term stability of fat-graft myringoplasty (FGM) for chronic tympanic membrane perforations, analyzing the perforation closure rate and re-gained hearing outcome with respect to the size and location of the perforations. Methods: Between August 2007 and June 2018, a total of 193 patients who underwent FGM due to chronic tympanic membrane perforation at a tertiary referral center were enrolled and analyzed. Results: The mean follow-up was 14.6 months (range 6–39). The complete perforation closure rate after FGM was 89.6%, with no statistical difference among the perforation size groups. The mean postoperative air-bone gap (ABG) was 11.0 dB and mean ABG improvement was 4.9 dB. Conclusion: Our FGM technique had a favorable tympanic closure rate for small to large perforations, and yielded relatively good hearing improvement in the mid-size perforation cases over long-term follow-up periods. According to the topographic evaluation of FGM, this procedure resulted in a reliable perforation closure rate and audiological results regardless of the perforation site.

Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?

To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. Prospective case series. Tertiary care facility. Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. In-office fat graft myringoplasty technique under local anesthesia. Complete perforation closure rate and audiometric outcomes. A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air-bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.

In situ grommet and fitness for flying

Introduction: Current policies followed in the country do not permit aircrew to fly with in situ grommet. This paper discusses the aeromedical implications of in situ grommet, assessment of its flying fitness, and the factors which may be considered for possible reflighting of such cases. Case Details: A 19 year old civil pilot developed otitic barotrauma middle ear (right) which was managed with the placement of grommet in the tympanic membrane (TM). He was awarded fitness to fly on removal of grommet and after complete closure of the residual TM perforation. Another case, a 50 year old military pilot, a case of chronic suppurative otitis media (inactive) left ear, after uneventful recovery, was awarded flying medical category initially for in situ grommet and subsequently for single dry perforation TM in the left ear with an waiver from the competent medical authority. Discussion: Insertion of grommet, in cases with middle ear effusion and/or infection following Eustachian tube dysfunction, is a common practice to promote early recovery. However, as per the current policies in India, such aircrew are considered unfit for flying duty. Policies in other countries, military and civil, are mostly silent. This paper recommends the award of flying fitness for aircrew with in situ grommet provided that the clinical condition is stable, there are no complications and hearing is normal. This paper also discusses the award of flying fitness for aircrew with single and uncomplicated TM perforation with normal hearing for a specific type of aircraft.

Use of Platelet Rich Fibrin in Acute Traumatic Tympanic Membrane Perforation Compared With the Conservative Treatment

Objectives: To evaluate the effect of platelet rich fibrin in treating acute traumatic tympanic membrane perforation as regards wound healing and hearing outcome compared with conservative treatment. Methods: This study was conducted on 50 patients presented with acute traumatic tympanic membrane perforation classified randomly into 2 groups: the study group; (25 patients) treated with platelet rich fibrin membrane and control group; (25 patients) underwent conservative treatment. Patients were followed up for 6 weeks to assess healing rate of the tympanic membrane perforation and hearing improvement. Results: In the group where platelet rich fibrin was used, complete perforation closure occurred in 88% of patients, while in the group treated conservatively, closure was obtained in 56% (P 0.004). The mean air bone gap improved in the platelet rich fibrin-treated group from 18.83±3.99 dB to 3.38±4.13 dB and in the control group from 18.90±3.43 dB to 9.84±8.04 dB. The post-treatment mean air bone gap significantly improved better in the platelet rich fibrin-treated group than in the control group (P 0.004). Hearing gain by >10 dB was obtained in 88% of patients in the platelet rich fibrin group and in 44% of patients in the control group (P 0.001). Conclusion: In comparison with the conservative management, platelet rich fibrin, as an autologus simple graft method, provided more healing rates with better audiological outcomes with low cost and no complications.

Use of nasal mucosa graft in tympanoplasty

IntroductionTympanoplasty techniques with different types of graft have been used to close tympanic perforations since the 19th century. Tragal cartilage and temporalis fascia are the most frequently used types of graft. They lead to similar functional and morphological results in most cases. Although little published evidence is present, nasal mucosa has also been shown to be a good alternative graft. ObjectiveSurgical and audiological outcomes at the six-month follow-up in type I tympanoplasty using nasal mucosa and temporalis fascia grafts were analyzed. MethodsA total of 40 candidates for type I tympanoplasty were randomly selected and divided into the nasal mucosa and temporalis fascia graft groups with 20 in each group. The assessed parameters included surgical success; the rate of complete closure of tympanic perforation and hearing results; the difference between post- and pre-operative mean quadritonal airway-bone gap, six months after surgery. ResultsComplete closure of the tympanic perforation was achieved in 17 of 20 patients in both groups. The mean quadritonal airway-bone gap closures were11.9 and 11.1 dB for the nasal mucosa and temporalis fascia groups, respectively. There was no statistically significant difference between the groups. ConclusionThe nasal mucosa graft can be considered similar to the temporal fascia when considering the surgical success rate of graft acceptance and ultimate audiological gain.

Transendothelial Perforations and the Sphere of Influence of Single-Site Sonoporation

Acoustically driven gas bubble cavitation locally concentrates energy and can result in physical phenomena including sonoluminescence and erosion. In biomedicine, ultrasound-driven microbubbles transiently increase plasma membrane permeability (sonoporation) to promote drug/gene delivery. Despite its potential, little is known about cellular response in the aftermath of sonoporation. In the work described here, using a live-cell approach, we assessed the real-time interplay between transendothelial perforations (∼30–60 s) up to 650 µm2, calcium influx, breaching of the local cytoskeleton and sonoporation resealing upon F-actin recruitment to the perforation site (∼5–10 min). Through biophysical modeling, we established the critical role of membrane line tension in perforation resealing velocity (10–30 nm/s). Membrane budding/shedding post-sonoporation was observed on complete perforation closure, yet successful pore repair does not mark the end of sonoporation: protracted cell mobility from 8 µs of ultrasound is observed up to 4 h post-treatment. Taken holistically, we established the biophysical context of endothelial sonoporation repair with application in drug/gene delivery.

Anatomical and Functional Consequences of Microneedle Perforation of Round Window Membrane.

Microneedles can create microperforations in the round window membrane (RWM) without causing anatomic or physiologic damage. Reliable delivery of agents into the inner ear for therapeutic and diagnostic purposes remains a challenge. Our novel approach employs microneedles to facilitate intracochlear access via the RWM. This study investigates the anatomical and functional consequences of microneedle perforations in guinea pig RWMs in vivo. Single three-dimensional-printed, 100 μm diameter microneedles were used to perforate the guinea pig RWM via the postauricular sulcus. Hearing was assessed both before and after microneedle perforation using compound action potential and distortion product otoacoustic emissions. Confocal microscopy was used ex vivo to examine harvested RWMs, measuring the size, shape, and location of perforations and documenting healing at 0 hours (n = 7), 24 hours (n = 6), 48 hours (n = 6), and 1 week (n = 6). Microneedles create precise and accurate perforations measuring 93.1 ± 29.0 μm by 34.5 ± 16.8 μm and produce a high-frequency threshold shift that disappears after 24 hours. Examination of perforations over time demonstrates healing progression over 24 to 48 hours and complete perforation closure by 1 week. Microneedles can create a temporary microperforation in the RWM without causing significant anatomic or physiologic dysfunction. Microneedles have the potential to mediate safe and effective intracochlear access for diagnosis and treatment of inner ear disease.

Experimental evidence for regenerative treatment of chronic tympanic membrane perforation

The aim of our study was an experimental evaluation of tissue engineering approach to chronic tympanic membrane perforation closure. Chronic tympanic membrane perforation models were created both sides in 12 chinchillas. Right sided perforations were divided into two equal groups (A and B) according to treatment; left sided perforations were used as a control group. Group A perforations were treated with collagen scaffold and fibroblast growth factor, group B perforations were treated with collagen scaffold only. During follow-up, we provided otovideoendoscopy for closure rates assessement every 2 weeks. In case of perforation closure, a morphological investigation of the regenerate was performed. Group A perforations were totally closed 2 weeks after treatment in all animals. In group B, complete closure of perforation was achieved after the third treatment procedure in one case. There were no spontaneous perforation closure in the control group. According to morphological investigation, the restoration of trilaminar structure was observed only in tissue engineering group tympanic membranes.

Endoscopic repair of septal perforation in children

ObjectiveBeing increasingly faced with the problem of pediatric nasal septal perforations, we have found that the surgical management of nasal septal perforations in children is not widely described in the litrature. The objective of our study was to demonstrate the results of different surgical techniques, including two original endoscopic techniques, in the septal perforation repair in children. Methods24 children, ranging between 6 and 17 years of age, with nasal septal perforations were operated using different endoscopic techniques from February 2015 to May 2019 at the special tertiary referral clinic. Apart from well-known techniques, such as anterior ethmoidal artery flap, intranasal bipedicled advancement flap, sublabial flap, free temporal fascia graft, we used two original techniques – inverted edges technique and cross-septal returned flap. ResultsThe total rate of complete perforation closure was 79% (19 of 24 patients). Regarding the reduction of symptoms, the efficacy of surgery was approaching 100%.The combination of inverted edges technique and anterior ethmoidal artery septal flap demonstrated the best results with no reperforations in all 10 cases. Using cross-septal returned flap, we achieved complete closure of perforation in 5 (83%) of 6 patients. The remaining techniques were performed rare and showed relatively low rates of success. There were 2 cases of complications (oronasal fistula), both developed in patients with sublabial mucosal flap. ConclusionUse of endoscopic assistance, vascularized mucoperichondrial flaps and bilateral closure demonstrates high effectiveness in septal perforation surgical repair in children. Level of evidence4.

What is the Role of Hyaluronic Acid Ester in Myringoplasty? Systematic Review and Meta-Analysis.

To reveal odds of tympanic membrane closure and postoperative hearing outcomes for myringoplasty utilizing hyaluronic acid ester via systematic review and meta-analysis. 1) Search of English articles in PubMed/Medline, Embase, and Cochrane databases published between January 1, 1998 and March 31, 2018. Inclusion criteria: 1) English language; 2) clinical studies; 3) reported posttreatment perforation status, hearing outcomes, or complications. hyaluronic acid used for middle ear packing or topical application of hyaluronic acid solution. Number of patients, surgical technique, mean age, overall rate of tympanic membrane closure, success rate based on size of perforation, mean air-bone gap improvement, and postoperative speech scores and complications. Ten studies encompassing 531 patients met criteria. Reported success rates for closure of chronic perforation ranged from 70.0 to 92.7% (mean, 85.21%). Smaller perforation predicted success in complete closure. Mean air-bone gap closure was 10.6 dB (4-24 dB). There were five complications reported. Meta-analysis was performed on five studies. No difference was noted in the success rates between hyaluronic acid ester myringoplasty and conventional tympanoplasty using fascia or perichondrium, with an overall closure rates of 89.8 and 89.4%, respectively (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.59-1.82, p = 0.896). A higher closure rate was seen in hyaluronic acid ester myringoplasty (87.9%) when compared with fat graft myringoplasty (70.8%), (OR 3.01, 95% CI 1.42-6.35, p = 0.004). Hyaluronic acid (HA) ester myringoplasty appears to be safe and effective at attaining complete closure of tympanic membrane perforation, although there exists significant selection bias and inconsistent reporting among existing papers.

Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting.

Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting. Retrospective case series. Tertiary care facility. Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection. In-office modified myringoplasty technique under local anesthesia without sedation. Complete perforation closure rate and audiometric outcomes. 250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04). The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

Surgical outcomes of tympanoplasty using a sterile acellular dermal allograft: a prospective randomised controlled study.

SUMMARYAcellular human dermal allografts have been shown to be effective for soft-tissue implantation. We compared treatment outcomes of tympanoplasty using tragal perichondrium and acellular human dermal allograft (MegaDerm®). In a prospective randomised controlled study, 60 patients scheduled to undergo tympanoplasty were randomly assigned to the autologous tragal perichondrium group (n = 33) or acellular human dermal allograft group (n = 27). Postoperative hearing gain, graft success rate at 1 and 6 months and operation times were compared between groups. Graft success rate, defined as the complete closure of tympanic membrane perforation, did not show any significant intergroup difference (75.8% vs 85.2%, p = 0.519). Air conduction thresholds and air-bone gaps showed significant improvements in both groups; from 38.7 ± 15.9 dB to 30.2 ± 15.6 dB (p < 0.001) and from 17.8 ± 7.3 dB to 11.5 ± 7.0 (p = 0.001) in the autologous tragal perichondrium group, and from 30.4 ± 12.2 dB to 24.5 ± 13.0 dB (p = 0.006) and from 14.3 ± 5.1 dB to 7.6 ± 4.6 dB (p < 0.001) in the acellular human dermal allograft group. The amount of hearing gain (p = 0.31) and closure of air-bone gap (p = 0.863) were not meaningfully different between groups. The mean operation time was significantly lower in the acellular human dermal allograft group (35.2 min vs 27.4 min, p = 0.039). In this prospective randomised controlled study, acellular human dermal allograft was shown to be an effective alternative to tragal perichondrium, with similar graft success rates and postoperative hearing results, but with reduced operation times.