Management Of Tympanic Membrane Perforation Research Articles

Rate and management of tympanic membrane perforations in children with Down syndrome and middle ear disorder

ObjectiveTo characterize the management and outcomes of observation versus surgical intervention of tympanic membrane (TM) perforations in children with Down syndrome (DS). In addition, to estimate the prevalence of TM perforations in children with DS. MethodsRetrospective case review analysis of TM perforation rate in children with DS with history of tympanostomy tube (TT) insertion at a tertiary pediatric referral center. Patients were divided into observation or surgical intervention groups and then further evaluated for the type of intervention, the number of required procedures, and success rate of hearing improvement. Risk factors contributing to perforations were analyzed, including TT type, number of TT surgeries, and perforation size. ResultsThe TM perforation rate in children with DS with TT history was 7.0 %. Tympanoplasty was performed in 41.5 % of perforated ears with a success rate of 53.1 %. There was no statistical difference between the surgical intervention and observation groups regarding perforation characteristics or TT number and type, but the surgical intervention cohort was older. Hearing improvement based on postoperative pure tone average (PTA) threshold was noted in the successful surgical intervention group. ConclusionThe rate of TM perforations in children with DS after TTs is comparable to the general population. Improved PTA thresholds were noted in the surgical success group influencing speech development. The overall lower success rate of tympanoplasty in patients with DS emphasizes the need to factor in the timing of surgical intervention based on the predicted age of Eustachian tube maturation.

Type 1 Tympanoplasty by Interlay Technique for Management of Tympanic Membrane Perforation

Tympanic membrane is the partition between the external ear and middle layer which is a vital component of the human ear. Neglected or maltreated earache, ear discharge and trauma lead to perforation of tympanic membrane. Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with/without reconstruction of the ossicles, with the aim of preventing reinfection and restoring hearing ability. Type 1 tympanoplasty is the simple closure of the tympanic membrane perforation. To study the outcome of type 1 tympanoplasty operation by interlay technique, a descriptive longitudinal study was conducted among 200 patients in Community Based Medical College Hospital and in private clinics of Mymensingh from January 2012 to December 2021. Our inclusion criteria was population of age ranging from 15 to 55 yrs of both sexes having dry central perforation for at least 6 weeks and exclusion criteria was patient with active stage of chronic suppurative otitis media (CSOM), ossicular discontinuity, sensory neural hearing loss. Data was analyzed by SPSS version 20.0. Prevalence of taking graft was 96.00%. Measured by difference of preoperative air bone gap (ABG) and postoperative ABG of 15 decibel (dB) hearing improvement rate was 90%. Complication was minimal (1%). The complication was infection due to non-compliance with postoperative advice and treatment. Type 1 tympanoplasty done by interlay technique has excellent results both in terms of graft taken and hearing improvement with minimal complications.
 CBMJ 2023 January: Vol. 12 No. 01 P: 67-72

Management of Tympanic Membrane Perforation with Cartilage Tympanoplasty in Relation to Temporalis Fascia Graft Technique

An Observational Study was undertaken at Department of Otorhinolaryngology,. The aim of this study was to observethe outcome of cartilage tympanoplasty for tubotympanic type of CSOM. All the patients attending ENT OPD at SIMSwithin the age group of 11-60 years, irrespective of sex with tubotympanic CSOM either unilateral or bilateral wereincluded in this study. In our study of 80 patients, 40 patients had graft uptake after disease clearance and 8 had failureof graft uptake without chronic otorrhoea and 2 had failure with chronic otorrhoea. Through this study we concludedthat cartilage tympanoplasty for tubotympanic type of CSOM is an excellent technique for complete removal of diseaseespecially from inaccessible areas of middle ear cleft.

A Comparative Study of the Interlay and Underlay Techniques of Tympanoplasty Type І for Management of Tympanic Membrane Perforation

Background: The remaining chronic non healing perforations result in recurrent ear discharge causing great discomfort to the patient and decreased hearing.Objectives: We aimed to assess and compare the results of the underlay and interlay techniques of tympanoplasty type I in cases of medium to large sized dry central tympanic membrane perforation.Patients and methods: : Prospective study was carried out on 54 patients having medium to large sized central tympanic membrane perforation who were divided randomly into two groups.Group I patients underwent for underlay tympanoplasty type I, while group II patients underwent for interlay tympanoplasty type I. Hearing results were assessed by comparing the preoperative and postoperative pure tone audiogram as well as closure of the air-bone gap.Results: In terms of graft uptake 3-months postoperatively, in the underlay group, the success rate was 92.6%, while in the interlay group, the success rate was 96.2%. In terms of hearing improvement at the end of the 3rd month, in the underlay group, 40.8% of the patients had hearing gain from 11-20 dB, while in the interlay group, 66.7% of the patients had hearing gain from 11-20 dB.Conclusion: The success rates for the interlay technique is better than the underlay technique and have been quite promising. Therefore, such technique should be more practiced among the surgeons.

Authors' Reply to the Letter to the Editor: "Endoscopic Tympanoplasty in the Treatment of Chronic Otitis Media" a Comment to the Article: "The Management of Tympanic Membrane Perforation with Endoscopic Type I Tympanoplasty".

Authors' Reply to the Letter to the Editor: "Endoscopic Tympanoplasty in the Treatment of Chronic Otitis Media" a Comment to the Article: "The Management of Tympanic Membrane Perforation with Endoscopic Type I Tympanoplasty".

The Management of Tympanic Membrane Perforation With Endoscopic Type I Tympanoplasty.

The objective of this study is to describe what we consider to be the state-of-the-art procedure for the treatment of tympanic membrane perforations, and to present the results attained in our institution. A retrospective cohort study, using data of Verona University Hospital, Italy. This medical record includes the data of 98 patients who underwent 100 transcanal endoscopic type I tympanoplasties from November 2014 to October 2017. Tertiary referral center University Hospital of Verona, Italy. Were enrolled 109 patients, that underwent endoscopic type I tympanoplasty in the period considered. Out of the selected patients, 11 (10.1%) were lost to long-term follow-up, and were therefore excluded from our study. Other exclusion criteria were surgical approaches that included other procedures. Patients whose follow-up was shorter than 6 months were excluded from this study. The technique is based on an endoscopic placement of underlay graft of temporal fascia or tragal cartilage. We consider the data of four surgeons from Verona University ENT department. In the study we considered the reduction of the Air Bone Gap as functional outcome and the integrity of the reconstruction as anatomical outcome of success. No major intraoperative complications were observed. The closure rate was 86%. The mean surgery time was 48.6 minutes. The air bone gap was improved within 20 DB HL in 89% of patient. Only 8% of patients needed revision surgery, and none needed a third surgical evaluation. Endoscopic ear surgery is by now a reality that has replaced in many cases exclusive microscopic ear surgery. Transcanal endoscopic type I tympanoplasty can be considered nowadays as an alternative technique for tympanic membrane perforations.

Role of Stem Cells in Healing of Tympanic Membrane Perforations

AbstractBackground: Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can self-renew to produce more stem cells. Currently, surgery is the treatment of choice for repairing the perforation. However, surgery is time-consuming and expensive, and there is a risk of complications. Repairing a perforation by office techniques has been successful for a few cases for small traumatic perforations.Aim of Study: In this study we aimed to study the role of stem cell therapy in management of tympanic membrane perforations by otoscopic examination, microscopic, endo-scopic examination and audiological assessment.Patients and Methods: Thirty patients included in our prospective study in Al-Zahra University Hospital and Shebin El-Kom Teaching Hospital from April 2014 up to December 2018. These patients were operated for simple myringoplasty with stem cell technique. These patients followed-up with otomicroscopic examination of the perforation, tympanometry and pure tone audiometry.Results: There were female patients much more than male patients. The mean age of the patients was 31.9±8.2 years. There is highly significant improvement in the air bone gap and ear canal volume differences before and 3 months after the operation. Doctor satisfaction was 96.7% while patient satisfaction was 94.1%. 96.7% of cases had successful results of perforation closure. Of 30 patients operated by stem cells therapy under complete aseptic techniques 29 patients TM perforations had completely healed after first trial (success rate 96.7%) and one case failed (failure rate 3.3%).Conclusion: Stem cells therapy is a new effective technique more safer successful, economic, easier to operate and time consuming than the traditional tympanoplasty. When the perforation is small to medium size maximum 4 X 4mm and dry since more than one month. This technique is better and to avoid complications and side effects of general anaethesia.

Preparation of gelatin/genipin nanofibrous membrane for tympanic member repair

The wound healing for tympanic membrane (TM) perforations is one of the most common clinical treatment in otomicrosurgery. Recently, tissue-engineered composites and grafts, also new designs of biomaterials are applied to the management of TM perforation. In this work, a series of gelatin/genipin nanofibrous films were prepared as a patch for repairing TM perforation. Gelatin, a type of biomaterial with excellent electrospinning performance, has been used for preparing the nanofibers. The genipin, as a crosslinking agent, has been blended into the gelatin nanofibers. The reaction between gelatin and genipin engender suitable tensile strength and water-resistance for TM patch. The survival rate of human umbilical vein endothelial cells and fibroblasts demonstrated that the gelatin/genipin nanofiber scaffolds had good biocompatibility, which indicated the genipin was a kind of effective and nontoxic crosslinking agent for improving the mechanical property and water-resistance of gelatin films. In short, our work provides a novel macromolecular material with good mechanical properties, water-tolerance and excellent biocompatibility which could be used as a potential patch for TM repair.

Preparation of CS/PVA Nanofibrous Membrane with Tunable Mechanical Properties for Tympanic Member Repair

The wound healing for tympanic membrane (TM) perforations is one of the most common clinic treatment. New designs of biomaterials, and lately tissue-engineered composites and grafts, have been applied for the management of TM perforation. In this work, a series of chitosan (CS)/polyvinyl alcohol (PVA) nanofibrous films have been fabricated as a kind of patch for repairing TM perforation. The scaffolds were crosslinked by glutaraldehyde solution to prevent them from being dissolved in the culture medium. The morphology of nanofibers from different precursors has been observed by using scanning electron microscopy (SEM). And the crosslinked films have been characterized by SEM and Fourier transform infrared spectroscopy for confirming its morphology and chemical structure. We found the films with crosslinking showed stronger tensile strength and modulus compared to the uncrosslinked one. And the mechanical properties could be tuned by the crosslinking time. In addition, after crosslinked, the films showed good thermostability and water-resistance, characterized by thermo gravimetric analyzer and contact angle meter. The cell viability studies with human umbilical vein endothelial cells, fibroblasts and mesenchymal stem cells demonstrated that the nanofibrous scaffolds formed by electrospinning process had no side effects for cell proliferation. However, a better way of crosslinking CS/PVA films needs to be further studied.

Pattern of tympanic membrane perforation in a tertiary hospital in Nigeria.

Tympanic membrane perforation is a common otological disorder with associated hearing impairment. This study aimed at determining the clinicoepidemiological pattern, etiological factors, clinical presentation, and management of tympanic membrane perforation in a tertiary hospital in Nigeria. This was a prospective, hospital-based study of patients with the clinical finding of perforated tympanic membrane. The study was carried out over a period of 5 years (September 2012 to August 2017). Interviewer-assisted questionnaire was administered to obtain the detailed history and clinical findings from consenting patients. Data collected were collated and analyzed using SPSS version 16.0. A total of 529 patients had tympanic membrane perforation, of which 368 (69.6%) were males and 161 (30.4%) were females with a male-to-female ratio of 2:1. The prevalence of tympanic membrane perforation in this study was 7.8%. The most common presenting symptom among the patients was otorrhea in 81.5%, otalgia in 72.8%, and tinnitus in 55.7%. Acute suppurative otitis media was a cause of tympanic membrane perforation in 28.4% of the patients while 55.7% of the patients proceed to chronic suppurative otitis media. Unilateral tympanic membrane perforation was 79.0%. The left ear tympanic membrane perforation was 43.9%. Grade 1 tympanic membrane perforation accounted for 39.3% while grade 2 accounted for 32.3%. The most common types of tympanic membrane perforation were central in 38.2%, anterior central in 32.3%, and posterior central in 19.3%. Conductive hearing impairment accounted for 61.6% while sensorineural hearing impairment 25.3%. The most common degrees of hearing impairment were mild and moderate and accounted for 47.1% and 25.1%, respectively. The most common complications of tympanic membrane perforation were hearing impairment in 52.6%. Majority of the patients (425) were treated conservatively, six had fat patches, while 98 were treated surgically. Tympanic membrane perforation healed at the end of 3 months in 81.5%, while 18.5% did not heal after 3 months. Tympanic membrane perforation arises mainly from middle ear infections and traumatic causes. At presentation, size and location of perforation vary which depend on duration of infection or the traumatic causes.

Tissue Engineering of the Tympanic Membrane

Tympanic membrane (TM) perforations are common, with current treatments for chronic perforations involving surgery, using various graft materials, from autologous cartilage or fascia through to paper patch. Recent research developments in this field have begun applying the principles of tissue engineering, with appropriate scaffolds, cells, and bioactive molecules (BMs). This has revolutionized the therapeutic approach due to the availability of a wide range of materials with appropriate compatibility and mechanical properties to regenerate the membrane acoustics and may also represent a paradigm shift in the management of TM perforations in an outpatient setting without surgery. However, many factors need to be considered in the fabrication of a bioengineered TM. This review discusses the issues associated with current treatment and examines TM wound healing relevant to the construction of a bioengineered TM. It also describes the tissue-engineering approach to TM regeneration by summarizing currently used scaffolds, BMs, and cells in TM wound healing. Finally, it considers the design of scaffolds, delivery of BMs, and cell engraftment toward potential clinical application.

Clinical Presentation and Conservative Management of Tympanic Membrane Perforation during Intrapartum Valsalva Maneuver

Background. Tympanic membrane perforation may occur when ear pressures are excessive, including valsalva maneuver associated with active labor and vaginal delivery. A pressure differential across the eardrum of about 5 psi can cause rupture; the increased intraabdominal pressure spikes repeatedly manifested by “pushing” during second-stage labor easily approach (and may exceed) this level. Material and Method. We describe a healthy 21-year old nulliparous patient admitted in active labor at 39-weeks' gestational age. Results. Blood appeared asymptomatically in the left ear canal at delivery during active, closed-glottis pushing. Otoscopic examination confirmed perforation of the left tympanic membrane. Complete resolution of the eardrum rupture was noted at postpartum check-up six weeks later. Conclusion. While the precise incidence of intrapartum tympanic membrane rupture is not known, it may be unrecognized without gross blood in the ear canal or subjective hearing loss following delivery. Only one prior published report on tympanic membrane perforation during delivery currently appears in the medical literature; this is the first English language description of the event. Since a vigorous and repetitive valsalva effort is common in normal vaginal delivery, clinicians should be aware of the potential for otic complications associated with the increased intraabdominal pressure characteristic of this technique.

Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot treatment algorithm

Purpose The objective of this study was to examine the success of a pilot treatment algorithm for tympanic membrane perforations in children after tympanostomy tube placement. Materials and Methods A retrospective chart review of children with diagnosed tympanic membrane perforations after tympanostomy tube placement from 1998 to 2003 at a tertiary care children's hospital was performed. The patients had been treated according to an algorithm used by 2 pediatric otolaryngologists for management of tympanic membrane perforations: observation vs myringoplasty. Success rates were examined. Results Ninety-five children were identified, 27% of whom had nonhealing perforations after tube extrusion; 73% of the perforations were caused by a retained tube. The median duration of tube retention was 48 months, ranging from 13 to 120 months. After the treatment protocol, 76% of the patients underwent gelatin film or paper patch myringoplasty, 23% had adipose myringoplasty, and 1% were observed. Overall, 91% had healed perforations after the first intervention. Among those requiring a second intervention, the sizes of initial perforations were between 15% and 40%, with postrepair perforation sizes between 5% and 40%. In addition, 75% of those requiring a second intervention underwent tympanoplasty repair and 25% had fat patch myringoplasty. None required a third intervention. Conclusions Our treatment algorithm for children with tympanic membrane perforations after tympanostomy tube placement appears to be successful and is an excellent model for other clinicians.