Background and aim:Retro-auricular approach using an autologous graft is the predominant surgical method for myringoplasty (MPL). Endaural and transcanal or endoscopic approaches are also used. There is no definitive consensus on the best MPL surgical technique. Aim of this study is to compare the two most used technique, over and underlay MPL, to evaluate the difference in anatomical and functional outcomes.Methods:We made a retrospective analysis of 497 adult patients who underwent underlay or overlay primary MPL, between 2010 and 2018, and evaluated the difference in anatomical and functional outcomes.Results:Successful functional results, evaluated after 18 months from surgery, were obtained in 380 patients (76,4%); in the underlay MPL, a successful result was obtained in 85%, in the overlay technique in the 68%. we observed anatomical failure in 13.4% patients; In detail 9,8% underwent MPL underlay and 17,2% MPL overlay.Conclusions:Our results indicate that underlay technique involves fewer complications. We believe that this remains the technique to prefer, except in subtotal or wide anterior perforations that could be better managed with the overlay technique. (www.actabiomedica.it)

Aim: This study aims to analyze the use of autologous platelet-rich plasma (PRP) to improve graft uptake and benefit on hearing after myringoplasty. Objectives: The objective is to compare pre- and post-operative graft uptake and audiological benefit following myringoplasty with and without PRP. Materials and Methods: A total of 70 patients diagnosed with chronic suppurative otitis media tubotympanic type were divided into groups of 35 each. Patients in group one who underwent myringoplasty with PRP while in second group underwent myringoplasty without PRP. Pre- and post-operative graft status and pure tone audiometry were performed for all the patients, and the outcomes were compared. Results: Of 35 patients in each group; four in the study group and eight in the control group had residual perforation. Graft uptake in case group was 88.57% and graft uptake in the control group was 77.1%. Result was better in cases that underwent myringoplasty with PRP. Of 35 patients in case group, audiological improvement (>10 dB) was seen in 31 patients (88.57%), whereas in the control group of 35 patients, 27 (77.1%) had audiological benefits. Conclusion: This study shows there is a definite benefit using PRP in myringoplasty. As the PRP can be easily prepared, PRP myringoplasty can be routinely performed.

Introduction: Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world-wide especially in developing countries where large percentage of the population lacks specialized medical care. With a large number of patients frequently undergoing tympanoplasty for chronic suppurative otitis media (CSOM), it is important to assess the severity of the disease and predict the outcome of the surgical management. Aims and Objectives: To study the efficiency of MERI in predicting the outcome of tympanoplasty in all age-groups. Materials and Methods: A prospective study was carried out in the department of Ear Nose and Throat (ENT), Banaras Hindu University (BHU), Varanasi, where all cases of chronic suppurative otitis media in the age-group of 8–40 years were included from September, 2017 to December, 2018. Total 74 patients with unilateral or bilateral perforation of tympanic membrane were included and these were followed-up for 4 months after surgery. Results: Maximum cases fell under MERI 1-3 (mild disease) and these patients had the best prognosis after tympanoplasty. Patients with unilateral perforation had better success rate as compared to patients with bilateral perforation. Conclusion: Our study showed that myringoplasty is a good treatment modality in the paediatric population and MERI scoring can be useful in predicting the outcome of tympanoplasty in all age-groups.

Hearing Assessment in Myringoplasty

Retrospectively analyzed the influences of preoperative acoustic immittance pressure balance tests and intraoperative wet ear findings in myringoplasty surgery results. One hundred and twenty-one chronic suppurative otitis media patients underwent myringoplasty surgeries were included and divided into functional group and non-functional group according to preoperative acoustic immittance pressure balance tests. Meanwhile, cases were divided into dry ear group and wet ear group according to intraoperative findings. Postoperative hearing improvement and perforation rate were compared between the two groups. Functional group had 72 cases, including 58 dry ears and 14 wet ears. Non-functional group had 46 cases, including 19 dry ears and 27 wet ears. Postoperative hearing improvement rate in functional group was 85.5% (59/69), and 72.1% (31/43) in non-functional group (χ(2) = 2.230, P = 0.093). Perforation rate in functional group was 16.7% (12/72), significant higher when compared with 2.2% (1/46) in non-functional group (χ(2) = 4.626, P = 0.015). Postoperative hearing improvement rate in dry ear group was 85.3% (64/75), and 71.8% (28/39) in wet ear group (χ(2) = 2.213, P = 0.085) . Perforation rate in dry ear group was 12.8% (10/78), and 7.0% (3/43) in wet ear group (χ(2) = 0.472, P = 0.377). Non-functional result of preoperative acoustic immittance pressure balance test had significant relationship with the intraoperative wet ear findings. It may result in lower postoperative hearing level, and lower perforation rate. Large sample studies should be carried out in future.

Aims:To predict the prognostic factors for myringoplasty and type 1 tympanoplasty. Methods and Material: The study was conducted in the Department of Otolaryngology & Head & Neck Surgery of a Postgraduate Medical Institute in South India. It comprised a retrospective chart review of patients with chronic suppurative otitis media between ages 10 and 58 years, who underwent myringoplasty during 2004-2010. Results: A total of 104 patients were included in the study of which 69 had unilateral disease and 35 had bilateral disease.The factors indicating good outcome were inctive stage of the disease, unilateral disease, male gender, middle age group, cellular mastoid and no evidence of focus of infection.

DOI: http://dx.doi.org/10.3329/bmj.v41i3.18959Bangladesh Medical Journal 2012 Vol.41(3): 45-48

Is office‐based myringoplasty a suitable alternative to surgical tympanoplasty?

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.

Objective To evaluate the effect and safety ofotoscopic myringoplasty and microscopic myringoplasty.Methods PubMed,CNKI,VIP database and Wanfang database were searched to identify citations mentioned otoscopic myringoplasty or microscopic myringoplasty.In addition,manual collection of clinical study of related reviews and its references were also conducted.Inclusion criteria of the ordinance made Meta analysis.Results A total of 15 clinical studies with 915 patients (otoscopic group was in 691patients and microscope group was in 224 patients) was identified.According to Q test,there was no heterogeneity between 2 groups (I2 =0),all computed by fixed effects model.Meta analysis demonstrated that there was no significant difference between 2 groups on the type of perforation (OR =1.00,95％ CI:0.70-1.42,P =0.13).Both curable rate and enhance of air conduction had no significant difference between 2groups (OR =0.97,95％ CI:0.72-1.29,P=0.97;OR =1.14,95％ CI:0.68-1.91,P=0.96).The curable rate in otoscopic group was 0.92 (95％ CI:0.90-0.94),and the complication rate was 0.030 (95％ CI:0.009-0.051).Conclusions The available clinical evidence shows that there is no significant difference between otoscopic myringoplasty and microscopic myringoplasty.However,otoscopic myringoplasty should be recommended to perform in clinical practice because of the feasible and convenient procedure. Key words: Surgical procedures, minimally invasive; Meta analysis; Ear endoscope; Tympanic membrane suture

Objectives: The aim of this study is to relate the tobacco smoke with graft failure and also with audiometry. Material and Methods: A retrospective review of medical records of patients undergoing myringoplasty or tympanoplasty type I, from July 2003 to December 2006. Results: Of 176 procedures, 19.53% of non-smokers and 22.92% of smokers have graft failure. The mean of the difference between preoperative and postoperative SRT was 13.17 dB in non-smokers and 12.79 dB in smokers. The mean of the difference between ABG and post-operative was 12.02 in non-smokers and 12.41 in smokers. None of these differences was statistically significant. Conclusions: To date, there has been no definitive study on the role of tobacco in tympanoplasty however some studies have shown worse outcomes in smokers.

Endoscope assisted myringoplasty

Introduction: Tympanoplasty associated to ossiculoplasty has the objective to reconstruct the tympanic membrane and the ossicular dynamics in order to restore the isolation of the middle ear and of hearing. Several materials have being used to recreate the sound transmission mechanism of the middle ear. The substitution or the reconstruction includes the use of biologic or aloplastic materials.Materials and methods: The authors describe two reconstruction methodologies of the ossicular chain trough type II tympanoplasty making a comparative analysis between: 1) Use of PORP and 2) Use of shaped incus interposed between the stapes and the tympanic membrane.Results: The use of partial ossicular replacement prosthesis (PORP) for interposition between the tympanic membrane and the stapes was used in situations of ossicular erosion or in situations where it was necessary to remove the incus and the malleus for a more effective control of the chronic infectious process. The shaped incus was used with the knowledge the the underlying disease was controlled. Myringoplasty was executed with temporal muscle fascia using underlay or overlay technique depending on the dimension and location of the tympanic perforation. Both alternatives were effective in what concerns recovery of the hearing loss.Conclusion: The ideal prosthesis for ossicular reconstruction must be biocompatible, stable, secure, easy to use and capable of resulting in a better sound transmission. The prosthesis selection is related with all these factors associated to the pathology and the intraoperatory conditions. The aloplastic PORP’s and the autologous material prostheses have proved to be equally effective restoring middle ear function.

Myringoplasty is commonly done under microscopy. This article discusses the experience of the authors in performing myringoplasty using endoscope. Endoscope is being widely used to perform various surgeries. Endoscopes are very useful while operating in cavities. In this study authors report their results of 50 myringoplasties performed using endoscope. This article reveals that results of myringoplasty performed using endoscope are more or less similar to that of myringoplasty performed using microscope

The aim of this study was to research the advantages and disadvantages of using a wet or dry temporalis fascia graft in myringoplasty surgery. Randomized prospective study. Teaching and research hospital. Dry graft was used in 210 cases, and wet graft was used in 174 cases in 384 patients who underwent tympanoplasty. (1) Rate of primary closure of perforation, (2) rate of recurrent and residual perforation, (3) difference in hearing improvement between the two groups, (4) total operation time and graft placement time, and (5) histologic properties of wet and dry fascia grafts. The success rate was 91.4% (159 of 174) in the wet graft group and 88.6% (186 of 210) in the dry graft group. There were no differences between groups regarding recurrent disease, residual disease, and postoperative hearing results (p > .05). The mean operation time and graft placement time were shorter in group 2 (wet graft), and this difference was found to be statistically significant (p < .01). Histologically, the number of fibroblast nuclei was higher in group 2 (wet graft), and this was statistically significant (p < .01). The temporal fascia graft has a high success rate regardless of its use, either wet or dry. Using wet grafts can shorten the operation time and result in a high number of fibroblast nuclei histologically.

‘Over-under’ myringoplasty with umbus-anchored graft

Objective To evaluate the application of the inlay butterfly cartilage graft technique in myringoplasty.Methods Thirty--eight ears in 38 patients (experiment group) with dry central drum perforations were treated with inlay butterfly cartilage myringoplasty,and 46 ears in 46 patients with underlay temporalis fascia myringoplasty (control group).Results After a mean follow-up of 6 months,the healing rate did not differ between two groups (92.1% in experiment group,91.3% in control group,P＞ 0.05).Average pure-tone hearing threshold improved than 10 dB and closure of the air-bone gap (ABG) within 10 dB were not different (P ＞ 0.05).The cured patients were followed up for 12-38 months,there was no ear perforation of drum in experiment group,but 4 ears in control group.Condusion Inlay butterfly cartilage myringoplasty is the reliable and ideal method for tzeating dry central drum pedoration with high success rate. Key words: Tympanic membrane perfomtion; Earcartilaga; Myringoplasty

Objective: The purpose of this study was to determine the acoustic transfer characteristics of cartilage for optimal cartilage myringoplasty. Material and Methods: We developed a cartilage plate-tympanic membrane coupled finite element model to investigate the transfer characteristics of cartilage myringoplasty. Cartilage specimens of the tragus were obtained from fresh human cadavers and were investigated by means of a tympanic membrane model. The parameters of tragus were determined by curve fitting and cross calibration. The cartilage plate was reconstructed based on an ear drum perforation using our 3-dimensional middle ear biomechanical model. The optimal thickness of cartilage myringoplasty was calculated using finite element analysis. Result: Reducing cartilage thickness leads to an improvement into acoustic transfer qualities. From an acoustic point of view, 0.1-0.2 mm thick cartilage plate seems to give the best results in term of tympanic membrane vibration. Conclusion: Tragal cartilage is useful for reconstruction of tympanic membrane from the perspective of acoustic properties. The acoustic transfer loss by the cartilage can be reduced by decreasing its thickness. A thickness of 0.2 mm at lower frequency and 0.1mm at higher frequency are regarded as a good compromise between sufficient mechanical stability and low acoustic transfer loss.

Lateralization of Fascia Graft Myringoplasty

Fibrine Gule in Myringoplasty