Overlay Tympanoplasty Research Articles

Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method

ABSTRACT Purpose The purpose of this research is to study the role of tissue glue (TISSEL) in overlay tympanoplasty when compared with the conventional overlay method. Study design A prospective randomized comparative study was carried out at the ENT department of Base Hospital, Delhi, in which 60 patients with dry central perforation underwent overlay tympanoplasty. Out of these, 30 underwent conventional overlay tympanoplasty (control) and in the rest of the 30, overlay tympanoplasty was done with the use of tissue glue (cases). Results Graft take-up rate in control is 90% and in cases 96.7% (p > 0.05). Hearing improvement within 20 dB of A–B gap (at 03 months) in control is 86.70 and 96.70% in cases (p > 0.05). Early hearing improvement (at 6 weeks) in cases was better when compared with the control (p < 0.05). The complication rate in cases is 10% with residual perforation in 01 patient, while that in control is 16.66% with residual perforation in 03 patients (p > 0.05). Conclusion Graft take-up rate in hearing improvement was found to be better in overlay tympanoplasty with the use of tissue glue when compared with the conventional method with no statistically significant difference. The only significant advantage with the TISSEL group was found to be an early hearing improvement at 6 weeks. Tissue glue (TISSEL) was found to be safe and effective. How to cite this article Pimparkar SV, Sethi A, Das A, et al. Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method. J Med Acad 2020;3(2):33–37.

Effect of middle ear gelfoam on hearing and healing process after tympanoplasty: A prospective randomized case-control study.

This prospective randomized case-control study was performed to compare the surgical outcomes of our swing-door overlay tympanoplasty with or without absorbable gelatine sponge (AGS, gelfoam) packing in the middle ear cavity, according to the surgical procedure. Fifty-seven patients who underwent swing-door overlay tympanoplasty by a single surgeon were enrolled in the study. The data of 30 patients of the gelfoam-packing group (GPG) and 27 patients of the non-gelfoam-packing group (NGPG) were prospectively collected and compared. Closure of the tympanic membrane was found to be successful in all patients at postoperative 3months evaluation. NGPG showed a statistically better healing process compared to GPG; earlier epithelialization and less fascia edema in NGPG than in GPG (P<0.05). The air-bone gap (ABG) measured at postoperative 1 and 2months was smaller in NGPG than GPG, although there were no statistical differences. This study revealed earlier healing process and faster recovery of ABG in NGPG, thereby indicating that the gelfoam in the middle ear may interfere with both hearing recovery and the healing process of neodrum.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

Objectives The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes.Methods Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed.Results A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P<0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%.Conclusion The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

PurposeIn 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort. Materials and methodsButterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap. ResultsThe reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%–100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB. ConclusionsThe butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.

Outcome of Overlay versus Underlay in Pediatric Tympanoplasty

Objectives: Determine whether overlay tympanoplasty has equivalent outcome to underlay tympanoplasty in children. Methods: A retrospective cohort study was performed. Data from primary tympanoplasties performed between 2005 and 2013 in children ages 2 to 13 years old by a single surgeon at a single pediatric tertiary care institution were reviewed. Outcome reviewed included anatomical success, hearing results and cholesteatoma. Results: A total of 104 cases were included; 21 overlay and 83 underlay tympanoplasties. Children having undergone an overlay tympanoplasty were more likely to have an anterior perforation ( P = .003); other characteristics were similar between the 2 groups including size of the perforation. The rate of anatomical success was 82% for underlay and 95% for overlay tympanoplasties (odds ratio = 4.41, P = .006). Children having undergone an overlay tympanoplasty had significantly worse hearing results ( P = .02) and had an increased rate of post-tympanoplasty cholesteatoma ( P = .03). After multivariate analysis controlling for the effect of perforation location and size the odds of anatomical success after overlay tympanoplasty was 2.45 times greater ( P = .44) compared to underlay tympanoplasty. Age and craniofacial anomalies were not found to influence the success rate of overlay compared to underlay tympanoplasty. Conclusions: In the current series, overlay pediatric tympanoplasty was associated with a higher rate of anatomical success, but worse hearing outcome and increased risk of cholesteatoma. Further, larger studies are needed to define which children benefit from the increased anatomical success rate of overlay tympanoplasty.

Experience with Overlay Tympanoplasty in 83 Chinese Patients

BackgroundIn many European and American hospitals, represented by the House Ear Clinic (HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay technique is used rarely. The aim of the current study was to report the authors’ experience with overlay tympanoplasty in 83 Chinese patients and study its value. MethodsEight-three patients (86 ears) underwent overlay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. ResultsAll patients gained stage I incision healing. The size of external auditory canal and tympanic membrane morphology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterioration or serious complications. ConclusionsOverlay tympanoplasty carries positive value in treating chronic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure, thorough disease elimination and extensive adaptation.

Loop overlay tympanoplasty for anterior or subtotal perforations

Objective To report our experience with “loop overlay” tympanoplasty, a modified overlay technique with a superiorly based skin flap, for the reconstruction of anterior, subtotal or total tympanic membrane (TM) perforations. Methods Retrospective review of patients undergoing loop overlay tympanoplasty from March 1998 to February 2007 was performed. Four hundred and twenty-nine patients who underwent loop overlay tympanoplasty and then follow-up visits a minimum of 6 months later were included in this study. Hearing test results were reported using a four-frequency (0.5, 1, 2, and 3 kHz) pure tone average air–bone gap. The outcome was considered successful if the TM was intact without lateralization or anterior blunting after the follow-up visit. Results There was a 98.8% success rate. There was no graft lateralization, anterior blunting, neocholesteatoma, or sensorineural hearing loss. The mean preoperative to postoperative four-tone air–bone gap improved from 23.5 to 8.1 dB, which is a mean gain of 15 dB; this was statistically significant ( p < 0.001, paired sample t-test). Conclusion The loop overlay graft method is a safe and effective technique for reconstruction of anterior, subtotal or total TM perforations, with excellent graft take and significant improvement of hearing. It provides a precise replacement of the flap and a preserved healing plane.

Experience in overlay tympanoplasty

To explore the experience and value of overlay tympanoplasty. Sixty-three ears with overlay tympanoplasty were reviewed and followed up for the external auditory canal, tympanic membrane and hearing. The diseases of the patients included middle ear cholesteatoma in 25 ears and chronic suppurative otitis media in 38 ears. The surgical techniques involved three kinds: overlay tympanoplasty, overlay tympanoplasty with canal wall up mastoidectomy and overlay tympanoplasty with canal wall down mastoidectomy. In middle ear cholesteatoma and suppurative otitis media patients, the case received the three techniques are 4, 17, 4 ears and 19, 18, 1 ears respectively. All patients gained stage I incision cure. Followed up for 0.5 to 3.5 years respectively, the external auditory canal was wide and tympanic membrane gained a good shape. The hearing in all case kept intact or increased while hearing decrease did not occur. Complications were free in patients with punctual visit. Overlay tympanoplasty has positive significance in treating the chronic otitis media with the merits of standard procedure, sufficient operative field and thorough erosion elimination.

“Window Shade” Tympanoplasty for Anterior Marginal Perforations

Anterior marginal perforations of the tympanic membrane often present a reconstructive challenge to the otolaryngologist. Poor surgical outcomes are often due to inadequate exposure, a lack of residual tympanic membrane, impaired vascular supply, and delayed healing. This study reports on the success of the "window shade" technique, combining aspects of both the traditional underlay and overlay tympanoplasty techniques, for the management of anterior marginal tympanic membrane perforations. Retrospective review of patients undergoing window shade tympanoplasty from July 1, 1994, to July 1, 2003, at a tertiary care referral center. Only patients found to have anterior tympanic membrane perforations and who underwent a window shade tympanoplasty were included in the study. Tympanoplasty success rate was studied by examining postoperative complications of recurrent perforation, tympanic membrane lateralization, or anterior blunting. The authors identified 164 patients who underwent window shade tympanoplasty during the study period. The overall success rate for tympanic membrane repair was 94.5%. There were no cases of tympanic membrane lateralization or significant blunting. The average healing time was 4 weeks. The surgical technique is described in detail. The window shade tympanoplasty is an excellent surgical option for repair of anterior marginal perforations of the tympanic membrane.