Rate Of Tympanic Membrane Perforation Research Articles

The study of otoendoscopic tympanoplasty (type I)

Background With the development of otoendoscopic surgery technology and the update of equipment, more and more otoendoscopic tympanoplasty are carried out. Objectives To investigate application of otoendoscopic tympanoplasty. Methods Seventy-six patients with tympanic membrane perforation were randomly enrolled into otoendoscopic group (OP, n = 38) and microscope group (MP, n = 38). We compared two-group patients using operative time, intraoperative blood loss, healing of postoperative perforations, and degree of postoperative hearing improvement. Results Average operation time was statistically significant shorter in the OP than the MP (p < .05); the intraoperative blood loss in the OP was significant less than MP (p < .05); after postoperative follow-up, the healing rate of tympanic membrane perforation was 92.11% in the OP compared to 89.47% in the MP. However, there was no statistically significant difference in the two groups (p > .05). There were no statistically significant differences between the preoperative and postoperative air and bone conduction thresholds in the two groups (p > .05). Conclusions Otoendoscopic tympanoplasty is a minimally invasive operation but with similar effects as compared to microscopic one. But the operation time and intraoperative blood loss in the OP were significantly better than those in the MP, thus it is a safe, effective and easy to be operated in clinical practice.

Evaluation of the Rate of Tympanic Membrane Perforation in Otomycosis

Introduction: Otomycosis (OM) is an external ear infection of fungi and sometimes associated with tympanic membrane perforation (TMP). In this study, we analyzed and discussed the rate of TMP in otomycotic patients with no other associated pathology. Materials and Methods: In this prospective observational study, a total of 120 cases of OM were seen from August 2017 to April 2018 and microscopy with local cleaning was done. Fungal material was collected from all patients individually and sent for Gram staining and histopathological confirmation of fungus species and looked for TMP. Topical clotrimazole (1%) drops were given as empirical treatment with weekly microscopy and follow up to 12 weeks. Results: Eleven cases (9%) had tympanic perforation at the time of the first examination. In all cases with the TMPs, the causative organism was the Aspergillus species. Persistent TMP was present in 6 cases (5%). A total of three persistent TMPs required surgical intervention after 12 weeks. Conclusion: In OM, TMP is not infrequent and it requires careful examination especially under a microscope to identify it.

Middle Ear Packing and External Ear Packing With Fibrin Glue Enhance the Success of Fat Myringoplasty Without Hyaluronic Acid Disc.

Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size. Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed. The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were 55.71, 12.98, and 42.73 dB respectively. The postoperative mean thresholds of AC, BC, and ABG were 23.67, 12.98, and 10.69 dB, respectively. Change in preoperative and postoperative hearing showed was statistically significant. Middle ear packing by gelfoam combined with external ear canal packing using fibrin glue enabled stable adhesion between the remnant TM and the fat graft. Regardless of the size of the TMP, the success rate of the fat myringoplasty by our technique can be enhanced without use of hyaluronic acid disc.

Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis.

Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10-20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.

A retrospective review of Paparella Type 1 tympanostomy tubes

ObjectiveThis study aims to provide data on ear tube extrusion and complication rates for patients who have Paparella Type 1 tympanostomy tube (TT) placement. MethodsRetrospective chart review of patients 6 months to 12 years old who underwent insertion of Paparella Type 1 TT by a single surgeon. ResultsOf 197 tubes evaluated, 3% were plugged between 1 and 3 months after surgery. Of the 144 tubes evaluated long-term, all tubes extruded within 4 years. There were no tympanic membrane perforations. ConclusionsThis chart review showed expected rate of initial ear tube plugging. The rate of tympanic membrane perforation was lower than expected.

Otomycosis With Tympanic Membrane Perforation: A Review of the Literature.

The purpose of the present study was to assess the rate of tympanic membrane perforation in patients with otomycosis and to discuss the literature regarding the difficulties in managing this condition. Literature review from 1999 to 2019, Web of Science, PubMed, and Medline. We searched for eligible articles concerning the clinical entity of tympanic membrane perforation secondary to otomycosis. Case series and clinical trials were the types of articles included for this review. All the articles described in the study selection were used for this review. Statistical techniques were not used. Based on the available literature, it seems that tympanic membrane perforation secondary to otomycosis is not uncommon. The presence of this complication is associated with 2 problems: Antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Although most cases of fungus caused tympanic membrane (TM) perforation resolve with proper medical treatment, in a few patients a tympanoplasty may be required.

A multi-center clinical retrospective study on the therapeutic effect of endoscopic myringoplasty

Objective: To analyze the therapeutic effect of endoscopic myringoplasty. Methods: A retrospective analysis of 523 patients with chronic otitis media who underwent endoscopic myringoplasty between June 2016 and June 2017 in eight tertiary hospitals in China. Among all the patients, 256 were male and 267 were female, aged from 18 to 68 years old. The grafts used to repair the tympanic membrane were all tragus cartilage-perichondrium complex. All patients were followed up at 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, at least 3 months. The closure rate of tympanic membrane perforation by different factors, the hearing results, and the incidence of postoperative complications were analyzed. SPSS 21.0 software was used to analyze the data. Results: Three months after operation, the closure rates of anterior, inferior, posterior and subtotal perforation were 92.4% (109/118), 94.9% (93/98), 95.6% (129/135), and 89.0% (153/172) respectively, the difference was not statistically significant (χ(2)=5.779, P=0.123). The closure rates of small, medium and large perforations were 100.0% (82/82), 93.7% (178/190) and 89.2% (224/251) respectively. The difference was statistically significant (χ(2)=10.927, P=0.004). The closure rates of dry ear and wet ear tympanic membrane perforation were 93.1% (392/421), 90.2% (92/102), the difference was not statistically significant (χ(2)=1.011, P=0.915). The preoperative pure tone audiometry(PTA) was (38.4±5.3) dBHL, while, the 3-month postoperative PTA was (25.1±5.7) dBHL. The difference was statistically significant (t=39.079, P<0.001). The preoperative air bone gap (ABG) was (22.4±4.3) dB, while 3 months postoperative ABG was (9.1±3.8) dB. The difference was statistically significant (t=53.004, P<0.001). Of all 523 patients, 14 (2.7%) had middle ear infection, 8 (1.5%) had dislocated tympanic membrane, 12 (2.3%) had parageusia, 35 (6.7%) had tinnitus, 28 (5.4%) had hearing loss, 26 (5.0%) had vertigo,33 (6.3%) had reperforation, 2 (0.4%) had secondary cholesteatoma, and none had facioplegia. Conclusions: Endoscopic myringoplasty is a safe and effective surgical method with good postoperative outcome.

Different states of otitis media were retrospectively analyzed of myringoplasty

Objective:Through analysis of the tympanic membrane perforation rate and hearing improvement rate with chronic suppurative otitis media (CSOM) by myringoplasty,to observe the effect of different preoperative conditions such as middle ear lesion,eustachian tube (ET) function and infection status on the postoperative curative effect.Method:Retrospective analysis of EENT Hospital of Fudan University from January 2012 to November 2016 during the 203 cases (203 ears) with clinical data of myringoplasty: according to intraoperative exploration of the presence of purulent secretions in the tympanic cavity,divided into infection active group and infection quiescence group; according to the preoperative results of the function of ET with acoustic impedance test divided into dysfunction or good group; according to the preoperative temporal bone HRCT suggested that the middle ear (mastoid cells,tympanic antrum and tympanic cavity) with or without soft tissue density,divided into the group with no focal lesion and the group with focal lesion. Review endoscopy and pure tone audiometry after 3 to 6 months. Using SPSS 19.0 statistical software to compare the differences among them of tympanic membrane perforation rate and hearing improvement rate.Result:Single factor analysis: ①The infection quiescence group of tympanic membrane perforation rate was 11.93%(13/109),higher than the infection active group ［8.51%(8/94)］; the infection quiescence group of hearing improvement rate was 75.23%(82/109),below the infection active group ［79.79%(75/94)］,no statistically significant differences of them (P>0.05).②The group with dysfunction of ET of tympanic membrane perforation rate was 14.06%(9/64),significantly higher than the group［4.04%(4/99)］with good function ET,with statistical difference of them (P<0.05); the group with dysfunction of ET of hearing improvement rate was 76.56% (49/64),lower than the group［81.82%(81/99)］with good function of ET,no significant difference of them (P>0.05).③The group with no obvious lesion of tympanic membrane perforation rate was 9.09% (10/110),lower than the group ［11.83%(11/93)］with focal lesion; the group with no obvious lesion of hearing improvement rate was 78.18% (86/110),higher than the group with focal lesion ［76.34%(71/93)］,no significant difference of them (P>0.05).Multivariate analysis: ①There was a significant correlation of postop-erative tympanic membrane perforation rate with preoperative ET functi-on (P<0.05).There was no significant correlation of the postoperative tympanic membrane perforation rate with the infection status and the temporal bone HRCT images in the middle ear lesions (P>0.05).②There was no significant correlation of the postoperative hearing improvement rate with the infection status,the ET function and the temporal bone HRCT images in the middle ear lesions (P>0.05).Conclusion:Dysfunction of ET and localized lesions of the ear were more common in infection active;the accumulation of purulent exudate on the surface of the tympanic mucosa and localized lesions of the middle ear did not affect the healing rate of the tympanic membrane and the hearing improvement rate; ET function is one of the most important factors that affect the healing rate of tympanic membrane after operation,the patients with ET dysfunction are more likely to affect tympanic membrane perforation,but does not affect the hearing improvement rate.

Analysis of curative effect on chronic suppurative otitis media by tympanoplasty with or without mastoidectomy

Objective:Analysis of perforation rate and hearing improvement rate of patients with chronic suppurative otitis media after operation, to observe the effect of tympanoplasty with or without mastoidectomy.Method:Retrospective analysis the clinical data of EENT Hospital of Fudan University from January 2011 to December 2016, 167 cases (ears) by tympanoplasty. According to the surgical approach were divided into simple tympanoplasty in 108 cases (group A), tympanoplasty with mastoidectomy in 59 cases(group B)(CWU in 23 cases, IBM in 11 cases, CWD in 25 cases). Endoscopy and pure tone audiometry after 3 to 6 months, using SPSS19.0 software to compare the difference of tympanic membrane perforation rate and hearing improvement rate. Result:The tympanic membrane perforation rate of group A and group B were 8.33%(9/108) and 5.08%(3/59),there was no significant difference(χ²= 0.604, P> 0.05). The hearing improvement rate of group A and group B were 83.33%(90/108) and 77.97%(46/59), there was no significant difference (χ²= 0.727, P> 0.05).Conclusion:For chronic suppurative otitis media with lesions confined to the mastoid and tympanic sinus, the removal of mastoid lesions in the treatment of tympanic membrane healing and improvement of hearing can not achieve better results than simple tympanoplasty.

Differences in myringoplasty between endoscopic and microscope

Objective:The intraoperative and postoperative clinical indexes of myringoplasty performed by endoscope or by microscope were collected retrospectively, the differences between the two different surgical methods were analysized. Method:Retrospective analysis of the clinical data of 70 cases (70 ears) udergoing myringoplasty in the department of Otolaryngology-Head and Neck Surgery, at the Second People's Hospital of Kashi from June 2014 to August 2015. According to the surgical approach cases were divided into two groups, 30 cases in group A by endoscopic myringoplasty and 40 cases in group B by microscope myringoplasty. The operation time, blood loss, postoperative dry ear time, wound healing scar hyperplasia, tympanic membrane perforation rate and hearing improvement rate were compared between the two groups, and SPSS 19.0 statistical software was used to analyze the differences between the two groups. Result:The operation time: Group A had an average of (35.23±6.38)min, less than group B (42.60±7.97)min, with statistical difference (P<0.05). The intraoperative blood loss: the average of group A was (7.33±2.11)ml, less than group B (17.93±3.84)ml, with statistical difference (P<0.05). The postoperative dry ear time more than 1 month: group A was 40%, lower than Group B (75%), with statistical difference (P<0.05). The postoperative incision healing scar hyperplasia: group A was 0%, lower than group B (5%), no significant difference (P>0.05). The tympanic membrane perforation rate: group A was 3.33%, lower than group B (7.5%), no significant difference (P>0.05). The postoperative hearing improvement rate: group A was 76.67%, lower than group B (80.00%), no significant difference (P>0.05). Conclusion:Compared with the traditional microscope surgery, endoscopic myringoplasty is a minimally invasive surgical technique which can get the same curative effect, but with a shorter operation time, less intraoperative blood loss, dry ear in shorter time , recovery more quickly, beautiful incision and other advantages. So it is worthy of clinical application.

Rate of tympanic membrane perforation after intratympanic steroid injection

PurposeTo determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection. Materials and methodsClinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation. ResultsOne hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078). ConclusionsThe rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.

A novel technique for reconstruction of the posterior wall of the external auditory canal and tympanum using pedicled temporalis myofascia

Conclusions: The procedure cleared the lesion completely and preserved the physiological function of the external auditory canal. Objective: To develop a novel surgical procedure to treat chronic suppurative otitis media (CSOM). To explore the merit of using pedicled temporalis myofascia (PTM) and reconstruction of the posterior wall of the external auditory canal with pedicled postauricular periosteal flap and intact skin of the external auditory canal. Methods: Forty-seven patients with CSOM were chosen. Open radical mastoidectomy was used to complete clean-up lesions; the fascia of PTM was used to repair the tympanic membrane. The PTM, pedicled postauricular periosteal flap, and intact skin of the external auditory canal were used in the reconstruction of the posterior wall of the external auditory canal. All subjects were followed up for over 2 years. Hearing thresholds, including air conduction (AC), bone conduction (BC), and air–bone gap (ABG) before and after surgery, and after follow-up, were compared. Results: The healing rate of postoperated tympanic membrane was 95.74% and the 2-year healing rate of tympanic membrane perforation was 95.65%. The 46 ears included in the 2-year follow-up showed significant improvement between preoperative and postoperative AC and ABG values.

A Retrospective Review of Ventilation Tube Removal in Children

Objective: Ventilation tube insertion is the primary surgical intervention in persistent otitis media with effusion. Around 7% of ventilation tubes require elective removal. The objective is to discover the tympanic membrane healing rate after ventilation tube removal and identify measures that improve this. Method: Retrospective case note review performed for patients who had elective ventilation tube removed over an 8-year period. Information gathered included if any concomitant procedure was performed to repair the tympanic membrane and final outcome of the tympanic membrane status. Results: A total of 113 cases were included in this study. The average age at grommet insertion and removal was 5.8 years old and 8.3 years old, respectively. After ventilation tube removal the perforation edges were freshened in all cases. The majority of patients (84.1%) subsequently had an intact tympanic membrane. Additional procedures were performed on 19 ears, 6 with insertion of overlay absorbable material and 14 with a fat plug. Closure rate in these patients was 100%. Shah and Sheperd grommets had a significantly lower residual tympanic membrane perforation rate compared to T-Tube and Titanium grommets. Conclusion: Tympanic membrane closure rate after ventilation tube removal was 84.1%. Additional procedures, ie, overlaying of absorbable material, appear to improve the closure rate. We therefore advocate the technique. In selected cases such as T-tube removal a concurrent fat plug myringoplasty may be appropriate.

Intravenous Sedation vs General Anesthesia for Pediatric Otolaryngology Procedures

To compare efficacy, safety, and hospital charges for common pediatric otolaryngology procedures with the use of intravenous sedation (IVS) vs general anesthesia (GA). Retrospective chart study. Hospital-based pediatric otolaryngology practice. Patients younger than 18 years who underwent tympanostomy tube removal and/or patch myringoplasty with absorbable gelatin sponge, nasal ciliary biopsy, fine-needle aspiration, or other minor procedures between September 1, 1998, and August 31, 2001. Procedures performed in 2 settings: outpatient clinic with IVS or operating room with GA. Procedure completion rate, tympanic membrane perforation rate after ear procedures, complications, and hospital charges. Of 103 procedures, 54 were performed with IVS and 49 with GA. Within the GA group, 32 of 49 patients had additional operations performed and were excluded from analysis of safety and hospital charges. Procedure completion rate was 100% in both groups. The most common procedure was tympanostomy tube removal with patch myringoplasty (IVS, 52 ears; GA, 42 ears). The rate of persistent tympanic membrane perforation was similar between these groups (IVS, 7 [16%] of 45 ears; GA, 5 [15%] of 33; P =.96). All complications were minor and occurred at similar rates (IVS, 10 [19%] of 54 ears; GA, 3 [18%] of 17; P =.94). These events included hypoxia, airway obstruction, and bradycardia, all of which resolved spontaneously or responded to noninvasive interventions such as oxygen or repositioning. Average hospital charges were significantly higher for the GA group (IVS, $356.22; GA, $1516.55; P<.001). Various procedures can be performed safely, effectively, and with decreased hospital charges with the use of IVS administered by a pediatric sedation service.

A long-term review of the Shah Permavent tube

A retrospective study of 74 Shah Permavent tube insertions is presented. These were inserted into 74 ears of 55 patients during the period between 1985 and 1988. At the time of review, 35 tubes had extruded spontaneously, 11 tubes had been removed for recurrent infections, 10 tubes had been removed electively and 10 tubes were still in situ. On examination of the ears approximately 12 months after the tubes had extruded, the overall rate of tympanic membrane perforation was 18.2 per cent. In ears in which the Permavent tube extruded spontaneously the perforation rate was 22.2 per cent. In ears which the tube was removed because of infection the perforation rate was 20.0 per cent. However in ears in which the tube was removed electively the perforation rate was zero. This finding has implications in the use and management of long-term ventilation tubes.

小児における鼓室内チューブ抜去後の鼓膜穿孔

Clinical courses, especially the rate of tympanic membrane perforation were compared in 215 ears of children receiving three kinds of ventilation tubes (Shepard grommet tube, Goode T-tube and Paparella type II tube). The average insertion period was 5.9 months with Shepard tube,10.7 months with T-tube and 15.1 months with Paparella II tube. The average rate of permanent perforation was 0%,7.9% and 15.3%, respectively. The overall incidence of perforation was higher in intensive extraction of the tubes compared with spontaneous extrusion.It was concluded that the incidence of tympanic membrane perforation was higher when the long-term tube was used, when the retention period was prolonged, when infection occurred and when the tube was intensively removed.