Size Of Tympanic Membrane Perforation Research Articles

Efficacy and safety of a self-expandable retainer in endoscopic ear surgery.

During endoscopic ear surgery (EES), it is important to maintain a clear view of the endoscopic camera to achieve a clean field. In this study, a self-expandable external auditory canal (EAC) retainer was developed to enable a more efficient and safer EES. This study aimed to evaluate the retainer's efficacy and safety in EES. Among adult patients scheduled for endoscopic tympanoplasty, 50 participants were recruited. They were assigned to either the retainer or control group in a 1:1 ratio. The anatomical characteristics, number of endoscopic cleanings during surgery, surgeon's satisfaction, and other factors were evaluated. No differences were observed in the surgical direction, EAC size measured on preoperative temporal bone computed tomography scans, location and size of tympanic membrane perforation, or bleeding degree between the two groups. When comparing the surgical time, including retainer insertion and removal, the time was similar between groups (retainer group, 35min; control group, 33.2min). The frequency of endoscopic cleaning per minute was statistically significantly lower in the retainer group than in the control group (0.18 times per minute, p = 0.048). No side effects, including sensory abnormalities or allergic reactions, were reported in any patient who used the retainer. A reduction in unnecessary endoscopic cleaning during EES was observed while using the self-expandable retainer, leading to increased surgeon satisfaction and efficiency. Furthermore, as a safe method without side effects, the retainer could be widely used to various indications for EES beyond tympanoplasty.

Factors related to the surgical outcomes of type I tympanoplasty for tympanic membrane perforation in children

Background Factors related to surgical outcomes of type I tympanoplasty for tympanic membrane (TM) perforation in children are controversial. Objectives To investigate factors related to anatomical results of type I tympanoplasty for TM perforation 1 year after surgery. Material and methods We examined 68 ears. Anatomical results were determined based on the presence or absence of re-perforation, atelectasis, and otitis media with effusion. We retrospectively analyzed factors based on age (≤8 and >8 years), cause and size of TM perforation (<50% and ≥50%), history of asthma and cleft palate, and size of mastoid air cell system in bilateral ears before tympanoplasty. Audiological prognosis was evaluated in ears with anatomical success 1 year after surgery. Results Anatomical success was achieved in 80.9% (55/68) of the ears. No significant differences were observed between these factors and anatomical results. All children with cleft palate had anatomical success. Mean pure-tone average (0.5–4 kHz) was 16.25 dB HL for ears with both TM perforations <50% and ≥50%. Conclusion and significance We observed no significant relationship between factors considered and surgical outcomes. However, audiological prognosis was favorable for anatomical success regardless of TM perforation size. Accordingly, type I tympanoplasty is considered useful for TM perforation in children.

The outcome of type I tympanoplasty in patients with chronic otitis media

Background. Tympanoplasty type 1 is a reconstruction of tympanic membrane perforation with an examination of the middle ear to ensure normality. Aim. Assess the effect of the age of the patient, site, and size of tympanic membrane perforation on hearing gain and graft uptake in patients with chronic otitis media. Patients and method. Thirty patients with type 1 tympanoplasty aged between 10 years and 50 years. Patients had been submitted for audiological tests and examination pre-operatively and at 1, 3 and 6-month intervals postoperatively. Results. Improvement was 57% in 10-25 years, 59% in 25-40 years, and 56% in 40-50 years. While graft uptake was 90% in the three groups. Hearing improvement in anterior perforation was (60%), ost. perforation (41.5%), inferior perforation (43%). While the take rate is 100% in the post, perforation, 80% in anterior perforation and 83.3% in inferior perforation, hearing gain was 40% in large perforation, 66% in medium size and 77% in small size. While the take rate in small perforation was 100%, in medium perforation 90% and large perforation 80%. About 70% of patients had closure of the air-bone gap to within 15 dB and 83 % to within 20 dB. Conclusion. Age had no impact on hearing gain and graft uptake. Size of perforation affects hearing gain and graft uptake where they are better in small and medium size perforation than large perforation. The site of perforation affects hearing gain and graft uptake where hearing gain was better in anterior perforation, while graft up was better in posterior perforation.

Outcomes of regenerative treatment for over 200 patients with tympanic membrane perforation

ObjectiveTo evaluate outcomes of a regenerative treatment (RT) for over 200 patients with tympanic membrane perforation (TMP). The RT-TMP method involves a gelatin sponge, basic fibroblast growth factor (bFGF) and fibrin glue. MethodsThe study population included 216 patients and 234 ears (male: female =100:116; age 1–93 years). All enrolled patients were treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the perforation. Fibrin glue was then dripped over the sponge. Patient outcomes including TMP closure rates, change in hearing level, and complications were obtained from retrospective medical chart reviews. The TMP was examined three or more weeks after surgery. The treatment was repeated up to 4 times until complete TMP closure was achieved. ResultsAfter mechanical disruption, the perforation size was Grade I, ≤1/3 of entire TM area in 22 ears (9.4 %), Grade II, 1/3–2/3 of entire TM in 77 ears (32.9 %) and Grade III, ≥2/3 of entire TM area in 135 ears (57.7 %). The overall TMP closure rates were 97.0 % (227/234). Complete TMP closure was achieved in 68.8 % (161/234), 22.6 % (53/234), 4.7 % (11/234) and 0.9 % (2/234) of ears after 1, 2, 3 and 4 treatments, respectively. In 7 of 234 ears (3.0 %), the TMPs were not closed completely after 4 treatments. There was no correlation between TMP size after mechanical disruption and number of treatments required to achieve complete closure (Fisher's exact test p = 0.70). The mean air-conduction hearing threshold at low frequency improved from 57.3 ± 16.7 dB before treatment to 37.3 ± 16.0 dB (p < 0.0001) after closure of TMPs. For middle and high frequencies, the improvement was 49.0 ± 19.3 dB to 36.9 ± 17.9 dB (p < 0.0001) and 57.7 ± 22.9 dB to 49.2 ± 23.3 dB (p < 0.0001), respectively. The mean air-bone gaps also improved significantly, and were within 10 dB at 250 Hz, 500 Hz and 1 kHz, and 11 dB at 2 kHz. One or more complications occurred in 32 patients (32/216; 14.8 %). The most common complication was formation of an epithelial pearl (16 ears; 6.8 %), followed by severe TM retraction (9 ears; 3.8 %) and otitis media with effusion (6 ears; 2.6 %). There were no serious complications that caused deterioration of the patient's general condition. ConclusionOur results showed that RT-TMP had high success rates for TMP closure and good hearing improvement and produced no severe complications that could affect general health status. This novel therapy is simple, safe and minimally invasive, and could help improve the quality of life in patients with TMP.

Assessment of tympanic membrane perforation size using ImageJ software by ENT clinicians of different grades.

To compare visual estimation versus ImageJ calculation of tympanic membrane perforation size in the paediatric population between clinicians of different experience. Five images of tympanic membrane perforations in children, captured using an otoendoscope, were selected. The gold standard was the ImageJ results by one consultant otologist. Consultants, registrars and Senior House Officers or equivalent were asked to visually estimate and calculate the perforation size using ImageJ software. The mean difference in variation from gold standard between visual estimation and ImageJ calculation was 12.16 per cent, 95 per cent CI (10.55, 13.78) p < 0.05, with ImageJ providing a more accurate estimation of perforation. Registrars were significantly more accurate at visual estimation than senior house officers. There was no statistically significant difference in ImageJ results between the different grades. Using ImageJ software is more accurate at estimating tympanic membrane perforation size than visual assessment for all ENT clinicians regardless of experience.

Successful Myringoplasty - Do The Site &amp; Size Of TM Perforation Matter?

Objective: To determine the success rate of myringoplasty based on the site and size of tympanic membrane perforation. Study Design: Cross sectional, Descriptive Study Settings: ENT Department Fauji Foundation Hospital, Rawalpindi Study Duration: 30 July 2019 to 29 December 2021. Material and Methods: After approval of Hospital Ethical Committee, a sample size of 100 patients was calculated by using WHO sample size calculator. Patients were selected through Non probability convenient sampling. Informed consent was obtained from all the patients. All the patients were operated upon through post auricular approach using underlay technique and temporalis fascia was used as a graft in all the cases. Success of myringoplasty was assessed one month after surgery. Myringoplasty was considered successful upon complete closure of the defect as assessed under surgical microscope. Data analysis was done for frequencies and percentages using SPSS version 24. Results: There were 52% males and 48% females. Mean age of patients was 35.5 years and they ranged between 17 to 48 years. Overall myringoplasty was successful in 71% patients. Regarding the size of perforation, it was successful in 100% pinhead size perforations, in 86.7% small sized, 89.5% medium sized, 42% large and 6.7% subtotal sized perforations. Regarding site of the perforations, myringoplasty was successful in 96% anterior, 100% posterior, 40% inferior, 40% middle and 8% subtotal/ large perforations. Conclusion: Myringoplasty is an effective surgery for sealing Tympanic Membrane perforations resulting in better quality of life. Success rate of myringoplasty has a definite association with size and site of perforation. The smaller the perforation, the higher would be the success rate. Similarly, anterior and posterior perforations heal better as compared to inferior and mid position perforations. Key words: Myringoplasty, Size and site of Tympanic membrane perforation, Tympanic membrane, Chronic Suppurative Otitis Media.

Effect of the size of tympanic membrane perforation on hearing

Tympanic membrane (TM) perforation is one of the most common causes of hearing impairment. Apart from conduction of sound waves across the middle ear, the tympanic membrane, also sub-serves a protective function to the middle ear cleft and round window niche. It has been established that the larger the perforation on the tympanic membrane, the greater the decibel loss. The aim of this study is to determine the effect of the size of the tympanic membrane perforation on hearing. The study was conducted at Al-Jumhoori teaching hospital during march 2011 to march 2012. Seventy-eight patients with perforated tympanic membranes were included in the study.They all have TM perforation due to recurrent or chronic otitis media. Patients with traumatic TM perforation were excluded from the study. There were 47 males (46.5%) and 54 females (53.5%). Twenty patients had left ear perforation, 35 patients had right ear perforation, and 23 patients had bilateral perforations. Each ear was taken as a case, so the total number of the perforated ear drums were 101. The age ranged from 13- 56 with the mean of (31.64 ± 13.249) years. The TM perforation was examined and photo image was taken with the aid of the endoscope, and the percentage of the perforation was measured from the whole area by using a special Microsoft (infomap). Controls were 55 patients with a mean age 30.73 ±12.09( range 14-53) years. Male controls were 34 (61.8%), and 21 female controls(38.2%). There was a highly significant correlation between size of TM perforation with the hearing level, air bone gap, high frequency hearing loss and low frequency hearing loss. As a conclusion, there is strong relationship between the size of TM perforation and the hearing level, air-bone gap and both the low frequency and the high frequency hearing level and air-bone gaps.

Endoscopic Versus Microscopic Type 1 Tympanoplasty (Myringoplasty) in a Rural Tertiary Care Hospital in India: A Retrospective Comparative Study.

Background Chronic suppurative otitis media (CSOM) is described as middle ear cleft inflammation that results in long-term alterations to the tympanic membrane and/or the middle ear structures.In cases of CSOM, type 1 tympanoplasty, also known as myringoplasty, is a successful procedure for repairing the tympanic membrane and can even help restore hearing loss. This study aims to compare functional and clinical outcomes of type 1 tympanoplasty performed using transcanal endoscopic ear surgery (TEES) versus those performed via microscopic ear surgery (MES) for perforation in the tympanic membrane in the safe type of CSOM. Methodology Between January 2018 and January 2022, a retrospective analysis of 100 patients (47 men and 53 women) operated for the safe type of CSOM with a perforated tympanic membrane was conducted in our department. Based on the surgical methods, cases were randomly divided into two groups. There were 50 people in group 1 who underwent endoscopic tympanoplasty and 50 in group 2 who underwent microscopic tympanoplasty. The following factors were assessed: patient demographics; tympanic membrane perforation size at the time of surgery; operating room time; hearing outcomes, that is, closure of air-bone gap (ABG); graft uptake success rate; postoperative hospital stay; and medical resource usage.Patients were followed up for 12 weeks. Results Both groups shared similar epidemiological profiles, preoperative hearing status, and perforation sizes. In both groups, the rate ofgraft uptake was comparable. The average ABG closure was also quite comparable. In the case of endoscopic surgeries, the mean operative time was shorter; which was statistically significant, and complications were significantly lower in group 1. Conclusions Compared to its microscopic counterpart, endoscopic tympanoplasty has a similar graft uptake success rate and a comparable hearing outcome; however, it requires less operative time and hospital stay, has early recovery, and makes lesser use of medical resources, and it is cosmetically better.

Hearing Improvement after Myringoplasty in Association with the Tympanic Membrane Perforation Size

Objectives: To evaluate hearing improvement following successful myringoplasty based on the degree of tympanic membrane perforation. Methods: This cross-sectional study was held in the department of ENT of Aziz Bhatti Shaheed Teaching Hospital and ENT, Head and Neck Surgery department, Pak International Medical College and Peshawar Institute of Medical Sciences (PIMS), Hayatabad Peshawar for the duration from December 2021 to November 2022. Myringoplasty procedures were performed on 80 individuals in total following thorough history-taking, clinical testing, and research. Hearing was tested both before and after the operation. A variety of tables, charts, and drawings are used to present the analysed data. Results: For minor perforations, 27.81 dB was the mean air-bone gap, 7.21 dB was the mean bone conduction threshold, and 33.40 dB was the mean air conduction threshold prior to surgery. In medium-sized perforations, 32.78 dB was the mean air-bone gap, 10.10 dB was the mean bone conduction threshold and 46.21 dB was the mean air conduction threshold prior to surgery. In the instance of a large perforation, 48.86 dB was the mean air-bone gap, 62.01 dB was the mean air conduction threshold, and 15.20 dB was the mean bone conduction threshold prior to surgery. After myringoplasty, the mean postoperative air-bone gap for medium, large and small perforations was 14.22 dB, 22.62 dB and 6.24 dB, correspondingly. Using the unpaired test, it was determined that the difference in airbone gap between minor and medium sized perforations closure was statistically significant. Conclusions: After myringoplasty of large size perforations, hearing gain is improved significantly. Myringoplasty and hearing enhancement are key words. Keywords: Myringoplasty, Hearing Improvement, Tympanic membrane perforations

Dry versus wet temporalis fascia graft in type-I tympanoplasty: a systematic review and meta-analysis of randomized controlled trials.

To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the efficacy of dry versus wet temporalis fascia graft among patients undergoing type-I tympanoplasty. Web of Science, Scopus, PubMed, and CENTRAL databases were screened from inception until July 2022. The Cochrane risk of bias tool was used to assess the quality of included RCTs. The outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) in a random-effects model. Eight RCTs with 989 patients (dry group = 514 and wet group = 475) were included. The overall quality was 'low', 'some concerns', and 'high' risk of bias in five, two, and one RCT(s), respectively. There were no significant differences between both groups regarding the surgical success rate (n = 8 RCTs, RR 0.99, 95% CI [0.95, 1.03], p = 0.6), audiological success rate (n = 5 RCTs, RR = 0.93, 95% CI [0.73, 1.13], p = 0.48), mean difference in pure tone average (n = 2 RCTs, MD = 2.73Hz, 95% CI [- 2.31, 7.77], p = 0.29), and mean difference in graft placement time (n = 3 RCTs, MD = - 2.18min, 95% CI [- 5.11, 0.76], p = 0.15). However, the mean difference in operative time was significantly lower in favor of the wet compared with the dry temporalis fascia group (n = 2 RCTs, MD = 2.95min, 95% CI [- 1.80, 4.11], p < 0.001). The surgical success rate was not significantly different between both groups according to the tympanic membrane perforation size and site. The type of temporalis fascia graft (dry or wet) did not influence the clinical outcomes of type-I tympanoplasty.

Correlation of Hearing Loss with the Site and Size of Tympanic Membrane Perforation

Objectives: This study was done to observe the relation of hearing loss with the site and size of tympanic membrane perforation. Methods: It was a prospective type of Observational study which was conducted at the Department of Otolaryngology and Head Neck Surgery, Uttara Adhunik Medical College Hospital, Dhaka during the period of May 2012 to October 2012 on patients that attended the outpatient department and also who were admitted in otolaryngology and head-neck surgery department. Total 200 patients (between 14 to 50 years of age) with perforated tympanic membrane in pars tensa were included by non-randomized purposive sampling. Among these patients 108 were male and 92 were female. They were categorized according to site and size of tympanic membrane perforation. Hearing threshold was assessed by pure tone audiometry. Results: According to size, there were small 44 (22%), medium 65 (32.5%), large 48 (24%) and subtotal /big central 43 (21.5%) perforations. According to location, there were anterior central 28 (14%), posterior central 35 (17.5%), central malleolar 94 (47.0%) and big central/subtotal 43 (21.5%) perforations. It was found that subtotal/big central perforations with the average bone conduction threshold 17.40 ±10.62 dB (SD), air conduction threshold 46.95 ±12.89 dB and air- bone gap 29.56 ± 5.85 dB caused more hearing loss than small and medium sized perforations. So it was seen that larger the perforation, more the hearing loss. Anterior central perforation had average bone conduction threshold 13.03 ± 3.61 dB, air conduction threshold 33.48 ± 4.81 dB and air-bone gap 20.86 ± 3.73 dB. Posterior central perforation had average bone conduction threshold 15.44 ± 7.38 dB, air conduction threshold 40.64 ± 10.34 dB and air-bone gap 25.11 ± 6.42 dB. This difference represent that posterior central perforation causes more hearing loss than that of anterior central. Hearing loss is also related to duration of perforation. Perforation for 0-5 years with ....

Relationship between size and site of tympanic membrane perforations and pure tone audiometry results

Background: Chronic otitis media is a condition commonly presenting with tympanic membrane perforation and resulting in conductive hearing loss. The aim of the study was to assess the relationship between the site and size of tympanic membrane perforation with the degree of hearing impairment in patients with inactive chronic otitis media of mucosal type. Methods: Hospital based cross sectional study of 174 patients with tympanic membrane perforation at government medical college, Alappuzha from November 2017 to March 2019. Patients were enrolled based on history and clinical examination findings. Images obtained by otoendoscopy were analyzed by measuring the percentage area of membrane perforation in relation to total area of the tympanic membrane using adobe acrobat area tool. Degree of hearing loss was calculated by pure tone audiometry test and calculating the average hearing thresholds at frequencies of 500Hz, 1000Hz, 2000Hz and 4000Hz. Results: The age distribution of patients ranged from 14 to 72 years with a mean age of 41.78years. Male to female ratio was 1.59:1. The degree of hearing loss increased as the size of the perforation increased which was statistically significant (p &lt;0.001). Posterior quadrant perforations resulted in more hearing impairment than anterior quadrant perforations. Conclusion: The size of the tympanic membrane perforation is closely related to the degree of hearing loss and posterior quadrant perforations have more degree of hearing impairment than anterior quadrant perforations which signifies improvement in hearing in patients with chronic otitis media by reconstructive surgeries, especially for perforations involving the posterior quadrant.

DEGREE OF HEARING LOSS IN INACTIVE MUCOSAL CHRONIC OTITIS MEDIA AND ITS CORRELATION WITH SITE AND SIZE OF TYMPANIC MEMBRANE PERFORATION- AN OBSERVATIONAL STUDY

Background: Studies have persistently associated the site and size of the tympanic membrane (TM) with the magnitude of hearing loss;however,the results are mixed and inconclusive on the effect of the site of the perforation on the hearing loss. Therefore, we conducted the present study to investigate the relationship between the size and site of TM perforation and hearing loss in inactive mucosal chronic otitis media. Methods: We conducted a hospital-based observational, prospective study in the Postgraduate Department of Otorhinolaryngology, Head and Neck Surgery, Government Medical College Srinagar, and recruited 94 patients diagnosed to have inactive mucosal chronic otitis media with dry tympanic membrane perforation. In addition to the site and size of TM perforation, the magnitude of hearing loss was also estimated. Results: We recruited 94 subjects presenting acute otitis media with TP perforation. The mean age (±SD) of cases was 36.3(±4) and males showed a marginal over-representation over females (male to female ratio: 1.2:1). We observed a positive correlation of the size of TM perforation with the average hearing loss. Moreover, subjects having perforations in the posterior ear reported higher average hearing loss. Conclusion: We report a positive correlation of the size of TM perforation with the average hearing loss and subjects having perforations in the posterior ear reported higher average hearing loss. However, more replicative studies with a larger sample size are warranted to substantiate our findings.

The Development and Evaluation of a Smartphone-Aided Diagnosis Application to Measure Tympanic Membrane Perforations.

Chronic otitis media is a long-term infection of the middle ear. It is characterized by persistent discharge from the middle ear through a perforated tympanic membrane. It is one of the most common causes of preventable hearing loss, especially in developing countries. Precise estimation of the size of tympanic membrane perforation is essential for successful clinical management. In this study, we developed a smartphone-based application to calculate the ratio of the area of tympanic membrane perforation to the area of the tympanic membrane. Twelve standardized patients and 60 medical students were involved to assess the area of tympanic membrane perforation, in particular, the percentage of perforation size. In total, 60 student doctors (including year 5 and year 6 medical students, intern and post-graduate year training of doctors) were recruited during their rotation at the Otolaryngology department of Taipei Medical University Shuang-Ho Hospital. Twelve standardized patients with chronic otitis media were recruited through a single otology practice. Oto-endoscopic examination was performed for all patients by using a commercially-available digital oto-endoscope, and clinical images of the tympanic membrane perforation were obtained. To demonstrate the variability of perforation size estimation by different student doctors, we calculated the percentage of perforation using the smartphone-based application for 12 tympanic membranes objectively and compared the results with those visually estimated by the 60 student doctors subjectively. The variance in the visual estimation by the 60 student doctors was large. By contrast, variances in smartphone-based application calculations were smaller, indicating consistency in the results obtained from different users. The smartphone-based application accurately estimated the presence of perforation for tympanic membranes with high consistency. The differences in visual estimations can be considerably great and the variances can be large among different individuals. The smartphone-based application is a dependable tool for precisely evaluating the size of tympanic membrane perforation.

Correlation of size of tympanic membrane perforation &amp; degree of hearing loss and frequency specific hearing gain following tympanoplasty

Introduction: The tympanic membrane (TM) serves as a key component of the tympano-ossicular system. Chronic otitis media is known to cause mild to moderate conductive hearing loss. Material &amp; Methods: The proposed study was conducted on 50 patients of either sex in age group of 15-50 years having unilateral or bilateral chronic inactive (mucosal) otitis media after obtaining their consent. Pure tone audiogram was done to confirm the degree, type and frequency specific hearing loss from frequency 250Hz to 8000Hz for air conduction and 250Hz to 4000Hz for bone conduction. TM perforations were divided into Group I (small), II (medium), III (Large) according to size of perforation. Results: Average Hearing loss in Group I, II, &amp; III was 33.86, 43.84 &amp; 46.75 dB respectively. Hearing improvement following tympanoplasty at 250, 500, 1000, 2000, 4000, 8000 Hz was 20.50, 18.1, 16.7, 14.3, 12.0, 1.6 dB respectively. Conclusion: Hearing threshold level depends on size of the tympanic membrane perforation. Hearing improvement following tympanoplasty is frequency-dependent also.

A Study to Assess the Effect of Size & Site of Tympanic Membrane Perforation on Hearing Loss.

The objective of the study was to assess the effect of size & site of tympanic membrane perforation on hearing loss. The study was carried out in ENT department of a tertiary health care hospital, between October 2018 and March 2020 (a total of 18months). Patients aged 15-50years having chronic otitis media with dry central perforation were included in the study after taking informed written consent and were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for Tympanoplasty and just prior to the procedure, the tympanic membrane perforation size was measured using the Castroviejo caliper and site was noted using otomicroscopy. The status of the middle ear mucosa and ossicles were also analyzed to ensure normal middle ear mucosa and normal ossicular mobility and continuity and only then were these patients included in the study. All the patients in the study were evaluated for hearing loss using air conduction measurements in pure tone audiometry done at 250Hz, 500Hz, 1000Hz, 2000Hz, 3000Hz and 4000Hz. Hearing loss was found to be directly proportional to the size of perforation in our study. The site of the perforation has a significant association with the degree of hearing loss. Those perforations with posterior quadrant involvement and multiple quadrant involvement had a higher hearing loss. From our study, we concluded that there is a significant relationship between size and site of the perforation and the amount of hearing loss.

Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs

BackgroundThe conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated.MethodsA retrospective case–control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration.ResultsMedical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group.ConclusionsEndoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

Review of endoscopic myringoplasty success: comparisons of intra-operative graft material and post-operative packing in terms of graft failure rate.

Myringoplasty success rate is estimated to be between 60 and 90 per cent. Factors predicting success include the choice of graft and use of auditory canal packing. This study aimed to determine the intra-operative factors associated with endoscopic myringoplasty success. A retrospective review of all endoscopic myringoplasty cases between January 2017 and January 2020 was undertaken. Data were collected on: patient demographics, tympanic membrane perforation size, intra-operative details, audiology and post-operative outcomes. There was no significant difference in graft success rates between cases using bismuth iodoform paraffin paste and Spongostan packing (86.7 per cent vs 84.9 per cent, respectively). Conchal cartilage graft had a higher success rate (100.0 per cent) compared with Biodesign grafting biomaterial (66.7 per cent), but was not superior to tragal cartilage (84.6 per cent) or temporalis fat or fascia (80.0 per cent). Spongostan packing is equivalent to bismuth iodoform paraffin paste in terms of endoscopic myringoplasty success rate. Although conchal cartilage graft had higher success rates, it was not statistically significantly different from tragal cartilage.

A comparative study between endoscopic and microscopic type 1 tympanoplasty

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020.&#x0D; Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17.&#x0D; Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% &amp; in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........