Small Tympanic Membrane Perforations Research Articles

ИСПОЛЬЗОВАНИЕ ХРЯЩЕВОГО ТРАНСПЛАНТАТА ПО ТИПУ «БАБОЧКА» ПРИ ТИМПАНОПЛАСТИКЕ

Purpose. To review the literature to evaluate the effectiveness of using the “butterfly” technique for tympanoplasty in patients with chronic suppurative otitis media (CSOM). Materials and methods. The research studies in which patients with CSOM (tubotympanic form) underwent tympanic membrane reconstruction using a butterfly cartilage graft were included. The following inclusion criteria were applied: the patients in the study had chronic tubotympanic otitis without signs of exacerbation, tympanoplasty using this technique, postoperative follow-up for at least six months, participation of the patients who underwent traditional tympanoplasty using the temporal fascia, cartilage or fat “patch” in the control groups. The exclusion criteria were CSOM with cholesteatoma, destruction of the auditory ossicles, other tympanoplasty methods than those mentioned above, the use of xenogeneic, allogeneic or other biomaterials as a graft. Results and discussion. The technique shows high efficiency (86-96%), comparable to tympanoplasty of the temporal fascia using the “underlay” technique, has technical advantages in the form of no need for an intra-auricular or post-auricular incision, mobilization of the meatotympanic flap, additional tissue separation forthe temporal fascia graft, which affects the speed of the surgery, the need for tamponade of the ear canal and the duration of the patient’s disability. The technique cannot be used if the patient has cholesteatoma and a ruptured auditory ossicular chain; the cartilage graft is technically difficult to produce for small tympanic membrane perforations without the aid of a microscope; the selection and shaping of the graft requires considerable experience and time. Conclusion. Butterfly cartilage tympanoplasty is highly effective in terms of anatomical and functional results for the treatment of small and medium tympanic membrane perforations in patients with chronic tubotympanic suppurative otitis media. Endoscopic modification of the surgery has obvious technical and economic advantages. The effectiveness of the technique for large perforations of the tympanic membrane, residual and recurrent perforations requires further comprehensive studying.

Advancement in Tympanic Membrane Repair: Exploring the Potential of Platelet Rich Fibrin.

To assess the effectiveness of the autologous plasma-rich fibrin plug technique for repairing small tympanic membrane perforations. Platelet rich fibrin (PRF) is also called second generation platelet rich plasma due to its high amount of growth factors which could be used in tympanic perforation closure. Being autologous, it is readily available with no immunogenic reactions. PRF membrane has a strong elastin fibrin structure containing growth factors and hence can be considered as an ideal sealing material or an adjuvant to the graft in repairing tympanic membrane perforations. Ours is a prospective study. A total of 52 patients with dry small tympanic membrane perforation were included in the study. In this technique, 10ml of blood is withdrawn from the patient, processed in a centrifuge machine, and platelet-rich fibrin (PRF) is separated from the mixture for use in the repair of small tympanic membrane defects. Out of the 52 patients, 42 experienced successful repair (full closure) of the tympanic membrane. The mean time of closure of the perforation was around 2weeks. However, five of them encountered failure. Although the size of the perforation decreased compared to the preoperative size. Additionally, two patients developed granulations on the tympanic membrane. No major side effects were noted. Autologous PRF is a product derived from whole blood through the process of centrifugation. It is safe and effective in promoting the natural process of wound healing by incorporating a high concentration of platelet-derived growth factors as well as fibrin into the graft mixture. This facilitates the rapid healing of tympanic membrane perforation.

A Proof-of-Concept Computer Vision Approach for Measurement of Tympanic Membrane Perforations.

Size, an important characteristic of a tympanic membrane perforation (TMP), is commonly assessed with gross estimation via visual inspection, a practice which is prone to inaccuracy. Herein, we demonstrate feasibility of a proof-of-concept computer vision model for estimating TMP size in a small set of perforations. An open-source deep learning architecture was used to train a model to segment and calculate the area of a perforation and the visualized tympanic membrane (TM) in a set of endoscopic images of mostly anterior and relatively small TMPs. The model then computed relative TMP size by calculating the ratio of perforation area to TM area. Model performance on the test dataset was compared to ground-truth manual annotations. In a validation survey, otolaryngologists were tasked with estimating the size of TMPs from the test dataset. The primary outcome was the average absolute error of model size predictions and clinician estimates compared to sizes determined by ground-truth manual annotations. The model's average absolute error for size predictions was a 0.8% overestimation for all test perforations. Conversely, among the 38 survey respondents, the average clinician error was a 11.0% overestimation (95% CI, 5.2-16.7%, p = 0.003). In a small sample of TMPs, we demonstrated a computer vision approach for estimating TMP size is feasible. Further validation studies must be done with significantly larger and more heterogenous datasets. N/A Laryngoscope, 134:2906-2911, 2024.

Does the Location of a Small Tympanic Membrane Perforation Affect the Degree of Hearing Loss in Adult Patients with Inactive Mucosal Chronic Suppurative Otitis Media?

Tympanic membrane perforation due to inactive mucosal chronic suppurative otitis media is a common problem in otolaryngology, with consequent conductive hearing loss. Still, there is controversy about the relationship between the location of the tympanic membrane perforation and the degree of hearing impairment. To assess the correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss in adult patients with inactive mucosal chronic suppurative otitis media. A prospective cross-sectional study enrolled 74 adult patients with small tympanic membrane perforations (perforation involves less than one quadrant of the tympanic membrane) and conductive hearing loss (airbone gap ≥ 20 dB HL) due to inactive mucosal chronic suppurative otitis media for at least 3 months. The locations of the tympanic membrane perforations were classified as anterosuperior, anteroinferior, posterosuperior, and poster inferior perforations. Audiometric analysis and a CT scan of the temporal bone were done for all patients. The means of the air and bone conduction pure tone hearing threshold averages at frequencies 500, 1000, 2000, and 4000 Hz were calculated, and consequently, the air-bone gaps were calculated and presented as means. The ANOVA test was used to compare the means of the air-bone gaps, and the Scheffe test was used to determine if there were statistically significant differences regarding the degree of conductive hearing loss in relation to different locations of the tympanic membrane perforation. The ages of the patients ranged from 20 to 43 years (mean = 31.9 ± 6.5 years), of whom 43 (58%) were females and 31 (42%) were males. The means of the air-bone gaps were 32.29 ± 5.41 dB HL, 31.34 ± 4.12 dB HL, 29.87 ± 3.48 dB HL, and 29.30 ± 4.60 dB HL in the posteroinferior, posterosuperior, anteroinferior, and anterosuperior perforations, respectively. Although the air-bone gap's mean was greater in the posteroinferior perforation, statistical analysis showed that it was insignificant (P-value=0.168). In adult patients with inactive chronic suppurative otitis media, the anteroinferior quadrant is the most common location of the tympanic membrane perforation, and there was an insignificant correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss.

Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, <i>p</i>=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

The Effect of Topical Insulin on Healing of Small Central Tympanic Membrane Perforations and Hearing Threshold

The Effect of Topical Insulin on Healing of Small Central Tympanic Membrane Perforations and Hearing Threshold

A Comparative Study of Using Collagen Patch or Fat Plug in Myringoplasty for Small Tympanic Membrane Perforations.

One of the most common problems in otorhinolaryngology is perforation of tympanic membrane. Although many small perforations heal spontaneously over time, some may remain persistent due to infection or some other causes. In the past years so many grafts have been used with good success rate. In this prospective study of 60 patients with small tympanic membrane perforations, we have compared newer biomaterial collagen patch and conventional fat plug as office procedures in treatment. According to our study, both groups had a significantly equal success rates & the rate of healing & complete closure at the end of 1 & 2months follow up. The hearing improvement in A-B gap during follow up of both groups were compared with pre-op A-B gap & showed a significant p value. This showed that both collagen patch & fat plug groups had a significant improvement in hearing following procedure. In our study quadrant of perforation does not correlate with the amount of hearing & healing rates were comparatively better in anterior quadrant than posterior quadrant. Infective causes were more & the failure rates were also high for such cause in both groups.

Different Grafts used In Closure of Central Small Tympanic Membrane Perforations

Background: Large number of patient seek ENT consultation for central perforation of tympanic membrane. A significant portion of these cases are often found with very small central perforation. Minimyringoplasty is a very simple procedure to close such small perforations. Objective: the aim of the present study is to compare the surgical and audiological results of temporalis fascia versus more simple methods ( fat graft, fat graft wih hyaluronic acid and platelet rich plasma)in myringoplasty. Patient and Methods: a randomized prospective study concerned with 80 patients for whom myringoplasty was done. Patients were randomly assigned into four groups; in the first group fat graft was used (20patient) and fat graft with hyaluronic acid was used in the second group (20 patients).and platelet rich plasma was used in third group (20 patients) and temporalis fascia was used in fourth group (20 patients). Results: our study included 80 patients, 45 males and 35 females with a range from 18- 55 years. Surgical success rates75% , 80%, 75%and 75%for fat graft, fat graft with hyaluronic acid, platelet rich plasma and temporalis fascia respectively. There was 6.5 dB, 7db , 6 db and 5.5 db mean hearing improvement improvement in fat graft, fat graft with hyaluronic acid, platelet rich plasma and temporalis fascia respectively. Conclusions: The myringoplasty with fat graft,fat graft with hyaluronic acid and PRP is a minimally invasive effective procedure in management of the small central tympanic membrane perforations . Also it is safe and feasible procedure In this study we have achieved High success rate of repair of tympanic membrane perforation.

Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

BackgroundThis study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults.In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes.ResultsThe success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing.ConclusionsInlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

A study on chemical cauterisation for small tympanic membrane perforation

To study the effectiveness of chemical cautery with patching on chronic tympanic membrane perforations of the pars tensa. Thirty-eight patients with dry tympanic membrane perforations due to inflammatory or traumatic etiology were selected after treating the primary etiological factors like septal deviation and allergic rhinitis. Fifty percentage silver nitrate was used to cauterize the margin and the perforation was covered with thin sterile aluminium foil as a patch. A maximum number of five applications were made, and the patients were followed up for the next 5 years. In this series of 38 patients, highest success was noted among those patients with traumatic perforation, while larger perforations were reduced to small pinhole sizes which were successfully closed by myringoplasty. An overall success rate of 73.75% was achieved. This is a time tested useful method which was popularized by Derlacki (1953), to close small to moderate sized tympanic membrane perforation and should be considered as a first line management in the treatment of tympanic membrane perforation prior to any surgical intervention. Apart from being a simple and economical mode of treatment, it is associated with minimal complications. Though various materials have been used to modify this technique, the principle remains the same and the results obtained in this study is comparable with the previous ones.

A study on fat plug myringoplasty for small tympanic membrane perforation

Introduction: Fat plug myringoplasty is an under-used technique to repair a small central tympanic membrane perforation. It is easy, quick and cost effective way with minimal morbidity. It can be done as an OPD procedure. The fat is readily available from ear lobe, abdomen and buttocks. Fat graft myringoplasty (FGM) is a noninvasive, but underused surgery for perforations of the tympanic membrane. It is also preferable for use in children. Fat tissue has been used as an autogenous material for different surgeries and is known to have a high capacity for resistance. Our study is conducted to evaluate the effectiveness of using fat plug in small central tympanic membrane perforation.Aim: To evaluate the effectiveness of using fat plug in small central tympanic membrane perforation.Materials and Methods: This study was conducted in the ENT department of Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari district in a time period from JUNE 2020 to November 2020.The sample size was taken as 30 patients who had presented with complaints of ear discharge, and hearing loss, surgical procedure was done where a fat graft was inserted through the perforation for those patients who fulfilled the inclusion criteria. The study was conducted after obtaining the clearance from Institutional Human Ethical Committee.Study Design: Prospective descriptive study.Results and analysis: 30 patients were included in the study. Age range, 20 to 80 years with a tympanic perforation (size, up to one-quarter of the pars tensa). Out of which 24 % had graft failure due to variety of causes. Success rate was 76% in our study, where as the study conducted by Ringenberg et al. The success rate was 86.5%. Posterior perforations had an overall closure rate of 63%, and in anterior perforations, the overall closure rate was 36%.Conclusion: In conclusion it is simple, safe, quick, economical procedure done under local anesthesia with as success rate as temporalis fascia and minimal or no morbidity and complications. The failure rate in our study was 24% due to infection, detached fat graft and dehiscence due to undersized grafts. Posterior perforations had an overall closure rate of 63%, and in anterior perforations, the overall closure rate was 36%. Pure tone audiometry was used to assess average AB gap pre and post operatively. Postoperatively there was an improvement in hearing compared to preoperative hearing.

Effect of Local Estrogen on Repairing Tympanic Membrane Perforation.

Introduction:Tympanoplasty is a surgical treatment of tympanic membrane perforation. Many efforts have been made to increase the success rate of tympanoplasty. Some studies confirmed the positive role of estrogen in wound healing. The current study was conducted to evaluate the effect of topical estrogen on the success rate of tympanoplasty.Materials and Methods:A total of 85 patients were randomly assigned to the case and control groups. Otomicroscopic examination was performed before and 3 months following the operation. At the final stage of tympanoplasty, gelfoam was placed on the lateral side of the graft. It was soaked in dexamethasone in the control group and combination of dexamethasone and estradiol valerate solution in the case group. Hearing thresholds were measured by audiometric tests pre- and postoperatively. Hearing levels were assessed as the mean air conduction (AC) at 500, 1000, and 2000 Hz. The graft status was evaluated using otomicroscopic examination 3 months following the operation. Results:Otomicroscopic examination revealed successful graft healing in 23 of 37 and 29 of 36 patients in the control and case groups, respectively. A higher rate (80.55%) of graft repair was observed in the estradiol group, compared to that (62.16%) reported for the control group; however, the difference was not statistically significant (P=0.08). The average improvement values of the AC levels were 20.45 and 24.7 dB in the control and case groups, respectively (P=0.3). Statistical analysis among the subgroup of patients with small perforations showed that the success rate of tympanoplasty was significantly higher in the estradiol group, compared to that reported for the control group (P=0.03). Conclusion:Although topical estrogen was generally ineffective in increasing the success rate of tympanoplasty, it improved the success rate among patients with small tympanic membrane perforations.

Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations.

Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR =0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.

The role of simple office-based surgery in small central tympanic membrane perforation

ObjectiveThe aim of this study was to evaluate the outcome of simple office-based surgery in small central tympanic membrane (TM) perforation.BackgroundThe purpose of closure of TM perforations is to restore the continuity of the TM in order to improve hearing and decrease the risk of middle ear infections. Rapid and cost-effective procedures like chemical cauterization and fat plug myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement.Patients and MethodsOur prospective study was carried out on 40 patients aged more than 15 years with dry small central persistent perforation during the period spanning from April 2017 to March 2018, divided in two groups: group A (20 patients underwent fat graft myringoplasty) and group B (20 patients underwent chemical cautery of the edge of perforation).ResultsOur study included 26 male patients and 14 female patients; the mean age was 27.2 ±9.3 years. Our study showed a 70% success rate in the healing of TM perforation in group A while there was a 55% success rate in group B.ConclusionFrom our study, we found that the two procedures are easy to perform, reliable with a satisfactory outcome, simple, rapid, risk free, and also lessen the financial burden and morbidity on the patient.

Timpanik Membrandaki Küçük Perforasyonların İşitme Üzerine Etkisi

Timpanik Membrandaki Küçük Perforasyonların İşitme Üzerine Etkisi

Silver cauterization: An office procedure for repair of small tympanic membrane perforation

Introduction: Patients with small tympanic membrane (TM) perforations often suffer from repeated infections rather than hearing loss. Repair of TM perforations is required regardless of its size, as without closure, morbidity may include hearing loss, chronic otorrhea, and cholesteatoma formation. Objective: To assess the effectiveness of the topical silver cauterization to refresh and close small TM perforation as an office-based procedure. Materials and Methods: Thirteen patients with small TM perforations were enrolled in the study. The margin of the perforation was cauterized using silver nitrate 10% that was repeated up to six times. The procedure was considered successful if there was no residual perforation within the follow-up period. Postoperative audiometry was performed before cauterization then at 3 months after. Results: Successful perforation repair was achieved in ten ears (76.9%). Mean hearing gain was 11.5 ± 8 for all cases and 15 ± 5.27 for succeeded cases. None of the patients developed infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. Conclusion: Office-based silver cautery is a safe, effective, and minimally invasive procedure. It is suitable for repairing small TM perforations with comparable success rate to conventional myringoplasty.

Role of trichloroacetic acid and gelfoam in closure of tympanic membrane perforations.

The aim of the study was to study the closure of dry central type of tympanic membrane perforations by chemical cautery and improvement of hearing, to analyse the effect of Gelfoam on nonhealing small tympanic membrane perforations, and to examine the relevance of conservative means of closure of tympanic membrane perforations as an office procedure. In this study, 100 patients attending the outpatient department were enrolled. Cautery of perforation margin was carried out with 50% trichloroacetic acid (TCA). After cautery, in small perforations less than 4 mm, a small piece of Gelfoam larger than the size of perforation was cut, impregnated with corticosteroid ointment, and carefully placed over the cauterized area under endoscopic visualization. In slightly larger perforations, that is, between 4 and 5 mm, after applying TCA to the margins of the perforation, a piece of Gelfoam larger than the size of perforation was soaked with corticosteroid ointment and placed in the middle ear cavity. Patients had relief from various symptoms, such as tinnitus, heaviness, and so on. There was some amount of auditory improvement in almost all the cases. It ranged from 5 to 23 dB. Cautery and patching of tympanic membrane perforation may be considered as the first-line management in the small- to medium-sized perforations before attempting the surgical closure.

A new graft material for myringoplasty: bacterial cellulose.

We aimed to determine the success rate of bacterial cellulose (BC) myringoplasty in tympanic membrane (TM) perforation. We reviewed the clinical records of 12 patients (16 ears) who underwent BC myringoplasty for long-standing TM perforations (>6months) between March 2012 and January 2015. The mean duration of postoperative follow-up was 12.8 (range 6-24) months. In all patients, the perforation involved less than 50% of the tympanic membrane, and the air-bone gap was ≤30dB on the operative side. The age, gender, preoperative air average, bone average, air-bone gap, perforation size and location, and postoperative TM microscopic examinations of the patients were recorded. Following the BC myringoplasty, complete coverage of the perforation occurred in the first 6months in 13 of 16 ears (81.3%), although retraction occurred in two of these ears within 6months. In three ears (18.8%), the perforation persisted during the first postoperative month. The pre- and postoperative average air threshold was 19.56 (range 7-75) and 15.69 (range 5-75) dB, respectively. The pre- and postoperative average air-bone gap was 9.25 (range 0-25) and 5.63 (0-25) dB, respectively. Both the air threshold and air-bone gap improved postoperatively (both p=0.008). No complications such as infection and granulation tissue formation were detected in any patient. BC is a safe graft material that is inexpensive, easy-to-use, and provides a high success rate in small tympanic membrane perforations. However, further studies of large tympanic membrane perforations with more samples and long-term follow-up are required.

English

Introduction: Day care surgery is the need of hour in the field of otology. Temporalis fascia is the most common material used for closure of tympanic membrane perforation. But it is a lengthy procedure requiring general anaesthesia (GA) or longer sedation, extensive middle ear manipulation and a longer recovery post operatively. Fat is said to have angiogenetic properties. The aim of this study is to evaluate the usefulness of adipose tissue fat for closure of dry small perforations of tympanic membrane as a day care procedure. Materials and Methods: 40 patients with small central dry tympanic membrane perforations were taken up for surgery under sedation using fat graft from ear lobule for closure of perforations. The results were evaluated inta operatively, immediate post operatively and at 1 st , 4 th , 8 th and 12 th monthly post operative visit for uptake of graft, hearing improvement and complications of the procedure if any. Results: The results showed that the graft uptake success rate`was high as good as traditional myringoplasty using temporalis fascia. The procedure was minimally invasive, requiring little sedation, taking much less time, cost effective where both ears can be operated in the same sitting and the patients can be discharged on the same day with no major complications. There was considerable hearing improvement noted in the patients in the study. Conclusion: So it can be concluded that fat graft myringoplasty is an effective method for closure of small central dry tympanic membrane perforations.

The button graft technique for perforations affecting less than 25% of the tympanic membrane: a non‐randomised comparison of a new modification to cartilage tympanoplasty with underlay and overlay grafts

To evaluate a new composite cartilage-perichondrium graft (button graft) for repair of small-sized tympanic membrane perforations and to compare its success rate with that of the underlay and overlay techniques with temporal fascia or tragal perichondrium. Prospective, sequential allocation of surgical technique study. Tertiary care university hospital. One hundred 95 patients aged 14-42 years with central, uncomplicated tympanic membrane perforations with completely visualised margins affecting less than 25% of the tympanic membrane, distributed in three groups: 1 (underlay), 2 (overlay) and 3 (button graft). Patients were allocated in sequence to: 1 underlay graft, 2 overlay graft and 3 cartilage tympanoplasty with button graft technique. Patients were operated on under local anaesthesia. Postoperative status of the tympanic membrane, hearing improvement, duration of surgery and incidence of complications at 12 months postoperative. Group 1 (underlay) had 66 patients; group 2 (overlay), 65; and group 3 (cartilage), 66. Success was defined as the complete closure of the tympanic membrane one year after the operation. The success rates were 98.5% (65 of 66), 97% (63 of 65) and 98.5% (65 of 66) cases, and the mean air-bone gap gains were 10.18 (±5.4) dB, 8.5 (+6.5) dB and 9.1 (+5.1) dB for groups 1, 2 and 3, respectively. No bone conduction threshold or speech discrimination score worsening was noted. The mean durations of the operative procedure were 35 ± 8.4 (range 22,63), 42 ± 6.8 (range 33,75) and 23 ± 6.3 (range 15,41) min for groups 1, 2 and 3, respectively (P = 0.02). Tympanic membrane retraction occurred in three cases in underlay group 1, and tympanic membrane cholesteatoma pearls occurred in two cases in overlay group 2. The button graft technique is an effective and fast alternative for the repair of small tympanic membrane perforations if complete visualisation of the margin is possible. The shorter time taken with the button grafts is mainly due to the non-requirement for a skin incision. The results are comparable to those of the underlay and overlay techniques.