Subtotal Tympanic Membrane Perforation Research Articles

Split-Thickness Cartilage Graft Combined With Perichondrium for Endoscopic Repair of Total and Subtotal Drum Perforations.

This study aims to describe our new modification to cartilage tympanoplasty for endoscopic repair of total and subtotal tympanic membrane perforations and evaluate its outcomes. Retrospective case series. Multiple institutions. The study was conducted using records of patients who underwent tympanoplasty for subtotal and total perforations from January 2018 to June 2022. Utilizing an endoscopic transcanal approach, we employed a double graft consisting of outer tragal perichondrium supported by inner split-thickness tragal cartilage as separate layers, both placed in an underlay fashion lateral to the malleus, without the need to elevate a tympanomeatal flap. Anatomical success was defined as complete primary closure of the perforation, while functional success was defined as achieving an air-bone gap of ≤20 dB at 12 months postoperative. The series involved 64 patients, predominantly males (53%). The mean age was 30.8 years. 56.3% of patients had subtotal perforations. The anatomical success rate was 90.6% while the functional success rate was 87.5%. Postoperative speech discrimination scores significantly increased in all patients. Our modification provides effective anatomical and audiological outcomes. This technique reliably resists graft displacement and shrinkage before adequate healing. It avoids problems of elevating tympanomeatal flaps with comparable results to traditional approaches.

Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation.

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

Endoscopic 270° subannular flap tympanoplasty: A case report

Tympanoplasty performed using 270 degree subannular flap has shown better success rates. This technique is quite useful for large subtotal tympanic membrane perforations. This case report has successfully demonstrated the feasibility of performing this difficult surgical technique endoscopically and thus avoiding a post auricular scar and reducing morbidity to the patient.

Double-Layer Fascial Grafts in Type I Tympanoplasty for Subtotal Perforation: A Case–Control Study

Objective: The objective of this study was to assess the double-layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Patients and Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow-up period. Results: Within included 60 patients, 30 patients in the study included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double-layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation.

Cartilaginous bending spring tympanoplasty: a temporal bone study and first clinical results

ObjectiveAnchoring grafts for tympanic membrane (TM) reconstruction in anterior and subtotal TM defects is essential to prevent medialisation and can be facilitated by cartilaginous bending spring tympanoplasty (CBST). The purpose of this study was to analyse the impact of spring cartilages on middle ear transfer functions and patient hearing levels.MethodsIn six fresh-frozen human temporal bones a cartilage graft (measuring 6 × 2 mm with a thickness of 0.1–0.2 mm) was formed into a ‘U’-shaped bending spring, to be placed between the medial tympanic wall and the tympanic underlay grafts. The stapes velocity for excitation by exponential sweeps from 400 to 10,000 Hz was measured with a laser Doppler vibrometer. The resulting middle ear transfer functions were compared with the reconstructed middle ear. For clinical evaluation, 23 ears in 21 patients with chronic otitis media and an intact ossicular chain were operated using CBST. At each follow-up visit, the patients underwent pure-tone audiometry and the Freiburg monosyllabic speech test at a presentation level of 65 dB SPL for the word recognition score (WRS).ResultsThe measured stapes velocities at one-third octave midband frequencies averaged 3.56 × 10–2 ± 9.46 × 10–3 (mm/s/Pa) compared to 3.06 × 10–2 ± 6.86 × 10–3 (mm/s/Pa) with the bending and underlay cartilage in place (p = 0.319; r = 0.32). The bending spring tympanoplasty reduced the transfer function by 1.41 ± 0.98 dB on average. In the clinical part of the study, the graft success rate was 96% (22 out of 23 patients) after a mean follow-up of 5.8 ± 2.4 months (min. 3.5 months, max. 12.0 months). The air–bone gap improved significantly by 6.2 dB (± 6.6 dB; p < 0.001; r = 0.69), as well as the WRS from 61.8 ± 33.3% preoperatively to 80.0 ± 20.9% postoperatively (p = 0.031; r = 0.35).ConclusionExperimental data as well as initial clinical results suggest that CBST is an effective method for reconstructing anterior or subtotal defects of the tympanic membrane with satisfactory audiologic results and graft success rates comparable to previously described methods. It can, therefore, be added to the arsenal of tympanoplasty techniques for anterior and subtotal TM perforations.

Application of posterior canal skin flap for the repair of large tympanic membrane perforations.

ObjectiveMany methods have been described for the repair of the tympanic membrane, but there is no general consensus as to the standard method. The aim of this study was to evaluate the effect of the inferior base posterior canal skin flap on the graft success rate in large tympanic membrane perforations.MethodsAfter the post‐auricular incision, the posterior canal skin flap with inferior pedicle was created by two vertical and one horizontal incisions. Then the flap was rotated over the temporalis fascia graft. The graft success rate and postoperation hearing test results were evaluated in 52 patients who suffered from large tympanic membrane perforations.ResultsWe achieved a 92.3% total graft success rate with about 9 dB improvement in speech reception threshold (SRT).ConclusionThe rotational inferior base posterior canal skin flap tympanoplasty technique is simple, fast, safe, and effective for the repair of subtotal tympanic membrane perforations.

Clinical study on repairing subtotal perforation of tympanic membrane with cartilage island technique combined with palisade technique under otoscope

Objective:To investigate the healing rate of subtotal perforation of tympanic membrane repaired by cartilage island technique combined with palisade cartilage technique under otoscope. Methods:A retrospective analysis was performed on 189 patients with chronic suppurative otitis media who were admitted to the Department of Otolaryngology and Head and Neck Surgery of Hunan Provincial People's Hospital from January 2018 to January 2020. The patients were divided into twogroups, in group onethere were 100 patients treated by senior surgeon, which were divided into two subgroups, Group A （68 cases） were treated with cartilage island technique alone, and Group B （32 cases） were treated with cartilage island technique combined with palisade cartilage technique. In group two there were 89 patients treated by junior surgeons, which were divided into two subgroups. In group C, 50 cases were treated with cartilage island technique alone, and in group D, 39 cases were treated with cartilage island technique combined with palisade cartilage technique. Results:The healing rate of tympanic membrane in group 1 was 96.0% （96/100）, and in group 2 was 87.6%（78/89）.There was statistically significant in group 1 and group 2（χ²=4.504, P=0.034）.The healing rate of tympanic membrane was 94.1% （64/68） in group A, 100%（32/32）in group B, 80.0%（40/50） in group C, and 97.4% （38/39） in group D. There was no statistically significant difference between group A and group B （χ²=1.961, P=0.161）, there was statistically significant difference between group C and group D （χ²=6.149, P=0.013）, and there was statistically significant difference between group A and group C（χ²=5.492, P=0.019）There was no statistical difference between group B and group D（χ²=0.832, P=0.362）. Conclusion:For beginners of tympanoplasty, the use of cartilage island technique combined with palisade cartilage technique in otoscope can significantly improve the success rate of tympanoplasty with subtotal tympanic perforation.

Single Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation

Single Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation

Cartilaginous bending spring for preventing tympanic membrane graft medialisation in anterior or subtotal tympanic membrane perforations\u2014how I do it

BackgroundThe reconstruction of anterior or subtotal tympanic membrane perforations is critical due to the risk of anterior graft medialisation and retraction or recurrent perforation.MethodAfter reconstruction of the tympanic membrane by means of grafting, a rectangular cartilage strut (length 6 mm, breadth 2 mm, thickness 0.1 mm) is prepared using a cartilage knife and scalpel. This strut graft is placed between the cartilage graft and the promontory in the anterior inferior part of the middle ear cavity.ConclusionOur experience shows that using a U-shaped cartilage strut to sustain the tympanic reconstruction effectively prevents the medialisation of the graft and recurrent perforations.

Preliminary experience and feasibility test using a novel 3D virtual-reality microscope for otologic surgical procedures

Background Current surgical microscopes suffer from inherent constraints in achievable viewing angles and require manual interaction to control settings. Overcoming these limitations may provide benefits for otologic surgical procedures. Objectives We present a first feasibility and usability assessment of a novel commercial surgical microscope featuring a virtual-reality interface and hands-free control of a robot-mounted 3D-camera. Materials and methods Ex vivo feasibility tests were conducted in a human cadaveric head sample based on common otologic procedures. Usability metrics were obtained from feedback forms. In a first clinical case, the device was used to perform a tympanoplasty in a 68-year-old patient with a subtotal tympanic membrane perforation. Results Overall practicability of using the device for otologic procedures could be confirmed in the ex vivo tests. Beneficial aspects of the novel system which were subjectively encountered in the ex vivo tests and the first clinical case included hands-free control, visualization quality, and teaching potential. Conclusions and significance The novel virtual reality 3D-microscope bears potential to provide benefits for various otologic procedures, which will be evaluated more quantitatively in clinical follow-up studies.

Endoscopic single versus double flap tympanoplasty: a randomized clinical trial.

This study aims to compare the results of endoscopic over-underlay tympanoplasty, single flap technique, with endoscopic over-underlay tympanoplasty combined with an anterior tab, double flap technique, in repair of the challenging total and subtotal tympanic membrane perforations with inadequate anterior remnant. This is to determine whether highly adequate visualization at the anterior meatal angle area offered by endoscopy can eliminate the need for anterior tab reinforcement. A prospective randomized single-blinded study involving 104 patients with total or subtotal tympanic membrane perforations was conducted. Patients were randomized into two groups: 52 with endoscopic single flap tympanoplasty, first group, and 52 with endoscopic double flap tympanoplasty, second group, between August 2017 and February 2019. The main outcome is graft take rate. Secondary outcomes include hearing results, pain score assessment, operative time and postoperative complications. Graft take rates were 94% and 98% for the first and second groups, respectively (P value = 0.307). Significant improvement was achieved in total air-bone gap from 21.45 ± 5.37 and 23.1 ± 4.47 preoperatively to 6.4 ± 5.46 and 6.15 ± 3.57 postoperatively for the first and second groups, respectively. Pain scores were not significantly different between the two groups. Mean operative time was significantly longer in the second group (P value = 0.010). There was no reported lateralization or anterior blunting in both groups. In repair of total and subtotal tympanic membrane perforations with inadequate anterior remnant, endoscopic enrollment provides excellent visualization and good manipulation at the anterior meatal angle area with favorable results, eliminating the need for adding an anterior tab and alleviating the burden of longer operative time. ClinicalTrials.gov (NCT03922295) "retrospectively registered" at 18/4/2019.

Interlay Myringoplasty With Anterior Subannular Grafting Technique for Anterior and Subtotal Perforations.

To describe the interlay myringoplasty with anterior subannular grafting technique and evaluate postoperative hearing and complications of this technique. Retrospective chart review. We included 141 patients with anterior and subtotal tympanic membrane (TM) perforation. Patients who underwent concurrent ossicular chain reconstruction were included in graft success and complication rates evaluations, and were excluded from audiometric evaluation. Only squamous layer of the TM continuous with posterior meatal skin is elevated except one of anterioinferior annulus. The inner tympanic remnant is released from the anterioinferior annulus and then the subannular mucosa is separated from the annulus to fashion a subannular pocket. The anterior edge of the graft is inserted into the pocket, and the rest of the graft is sandwiched between the two divided layers of the TM. Graft success rate and hearing results were evaluated at 6 months postoperatively. Postoperative complications were also noted. The technique was successfully performed in 132 (93.6%) cases. Graft success rate was 98.3% (111/113) and the mean improvement of the air-bone gap was 9.5 dB, which was statistically significant (p < 0.001). There was no anterior blunting or TM lateralization. The pearl formations were found in six (5.3%) patients. All of them were easily removed at follow-up examination. The present study showed the interlay myringoplasty with anterior subannular grafting technique produces excellent results to repair anterior or subtotal TM perforations with few risk of anterior blunting and lateralization of the TM.

Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study.

The endoscopic approach to tympanoplasty is gaining popularity, but its adoption for the palisade tympanoplasty technique is unstudied. The aim of the present study was to evaluate the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations. Retrospective study of 42 adult patients who underwent endoscopic tympanoplasty for a subtotal perforation in a university tertiary referral center from January 2018 to June 2019. Patients underwent transcanal tympanoplasty either with cartilage palisade grafts or with one-piece composite cartilage-perichondrium grafts. Both techniques were compared for graft take rate and audiometric results. Twenty palisade and 22 single-piece tympanoplasties were analyzed. No statistically significant differences between groups were found in terms of tympanic membrane closure (85% vs. 86.3%, p = 0.5) or hearing improvement. The results of the present study suggest that similar results can be obtained with palisade cartilage grafts compared to the one-piece composite cartilage-perichondrium technique for endoscopic tympanic membrane closure. Further studies with long-term results will be needed to confirm these findings.

Effect of interlay tympanoplasty on anterior tympanomeatal angle and pure tone audiometry at one month, six month and one year follow up

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to determine the effect of interlay tympanoplasty on anterior tympanomeatal angle and on puretone average at 1 month, 6 month and 1 year follow up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was done at department of Otorhinolaryngology, RMRI, Bareilly, India, a tertiary-care Teaching hospital. A total number of 187 patients (86 females, 101 males) were included in this study from April 2014 to March 2018. Age range of selected patients was 15 years to 62 years, 133 patients were having subtotal perforation and remaining having perforation in the anterior half extending upto the annulus. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The anterior tympanomeatal angle blunting and pure tone audiometry (PTA) at the due follow up time was assessed and results were analyzed in terms of angle of blunting and hearing loss detected by PTA. Anterior tympanomeatal angle (ATA) blunting was categorized in three groups as follows &amp;lt;90&lt;sup&gt;o&lt;/sup&gt;,90-120&lt;sup&gt;o &lt;/sup&gt;and &amp;gt;120&lt;sup&gt;o&lt;/sup&gt;. Only 3 patients were having &amp;gt;120&lt;sup&gt;o &lt;/sup&gt;ATA after one year and mean hearing loss (air bone gap) was significantly less after 1 year follow up. There were only 3 patients with remnant perforation, after 1 year of surgery out of 187 cases, with 98.4% success rate.&lt;/p&gt;&lt;p class="p1"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Interlay tympanoplasty was significantly effective in repairing anterior and subtotal tympanic membrane perforations with avoidance of blunting at the anterior tympanomeatal angle and achieved good functional results. &lt;/p&gt;

Repair of subtotal tympanic membrane perforations: A temporal bone study of several tympanoplasty materials.

The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer.

Medial versus Medio-lateral Tympanoplasty in Large Central and Subtotal Perforation – A Prospective Study

Introduction: &#x0D; Large central and subtotal tympanic membrane (TM) perforations are difficult to repair because of less vascularity of anterior TM than posterior TM and the anterior bony overhang that blocks visualization. Some studies reported very encouraging results with the medio-lateral tympanoplasty in such cases. We have undertaken this study to find out efficacy of this technique in large central and subtotal perforations and to compare the results of medio-lateral with medial tympanoplasty.&#x0D; Materials and Methods: &#x0D; The present prospective study was conducted in the Department of Otorhinolaryngology of a medical college and hospital, West Bengal from January 2013 to December 2014. Patients were alternatively divided into two groups. Medial technique was used in Group I and medio-lateral technique was used in Group II. &#x0D; Results: &#x0D; Each group comprised of 40 patients each. Maximum number of patients in each group was in the age group of 15-25 years. The overall graft uptake rate in this study was 95% in medio-lateral technique compared to 80% of underlay technique.&#x0D; Conclusion: &#x0D; The medio-lateral tympanoplasty is suitable for reconstruction of large central or subtotal TM perforation. It takes advantage of both medial and lateral grafting methods while avoiding their pitfalls.

Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between 'U' flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation. Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sized anterior and subtotal perforation of tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in 'U' flap group and thirty two cases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups. Graft uptake rate was 90.3%(28/31) in'U' flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in 'U' flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504). The graft uptake rate and hearing results of 'U' flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group.

Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

Background: Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between ‘U’ flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation.Methods: Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sized anterior and subtotal perforation of tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in ‘U’ flap group and thirty two cases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.Results: Graft uptake rate was 90.3%(28/31) in‘U’ flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in ‘U’ flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504).Conclusions: The graft uptake rate and hearing results of ‘U’ flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group. Keywords: Anterior perforation; myringoplasty; subtotal perforation; ‘U’ flap.

The role of anterior tucking of graft in subtotal perforation of tympanic membrane

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympnaoplasty has been well accepted as the surgery of choice for chronic otitis media. Since the introduction of tympanoplasty, there has been many modifications in terms of technique, approach, and materials used for grafting the tympanic membrane; each with their respective advantages and disadvantages. But irrespective of procedure done, very large and subtotal perforations have always posed a problem with failure after surgery. This demands further modification of the procedure to support the graft. This study was done to know the role of Anterior tucking of graft in subtotal perforation of tympanic membrane in terms of graft uptake rate and hearing outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A systemic retrospective analysis of case files was done. The case files of patient who fulfilled the inclusion criteria were selected. Detailed preoperative and postoperative clinical and audiometric findings were noted down. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total of 40 cases with 3 cases being bilateral, 43 ears were operated by cortical mastoidectomy with tympanoplasty along with anterior tucking of the graft. Our success rate was 95.3% (n=40). 40 patients had showed the improvement in hearing with average air bone gap gain of 12.7 dB HL.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Underlay grafting for subtotal perforations of tympanic membrane is a surgically challenging and results in poor outcome. Modification to this method by anterior tucking of the graft is an effective surgical technique with satisfactory outcomes and hence is advocated for the routine practice.&lt;/p&gt;

Anterosuperior anchoring myringoplasty using cyanoacrylate glue can prevent packing gelfoam in the middle ear cavity

ObjectivesAlthough a number of methods have been attempted to improve securing the graft, packing gelfoam in the middle ear cavity cannot be avoided, which could obstruct the tympanic ostium of the Eustachian tube and affect inner ear function. Myringoplasty using tissue adhesive has gained traction because tissue adhesives can effectively stabilise the graft and act as scaffolding to improve the graft uptake. The aim of this prospective study was to explore myringoplasty using cyanoacrylate glue with no packing in the middle ear cavity for the repair of subtotal tympanic membrane (TM) perforations. MethodsBetween March 2014 and November 2015, 71 patients with subtotal TM perforations were randomly and prospectively divided into a glue group and a control group. Two securing techniques were performed using only cyanoacrylate glue or using only filling gelfoam in the middle ear cavity, respectively, during an anterosuperior anchoring myringoplasty operated by a single surgeon. ResultsAt a 6-month follow-up, the graft uptake rate was 87% in the glue group and 89% in the control group. A significant hearing improvement was found in both groups postoperatively when compared to the preoperative values (P<0.05 for both). There was no significant difference in the graft uptake rate and hearing improvement between the 2 groups (P>0.05). Similar complications were found in each group. ConclusionCyanoacrylate glue is a helpful material for graft stabilisation and can substitute for filling gelfoam in the middle ear cavity during anterosuperior anchoring myringoplasty for subtotal TM perforation.