Total Tympanic Membrane Perforations Research Articles

Comparison of healing of acute total tympanic membrane perforation between rats with and without excision of the mallear handle

AbstractObjectiveWe compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague–Dawley (SD) rats with and without excision of the mallear handle.Materials and methodsBilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle‐preserved ear [HPE]) and excised from the right ear (handle‐excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed.ResultsEndoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p = .029 and p = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p = .011 and p = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies.ConclusionAlthough the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.

Опыт лечения мукозита при хроническом гнойном среднем отите у детей

Background: the most common clinical subtype of chronic suppurative otitis media (CSOM) in childhood is low-grade catarrhal inflammation affecting the middle ear mucosa (mucositis). The etiology and pathogenesis of mucositis remain unclear. Virtually no data on the course and treatment of this disease in children are available. Aim: to share our experience with mucositis treatment in children with CSOM. Patients and Methods: we performed a retrospective analysis of treatment results in 118 children aged 5–14 years with subtotal and total tympanic membrane perforations and mucositis of the tympanic cavity of various severity without cholesteatoma. Results: no pathognomonic signs were identified in children with mucositis. All children had mild hearing loss. Temporal bone CT revealed signs of temporal bone and ossicular system destruction in 15 children (12.7%). Microbiological diagnostics demonstrated that the key bacterial pathogens were Pseudomonas aeruginosa (n=26, 22%) and Staphylococcus aureus (n=21, 17.8%). In children with mesotympanitis, the secretory stage of mucositis was diagnosed most often (n=79, 67%), as demonstrated by otomicroscopy. Hyperplastic and atrophic stages of mucositis were diagnosed in 31 (26%) and 8 patients, respectively. During CSOM remission, all patients underwent scheduled myringoplasty and tympanoplasty with revision of the tympanic cavity and mastoid. These procedures were performed under microscopic control via an endaural or transcanal approach. 12 weeks after surgery, 108 patients (92%) reported an improvement in hearing. Diastasis in the lower part of the created eardrum was detected in 11 patients (9.3%) only. Conclusion: given the understudied etiology and pathogenesis, conservative treatment is reasonable only during uncomplicated exacerbation of CSOM. The most effective treatment for mucositis of the tympanic mucosa is timely myringoplasty and tympanoplasty. KEYWORDS: chronic suppurative otitis media, mucositis, children, myringoplasty, tympanoplasty, hearing loss. FOR CITATION: Naumov O.G., Karpova E.P., Tulupov D.A. Treatment for mucositis in children with chronic suppurative otitis media. Russian Medical Inquiry. 2023;7(8):543–548 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-12.

Transcanal Endoscopic Cartilage and Perichondrium Graft Myringoplasty for Large Tympanic Membrane Perforations.

The objective of this study was to evaluate the outcomes following transcanal endoscopic cartilage and perichondrium double-layer myringoplasty for subtotal and total tympanic membrane (TM) perforations. Retrospective case review. Tertiary referral center. Adult patients who underwent transcanal endoscopic double-layer myringoplasty for subtotal and total TM perforations between January 2015 and December 2017 were included. The graft success rate, hearing outcomes, and complications were evaluated postoperatively. Temporal bone computed tomography or magnetic resonance imaging was performed at 24 months postoperatively. The mean follow-up period was 28.2 ± 6.1 (range, 24-36) months. The graft success rate was in 95.7% (45/47) at 6 months, 93.6% (44/47) at 12 months, and 87.2% (41/47) at 24 months, respectively. The mean ABG improved from 32.89 ± 5.31 dB preoperatively to 10.89 ± 4.78 dB postoperatively 12 months (p < 0.05) for subtotal perforations; from 33.41 ± 7.41 dB preoperatively to 11.45 ± 2.41 dB postoperatively 12 months (p < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion) were encountered during the follow-up period. Postoperative temporal bone imaging revealed a pneumatized middle ear and mastoid in all cases with no evidence of cholesteatoma. Transcanal endoscopic myringoplasty for large TM perforations using a double-layer perichondrium and cartilage graft is feasible with comparable rates of closure to more invasive approaches.

Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review

BackgroundThe study aims at reporting our experience with loop underlay tympanoplasty, a modification of the underlay technique previously reported, for the reconstruction of anterior, subtotal or total tympanic membrane perforations.MethodsA retrospective review of charts of patients who have undergone loop underlay tympanoplasty from January 2002 to January 2012 was performed. One thousand one hundred patients were included. Hearing test results preoperatively and postoperatively were reported. On follow up visits, the closure of the tympanic membrane perforation and the improvement of hearing compared to preoperative measurements with absence of complications were considered as successful outcomes of the surgery.ResultsAt the three-month follow-up visit, the perforation closure rate was found to be 99.3% and Air-Bone Gap closure rate to less than 10 dB was 99.5%. The complication rate, including post-operative infection, was 0.72%.ConclusionThe loop underlay technique combines advantages of both underlay and overlay techniques with excellent postoperative outcomes.

The wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia for type 1 tympanoplasty: a prospective, randomized study.

To compare the anatomical and functional outcomes of two different grafts which are used for the reconstruction of subtotal or total tympanic membrane perforations: the wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia (TF). Ninety patients (94 ears) who underwent type 1 tympanoplasty for non-complicated chronic otitis media between March 2014 and June 2016 in a tertiary referral center were included in a randomized, controlled, prospective clinical trial. Tympanic membranes were reconstructed with the WsCCG or TF. Outcomes of 91 surgeries performed on 87 adults (> 18years of age) were evaluated in the study. Forty-three patients (44 ears) were included in the WsCCG group; 44 patients (47 ears) were included in the TF group. The mean post-operative follow-up was 14.9months for the WsCCG group and 15.1months for the TF group. There was no statistically significant difference in post-operative pure tone average (PTA) (p = 0.19), air-bone gap (ABG) (p = 0.64), PTA gain (p = 0.82) and ABG closure (p = 0.89) values between two groups. Graft success rates at 6months after surgery were 82.9% (39/47) and 97.7% (43/44) for TF and WsCCG, respectively. At the first year, success rates were 85.1% (40/47) for TF and 97.7% (43/44) for WsCCG. A statistically significant difference was observed in graft success rates between two groups (p = 0.039). Both TF and WsCCG lead to satisfactory functional results, but the WsCCG clearly leads to superior anatomical outcomes with a graft success rate of 97.7%. The WsCCG is a suitable graft for subtotal or total tympanic membrane perforations and has the advantages of being a one-piece, flexible, composite, and physically resistant graft.

A Cotton Wick Improves Hearing in a Patient with Profound Hearing Loss

Dear Editor,&#x0D; &#x0D; The tympanic membrane and the ossicular chain contribute roughly 28 dB in hearing gain. In chronic suppurative otitis media, loss of tympanic membrane and lysis of the ossicular chain are significant causes of hearing loss.1 Through the years, hearing impairment has been augmented using various devices such as ear trumpets, carbon hearing aids, vacuum tube and transistor hearing aids, bone anchored hearing aids, and cochlear implants.2 This case report describes how a cotton wick was used to amplify sound.&#x0D; &#x0D; Case Report&#x0D; A 65-year-old man consulted for hearing loss. He had a childhood history of recurrent ear discharge and hearing loss and was diagnosed with chronic suppurative otitis media. At age 55, he underwent tympanomastoidectomy of the left ear. While surgery stopped the left ear discharge, there was complete hearing loss in this ear. For this reason, he opted not to have surgery on the right ear. There was subsequent recurrent ear disease of the right ear. He would clean his ear with a cotton wick and apply antibiotic drops during bouts of ear discharge. He observed that leaving the ear wick with a few drops of topical otic preparations (polymyxin-neomycin-steroid or ofloxacin) would lessen the frequency of ear discharge and improve his hearing. He found that morning application and positioning of the cotton wick in his right ear using tweezers and a toothpick allowed him to hear adequately to conduct his daily activities as an architect. (Figure 1, 2) The fear of hearing loss from another surgery, cost of a commercial hearing aid, and great utility of a simple cotton wick made him continue his practice for these ten years.&#x0D; Examination of the right middle ear without the cotton wick showed thickened mucosa, absent malleus and incus structures, a patent Eustachian tube and a near – total tympanic membrane perforation. There was no keratinous material or foul smelling discharge. (Figure 3) Pure tone audiometry confirmed that with the cotton wick, the right air-bone gap decreased at 500 hz, 1kHz, 2Kh and 4KHz by 30db, 40dB, 35dB and 25dB respectively. (Table 1)&#x0D; DISCUSSION&#x0D; At different anatomic levels, mechanical sound energy is amplified and transmitted to the functional parts of the ear. The tympanic membrane and oval window ratio of 21:1 and malleus-incus lever mechanism ratio of 1.3:1 provide a 28 dB amplification of conductive hearing.1 This gain is reflected by frequency specific air-bone gaps, which can range between 25-40 dB. With the contribution from the external ear, the overall conductive gain is 60 dB.1,3 Damage to the auditory system often results in a loss of hearing sensitivity that is frequency – specific. The presence of a frequency – specific wide air-bone gap suggests ossicular chain discontinuity among patients with chronic otitis media.4 Narrowing of the air-bone gap, which in this case was provided by insertion of the cotton wick, may lead to at least partial restoration of ossicular coupling.&#x0D; The ability of the cotton wick to improve hearing may be attributed to its possession of characteristics for sound conduction and acoustic impedance, such as stiffness, resistance and mass. The effectiveness of the cotton wick was reported to be dependent on its positioning in the ear; the patient would have to insert the wick down to the level of the promontory or oval window, occasionally blow his nose, or reposition the cotton wick to achieve an acceptable hearing level. However, for a patient with completely deaf contralateral ear, a 32.5 dB gain in hearing is very pronounced and significant. &#x0D; The hearing gain produced by the cotton wick only amplified the air conductive component of hearing but not bone conduction. While it afforded amplification of sound and a route of medicine administration, it may also have contributed to sensorineural hearing loss brought about by ototoxicity of medications and thickening of the oval and round window from chronic irritation. For this reason, utmost caution must be advised before considering use of a “cotton wick” to amplify hearing in this manner-- a practice we do not endorse.&#x0D; The cotton wick may have served as a vibrating piston on top of the oval window which amplified hearing. Such a mechanism may conceivably prognosticate potential gain from a contemplated tympanoplasty in the same way that the “paper patch test”5 predicts simple myringoplasty outcomes. Having said that, the diagnostic utility of such a cotton wick requires further investigation before potential clinical applications such as prognostication of tympanoplasty are theorized. Could future studies show that a preoperative cotton wick (or equivalent device) may approximate potential gains from a good tympanoplasty with ossiculoplasty in a patient with total tympanic perforation and ossicular chain loss?&#x0D; &#x0D; Sincerely,&#x0D; Ryner Jose D. Carrillo, MD, MSc&#x0D; Precious Eunice R. Grullo, MD, MPH&#x0D; Maria Luz M. San Agustin, RN, MClinAudio&#x0D; &#x0D;

Cartilage Shield Tympanoplasty: A Retrospective Chart Review of 69 Cases

ABSTRACT Objective Cartilage shield tympanoplasty (CST) is an acknowledged procedure to repair total tympanic membrane perforations. The main objective of this study was to share our experience of CST, in form of its technique, graft uptake and hearing outcomes. Study design Retrospective chart review. Setting Tertiary care hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. Patients A total of 69 cases of type 1 CST, from January 2013 to March 2014. We followed all patients for a minimum period of 6 months. Intervention Therapeutic. Main outcome measures Graft uptake rate, along with preand postoperative pure tone audiogram air bone gap (ABG) and postoperative complications, was evaluated. We compared ABG using Student's t-test. Results Graft uptake was seen in 68 cases (98.5%). The mean pre- and postoperative pure tone audiometry (PTA)-ABG was 37.58 ± 6.43 dB and 20.19 ± 8.14 dB, respectively. Hearing improvement was maximum at 2 kHz with mean postoperative value of 17.73 dB, and the least improvement was seen at 8 kHz with value of 30 dB in postoperative period. Conclusion The graft uptake rate was excellent, and hearing results were satisfactory. Cartilage shield tympanoplasty should be a recommended procedure for total perforation, subtotal perforation and revision cases. However, long-term results are still awaited. How to cite this article Patadia S, Keshri A, Shah S. Cartilage Shield Tympanoplasty: A Retrospective Chart Review of 69 Cases. Int J Otorhinolaryngol Clin 2015;7(3):105-108.

Gelatin Hydrogel With Basic Fibroblast Growth Factor for Tympanic Membrane Regeneration

In this developmental research study that aimed to develop tympanic membrane regeneration therapy, we devised a method of sustained bFGF formulation release using gelatin hydrogel in a guinea pig eardrum perforation model. Basic fibroblast growth factor (bFGF) can promote perforation closure. In addition, several studies of bFGF formulations have used gelatin hydrogel-bFGF coupled electrostatically to a gelatin polymer. BFGF is released gradually as a result of degradation of the gelatin polymer, and studies have shown that the long-term pharmacologic effects of bFGF can be maintained. Using a CO(2) laser, total tympanic membrane perforations were created in 24 guinea pig ears and divided into 3 groups: the bFGF-gelatin hydrogel group(n = 8), the saline-gelatin hydrogel group (n = 8), and the control group (n = 8). Either a bFGF formulation or saline was impregnated into gelatin hydrogen and implanted into the perforated tympanic membrane. All ear drums of the control group showed large perforations at even the 30th postoperative day. The perforation persisted in 3 of 8 ears in the saline-gelatin hydrogel group, and the tympanic membranes that had achieved closure were thinned, whereas all ears in the bFGF-gelatin hydrogel group achieved closure of the perforation. In the ears in which a normal tympanic membrane had regenerated, histologic observation with hematoxylin and eosin staining revealed that, although mucosal and epithelial layer regeneration had occurred in the saline-gelatin hydrogel group, the bFGF-gelatin hydrogel group showed regeneration of the fibrous layer in addition to the other 2 layers. These data suggest that hydrogel impregnated with bFGF induces regeneration of the tympanic membrane and can conservatively treat tympanic membrane perforation.

Cartilage “shield” tympanoplasty: an effective and practical technique

The aim of the present study is to report our results with cartilage "shield" tympanoplasty (CST) for total tympanic membrane perforations. A retrospective chart review of patients undergoing CST was performed in tertiary referral centers. One hundred and seventy-seven patients who had undergone CST were identified. Patients' age ranged from 7 to 74 (mean 35) years. The mean postoperative follow-up was 23 (range 6-73) months. The main outcome measures were Graft take, pre and postsurgery audiologic evaluation. Graft take was 97.2%. Three patients developed recurrent cholesteatomas, one an anterior pinhole perforation, and one a minimal graft anterior lateralization. The average pre and postoperative pure-tone air-bone gaps (PTA-ABG) were 32.06 ± 11.21 and 18.69 ± 10.53 dB, respectively. The overall average ABG improvement was 13.37 ± 9.34 dB. An overall postoperative ABG of 25 dB or less was achieved in 140 of the 177 patients (79.1%). Hearing improvement was statistically significant in all cases (p < 0.0001). Cartilage shield tympanoplasty is a very reliable procedure. Graft take is excellent and hearing improvement is significant.

“Mucosal pocket” myringoplasty: a modification of underlay technique for anterior or subtotal perforations

PurposeChronic otitis media surgery is the most common procedure in otology in developing countries. Subtotal and total tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rate of graft failure. It was the goal of this study to test the anatomical and functional outcomes of a modified underlay myringoplasty technique. Materials and methodsIn a prospective clinical study, 45 patients with subtotal or total TM perforation and inadequate anterior remnant underwent tympanoplasty (+/−mastoidectomy). The anterior tip of the temporalis fascia was secured in a mucosal pocket on the lateral wall of eustachian tube orifice. Data on graft take rate, preoperative and postoperative hearing status, and intraoperative findings were analyzed. ResultsWe achieved the graft success rate of 91.1%, without lateralization, blunting, atelectasia, or epithelial pearls. Approximately 24% patients had air-bone gap within 25 dB before intervention, which increased to 71% postoperatively (P < .001). ConclusionWe believe that this technique could be a convenient and suitable method for cases with subtotal or total TM perforation and inadequate anterior remnant.

Loop overlay tympanoplasty for anterior or subtotal perforations

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

Lateral Tympanoplasty for Total or Near‐Total Perforation: Prognostic Factors

To identify prognostic factors affecting outcome in lateral tympanoplasty for total or near-total tympanic membrane perforation. Retrospective case series. Patients were those presenting with total or near-total tympanic membrane perforation undergoing lateral tympanoplasty from 1999 to 2004. We systematically collected demographic, clinical, audiologic, and outcome information. Student t test was used to determine group differences. Logistic regression analysis was used to examine the relationship between success of grafting (dependent variable) and the independent variables. Multiple regression analysis was used to examine the relationship between postoperative air-bone gap (ABG) and independent variables. There were seventy-seven cases (58 primary and 19 revision cases) with average follow-up of 17 months. Successful tympanic membrane grafting occurred in 91% of cases. None of the independent variables studied was predictive of the success of graft incorporation (P > .05). The mean preoperative ABG was 29.8 +/- 10 dB and improved to a postoperative ABG of 16.5 +/- 11 dB (P < .001). Smaller preoperative ABG and normal malleus handle were associated with smaller postoperative ABG. In revision cases, mastoidectomy was associated with better functional results. Successful grafting of near-total and total tympanic membrane perforations occurred in 91% of the cases and was independent of demographic, disease, and technical variables. Disease variables (preoperative ABG and status of malleus handle) had a greater prognostic value on postoperative ABG than other variables. In revision tympanoplasty, mastoidectomy is associated with a better functional outcome.

Cartilage Shield Tympanoplasty: A Reliable Technique

Cartilage shield tympanoplasty is a procedure for repairing total tympanic membrane perforations. This procedure is indicated primarily for patients with total perforations, severely atelectatic tympanic membranes, and failures of previous tympanoplasty associated with chronic eustachian tube dysfunction. Although the graft take of this technique has been reported to be excellent, there have been concerns regarding hearing results because it replaces the entire tympanic membrane with cartilage. The purpose of this study was to report our experience with this technique. Retrospective chart review. Tertiary care hospital: Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. Between 1998 and 2003, 62 patients were identified who had a cartilage shield tympanoplasty. The patients' ages ranged from 7 to 72 years (mean, 32 years). Therapeutic. Graft take was evaluated in all patients and postoperative complications were noted. In 58 patients, pre- and postoperative audiograms were available and pure-tone average air-bone gaps were compared using the Student's t test. Graft take was accomplished in 61 patients (98.4%) and there were no postoperative complications. The average preoperative and postoperative pure-tone average air-bone gap was 32.4 +/- 14.1 dB and 24 +/- 13.7 dB, respectively (p < 0.005). This study reveals that cartilage shield tympanoplasty has a high degree of graft take, and hearing results are satisfactory.

Mediolateral graft tympanoplasty for anterior or subtotal tympanic membrane perforation

To describe and evaluate the mediolateral graft tympanoplasty for the reconstruction of anterior or subtotal tympanic membrane (TM) perforation. Retrospective study of 100 patients who underwent the mediolateral graft tympanoplasty at community and tertiary care centers from 1995 to 2001. All patients underwent preoperative and postoperative audiograms. Posterior tympanomeatal flap is elevated same as in the medial (underlay) graft tympanoplasty. Anterior-medial canal skin is elevated down to the annulus. At the annulus, only squamous epithelial layer of TM is elevated up to anterior half of the TM perforation. Temporalis fascia is grafted medial (underlay) to the posterior half of the perforation and lateral (overlay) to the anterior half of the de-epithelialized TM perforation, up to the annulus. Anterior canal skin is rotated to cover the fascia graft and TM perforation as a second-layer closure. Patients were followed for at least 6 months. Outcome was considered successful if the TM is intact. There were 3 failures (97% success rate), attributable to a postoperative infection, anterior blunting, and recurrent cholesteatoma, respectively. There was no significant postoperative hearing loss compared with preoperative hearing. More than 70% of the operated ears had hearing improvement of 0-40 dB (0-10 dB in 19% of ears, 11-20 dB in 44%, 21-30 dB in 7%, and 31-40 dB in 4%) even without ossiculoplasty. With ossiculoplasty using either partial ossicular replacement prosthesis (PORP, 15%) or total ossicular replacement prosthesis (TORP, 11%), there were various degree of hearing improvement from 11 to 30 dB. The mediolateral graft method is superior to the traditional medial or lateral graft technique for the reconstruction of large anterior or subtotal TM perforation. This new method should help otologic surgeons to improve outcome of tympanoplasty for anterior or total TM perforation. C-1.

Repair of the total tympanic membrane perforation: AlloDerm vs temporalis fascia

Objectives: Patients who require surgery for chronic otitis media with perforation and cholesteatoma frequently have scarce residual tympanic membrane or cholesteatoma adherently involving its entire undersurface. These situations prove poor for standard underlay tympanoplasty techniques. A novel technique is described that maximizes healing and minimizes complications of mucosalization and anterior blunting. The results are compared using Alloderm vs temporalis fascia as grafting materials. Fascia is used when available in primary cases, while AlloDerm has proven successful in revision cases or when delayed epithelialization can be expected. Methods: A retrospective review was performed on all otologic cases at a tertiary care public hospital from 1999 to 2003. Fifty-five cases where total reconstruction was required were included in the study. Simple underlay grafting cases were excluded. Data reviewed included preoperative diagnosis, intraoperative findings, grafting material used, surgical technique, postoperative healing, complications. The group of patients who underwent reconstruction using fascia were compared to those who underwent AlloDerm reconstruction. Results: The 2 groups of patients were similar in preoperative diagnosis, intraoperative findings, surgical technique, and postoperative healing. The AlloDerm group had a slightly higher postoperative perforation rate, likely due to pores within the AlloDerm itself. The closure rate in the Alloderm group was still high at 93%. Audiologic data is analyzed. Conclusions: Temporalis fascia and AlloDerm are both safe and highly effective grafting materials in the reconstruction of the total tympanic membrane perforation if used with the described technique.

Use of hydroxyapatite bone cement for difficult ossicular reconstruction

Objectives: Conventional ossiculoplasty relies on favorable anatomy, surface tension, and packing to hold the reconstruction in its desired position. This can be frustrating when faced with difficult ossicular chain abnormalities that need a more stable fixation. We describe the use of Mimix™, a rapidly setting, nontoxic hydroxyapatite bone cement for the repair of complex ossicular problems in patients undergoing tympanomastoidectomy or stapedotomy. Methods: Mimix™ was used to cement partial ossicular replacement prostheses into position, repair incudostapedial joint separation and incus necrosis, repair incus necrosis during revision stapedotomy, augment the tapered incus during primary stapedotomy, and rebuild a total tympanic membrane perforation with a tympanic membrane/malleus head homograft. Preoperative and serial postoperative audiograms were examined for 4-tone pure tone average (PTA), speech reception thresholds (SRT), and word recognition scores (WRS) in 14 patients with up to 18 months follow-up. Results: The average improvement for PTA, SRT, and WRS approximated 22dB, 23dB, and +6%. Most patients demonstrated a significant closure of their air-bone gap. There was 1 case of unexplained delayed mixed hearing loss 7 months after surgery following successful air-bone gap closure. Conclusions: Even experienced otologists have desired some way to better fixate an ossicular repair into place during difficult cases. Our experience with Mimix™ hydroxyapatite bone cement suggests that such rigid fixation may now be available. Its paste-like consistency, rapid setting time, osteoconductivity, and lack of neurotoxicity make it ideal for middle ear reconstruction. Prolonged stable fixation may translate into long term improvements in hearing.

Dry Central Total Tympanic Membrane Perforation

Dry Central Total Tympanic Membrane Perforation

Tympanoplasty using formaldehyde formed fascia grafts.

The closure of total perforations of the tympanic membrane has always been more difficult than lesser eardrum defects. Postoperative anterior sulcus blunting and graft lateralization occur with greater frequency in this situation and thus compromise results. In 1975, Rodney Perkins developed and described a technique for the closure of such total perforations which involved the use of formaldehyde treated temporalis muscle fascia, shaped by means of a metal mold into the configuration of a normal tympanic membrane and medial end of the bony external ear canal. This formaldehyde formed fascia (FFF) graft impressed us with its adaptability and logic. This article is a review of 139 cases involving the use of formaldehyde treated grafts not only for closure of total performations, but also for closure of total performations with concomitant middle ear ossicular reconstruction. The postoperative nonperforation rate in this series is 96.4%; blunting and/or graft lateralization was absent in 94.2% of cases. Closures of the air-bone gap to within 20 db occurred in 74% of cases with an overall gain in hearing for all cases of 84%. We believe that formaldehyde formed fascia grafts are an effective tool for the closure of total tympanic membrane perforations with or without concomitant ossicular chain reconstruction.