Healing Rate Of Tympanic Membrane Research Articles

Application and efficacy analysis of tympanic cartilage shaping device in endoscopic type Ⅰ tympanoplasty

Objective:To study the feasibility and efficacy of using a tympanic cartilage shaping device in endoscopic type Ⅰ tympanoplasty. Methods:A tympanic cartilage shaper was designed and manufactured by measuring tympanic membrane dimensions with HRCT imaging for cutting and shaping cartilage to repair the tympanic membrane. From August 2019 to October 2021, 66 patients（72 ears） with chronic suppurative otitis media in Xiangya Hospital underwent endoscopic type Ⅰ tympanoplasty with this tympanic cartilage shaping device, and were observed the tympanic membrane healing and hearing recovery effect after surgery. Postoperative follow-up ranged from 3-24 months, with an average of 9 months. The data were analyzed by the SPSS 26.0 software. Results:According to the imaging measurements, tympanic pars tensa width（8.60±0.20） mm, height（8.64±0.19） mm, design and manufacture a cylindrical cartilage shaping device with inner diameter 8.60 mm. After tympanoplasty, the healing rate of tympanic membrane was 100%; The average air-bone gap before surgery was（23.10±7.33） dB, then（14.30±6.40） dB 1 month after surgery, which were significant reduced compared with those before surgery. The average air-bone gap was（14.30±6.40） dB 3 month after surgery compared with 1 month after surgery, the difference was also statistically significant（t=6.630, P<0.05）. Conclusion:The tympanic membrane cartilage shaper shaping cartilage in endoscopic tympanoplasty is simple, stable and reliable, which can reduce the time of graft cartilage processing, improve the efficiency of surgery, and restore the tympanic membrane morphology and function in the postoperative period.

Prophylactic antibiotics has no benefit for outcome in clean myringoplasty-A register-based cohort study from SwedEar.

To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6-24 months after surgery. A retrospective cohort study of prospectively collected data. Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013-2019. All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit. The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery. In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.

Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media

BackgroundTo compare the results between type I tympanoplasty performed with transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) for treatment of chronic otitis media in a homogenous group of patients.MethodsA retrospective study was performed in our department between January 2011 and January 2016 to review primary type I tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least 1 month, normal middle ear mucosa, and a follow-up period of at least 6 months post surgery. The adoption of TEES or MES was divided temporally (before and since 2013). TEES was undertaken in 224 patients (224 ears) and MES in 121 patients (121 ears).ResultsThe successful graft take rate was 94.64% (212/224) in the TEES group and 90.91% (110/121) in the MES group (P = 0.239). The improvements in the air conduction levels between the 2 groups were not statistically different at 1, 3, or 6 (> 6) months (P > 0.05) after surgery. The improvements in the air–bone gaps were not significantly different between the 2 groups (P > 0.05). The average hearing gains in the TEES group 6 (and > 6) months post surgery were 11.85 ± 5.47 dB, which was better than 10.48 ± 5.18 dB in the MES group (P = 0.031). The use of medical resources was lower in the TEES group than in the MES group regarding the average operating time (49.22 ± 8.24 min vs 81.22 ± 14.73 min, respectively; P < 0.0001). Patients receiving MES had a significant higher incidence of the wound problems (ear pain, numbness around the ears, and wet ear; P < 0.05).ConclusionTEES for type I tympanoplasty seems to achieve a shorter operative time and ideal tympanic membrane healing rate and hearing results in patients with chronic otitis media.

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.

Observation of the short-term effect of tympanoplasty（type Ⅰ） in dry and wet ears with chronic otitis media

Objective:To explore the difference of short-term effect of transear endoscopic tympanoplasty （type Ⅰ） in the dry and wet ear of chronic otitis media. Methods:Patients with chronic suppurative otitis media were prospectively recruited in the Department of Otorhinolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital from July 2018 to July 2020. Two otoscopicians independently judged the condition of tympanic membrane and tympanic mucosa before operation. One hundred and ten patients were divided into dry ear group （n=78） and wet ear group（n=32）. The healing rate of tympanic membrane and the degree of hearing improvement were recorded at postoperative 1 month, 3 months and 6 months. Results:Six months after operation, the healing rate of dry ear group was 97.4% （76/78）, and that of wet ear group was 96.9%（31/32） 6 months after operation, there was no significant difference in tympanic membrane healing rate between the two groups （P>0.05）. The hearing of the patients in both groups was improved, and the air conduction hearing in the dry ear group increased by （10.57±8.73） dB, and decreased by （6.44±4.98） dB after operation. In the wet ear group, the air conduction hearing increased by （8.91±11.79） dB, and decreased by （6.89±6.99） dB after operation. There was no significant difference in the degree of hearing improvement between the two groups（P>0.05）. Conclusion:For quiescent chronic otitis media without ossicular chain lesions, the preoperative wet ear state is not a taboo in tympanoplasty （typeⅠ）, and the postoperative tympanic membrane healing rate and hearing improvement are the same as those in dry ear surgery, and can reduce the preoperative waiting time of patients, reduce the use of antibiotics.

Comparison of acellular dermal allograft and tragus cartilage perichondrium in type Ⅰ tympanoplasty under otoendoscopy

Objective:To compare the therapeutic effect of otoendoscopic tympanoplasty with acellular dermal allograft（AlloDerm） and tragus cartilage perichondrium. Method:121 patients who underwent type Ⅰ tympanoplasty under otoscope were retrospectively analyzed. According to the grafts used, they were divided into two groups: AlloDerm group （56 cases） and tragus cartilage perichondrium group （65 cases）. The operative time, postoperative tympanic membrane healing rate, and hearing recovery were compared between two groups. The follow-up time was twelve months. Result:The operative time in the AlloDerm group were lower than those in the tragus cartilage perichondrium group（P<0.05）. The successful closure rates between the acellular dermal allograft group and tragus cartilage perichondrium group at 1-month follow-up were 92.86% and 92.31% respectively, while the closure rates between two groups at 6-month follow-up were drop to 91.07% and 90.77% respectively, the closure rates between two groups at 12-month follow-up were also 91.07% and 90.77% respectively,the was no statistically difference between two groups（P>0.05）. The difference in pre-and post-operative air bone gap（ABG） values between two groups was no statistically significant（P>0.05）. Conclusion:Both the AlloDerm and the tragus cartilage perichondrium tympanoplasty can achieve satisfactory healing rate of the tympanic membrane and audiologic improvement. However, AlloDerm has a short operation time, no need to obtain materials and less trauma, and is worth of promotion and application.

Preliminary outcomes of endoscopic middle-ear surgery in 103 cases: a UK experience.

Totally endoscopic ear surgery and endoscope-assisted microsurgery are still new concepts, with relatively few centres in the UK performing them. Advantages include better visualisation of difficult to reach areas, such as the sinus tympani, and limited external incisions. This paper reports our short-term outcomes for endoscopic middle-ear surgery. A prospective review was conducted of the first 103 consecutive patients undergoing totally endoscopic ear surgery or endoscope-assisted microsurgery in 1 centre performed by 1 operator. The outcomes assessed were: tympanic membrane healing, audiological data and complications. Twenty-five patients underwent endoscope-assisted microsurgery, while 78 had totally endoscopic ear surgery. There were no reported cases of dead ear or permanent facial nerve palsy. The average air-bone gap following stapedectomy was 7.38 dB. The tympanic membrane healing rate was 89 per cent. Our results confirm that endoscopic middle-ear surgery is safe, and the short-term outcomes are comparable with conventional surgery.

Different states of otitis media were retrospectively analyzed of myringoplasty

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

Novel transparent collagen film patch derived from duck’s feet for tympanic membrane perforation

To increase healing rate of tympanic membrane (TM) perforations, patching procedure has been commonly conducted. Biocompatible, biodegradable patching materials which is not limited across cultures is needed. The authors evaluated the effectiveness of novel transparent duck’s feet collagen film (DCF) patch in acute traumatic TM perforation. This procedure was compared with spontaneous healing and paper patching. Cell proliferation features were observed in paper and DCF patches. Forty-eight TMs of 24 rats were used for animal experiment, perforations were made on each TMs, and divided into three groups according to treatment modality. Sixteen were spontaneously healed, 16 were paper patched and 16 were DCF patched. The gross and histological healing results were analyzed. Both paper and DCF patch showed no cytotoxicity, but cell proliferations were more active in DCF than paper in early stage. In animal study, the healing of TM perforations were completed within 14 days in all three groups, but found to be faster in DCF patch group than paper patch or spontaneous healing group. The DCF patches were transparent and size of DCF patches were gradually decreased, so there were no need to remove the DCF patches to check the wound status or after the completion of healing. According to this result, authors concluded that DCF patch is transparent, biocompatible and biodegradable material, and can induce fast healing in acute traumatic TM perforations.

A novel technique for micro-reconstruction of posterior wall of external auditory canal and tympanum in patients with chronic supprative otitis media using pedicled temporalis myofascia

Objective To explore a novel surgical treatment for chronic suppurative otitis media (CSOM) and evaluate its treatment effect.Methods All 97 patients with chronic suppurative otitis media were chosen to be treated using this new surgical method.The skin of the external auditory canal was maintained intact.Open radical mastoidectomy was used to complete clean-up lesions ; the fascia of pedicled temporalis myofascia (PTM) was used to repair the tympanic membrane.The pedicled temporalis fascia,pedicled postauricular periosteal flap and intact skin of the external auditory canal were used in reconstruction of the posterior wall of external auditory canal.Pure tone audiometry (PTA) was performed before and after surgery,recording the air conduction and bone conduction thresholds at 0.5 kHz,1.0 kHz,2.0 kHz,4.0 kHz.The average of the patient's air and bone conduction hearing thresholds was recorded at the 4 frequencies.External auditory canal gauze was removed 3 weeks after surgery.All subjects were followed up for over 2 years.Comparison of hearing thresholds (PTA) was made ① Before and 4 weeks after surgery.② Before and 2 years after surgery.Hearing function comparison include air conduction (AC),bone conduction (BC) and air-bone gap (ABG) analysis.SPSS 16.0 was used in statistical analysis.Pre-and postoperated AC,BC and ABG were compared using T-test.P ＜ 0.05 was considered statistically significant.Results The healing rate of post-operated tympanic membrane was 95.88％ (93/97).Ninty-six ears had 2-year follow-up,and 1 patient was lost in follow-up.There were 2 patients presented with eardrum perforation during the follow-up,and the 2-year healing rate of tympanic membrane perforation was also 93.85％ (92/97).In 96 ears with 2-year followed-up,the average of pre-AC was (52.10 ±3.96) dB,the average of post-AC was (35.67 ±2.52) dB; the average of preABG was (36.6 ± 5.2) dB,and the average of post-ABG (± SD) was (12.14 ± 6.20) dB.Statistical analysis showed significant difference between preoperative and postoperative AC or ABG values (P ＜ 0.05).Conclusion The present surgical procedure broke through the existing conventional mastoidectomy of making a surgical incision in the posterior wall of the external auditory canal.This procedure cleared the lesion completely and preserved the physiological function of the external auditory canal.The acoustic systems and state of gasification to the mastoid tymnpanum were reconstructed,rehabilitated and maintained.The healing rate of hearing and tympanic membrane perforation was improved. Key words: Chronic suppurative otitis media; Tympanoplasty; External acoustic meatus; Tissue flaps

Improved intact canal wall radical mastoidectomy with sandwich graft tympanoplasty

Conclusions: The procedure maximally retains the physiological structure of the middle ear and external auditory canal, thus effectively improving the patient's hearing ability. Objective: We explored the clinical outcomes of treating chronic suppurative otitis media using improved intact canal wall radical mastoidectomy with sandwich graft tympanoplasty. Methods: We chose to perform intact canal wall radical mastoidectomy with sandwich graft tympanoplasty in patients with chronic suppurative otitis media. A total of 170 patients were included in the study. Statistical analysis was carried out using software SPSS18.0, adjusted with the chi-squared test. Results: In all, 140 cases were shown to have been treated effectively (82.35%, 140/170). The increased auditory threshold of preoperative bone conduction was not related to the duration of disease and/or the presence of cholesteatoma (p > 0.05), but was associated with ossicular chain disruption or fixation (p < 0.05), specifically the ossicular chain destruction/absorption, granulation tissue wrapping, and consequent fixation. During the procedure, the sleeve-like pedicle flap of external auditory canal and tympanic membrane is covered with graft, allowing good fixation with maintenance of the tympanic membrane's natural shape. The auditory threshold test revealed equal or above normal levels (30 dB) for 126 cases (74.12%, 126/170). The primary healing rate of tympanic membrane achieved was 96.47% (164/170).

A Retrospective Review of Ventilation Tube Removal in Children

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

The results of chronic ear surgery in a training programme.

A retrospective study was undertaken of the results of surgery in a series of 782 patients with chronic otitis media. The recurrence rate of cholesteatoma was 20% of patients operated on by trainees and 12% operated on by the faculty. In ears with granulating otitis media, control of infection was achieved by trainees as often as by the faculty. The tympanic membrane healing rate of myringoplasty and tympanoplasty operations was 78% for trainees and 95% for the faculty (P < 0.001). Major surgical complications were relatively rare. It is concluded that the performance of trainees was fairly safe and better than expected, but some failures might have been prevented by closer supervision. Because of the decline in available patients for chronic ear surgery, it is suggested that the training programme should be restructured so that only those trainees who wish to pursue otological surgery as a career are trained in this field.