Tympanoplasty For Tympanic Membrane Perforation Research Articles

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

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

A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation.

To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation. A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded. Ears were packed using one of two distinct methods. Pack A: gelatin sponge, chloramphenicol ointment and anantibiotic-soaked ear wick. Pack B: antibiotic-soaked gelatin sponge, bismuth iodoform paraffin paste (BIPP) impregnated gauze dressing. The primary outcome measure was post-operative complications associated with each packing method RESULTS: One hundred and fifty-three tympanoplasties were performed during this period: 68 underwent Pack A and 85 underwent Pack B. Chi squared test showed no significant association between pack type and complication rate (p = 0.572). Univariate analysis suggested that age (p = 0.047) and concurrent bony canaloplasty (p = 0.006) significantly increased complication rates. Pre-operative ear status, indication, graft type and gender did not affect complication rate. BIPP-impregnated ribbon gauze and chloramphenicol/wick are both comparable methods for packing an ear following tympanoplasty for tympanic membrane perforation. This is useful information both for surgeons who commonly use BIPP and have a patient with a known iodine allergy, or who is not known to be allergic to iodine but has been packed with BIPP previously, and for those who do not have access to BIPP and wish to use a pack with comparable success.

The Role of Concomitant Mastoidectomy in Improving Outcomes Following Tympanic Membrane Perforation Repair: A Systematic Review

AbstractBackground: The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma remains controversial. Many otolaryngologists continue to routinely perform mastoidectomy with tympanoplasty, others argue that performing mastoidec-tomy in these patients is unnecessary, does not improve surgical outcomes, and subjects patients to increased surgical risks.Aim of the Work: To assess the effectiveness and safety of performing routine cortical mastoidectomy in addition to tympanoplasty in treatment of tympanic membrane perforation in cases of chronic suppurative otitis media in the absence of cholesteatoma.Patients and Methods: Five randomized controlled trials with total of 610 participents were included of any age with chronic suppurative non cholestaetomatous otitis media, divided into two groups: Group A (received Tympanoplasty alone), Group B (Tymanplasty with cortical mastoidectomy).Five outcomes measured namely (healing rate,hearing rate, tympanometric evaluation, rate if otorrhea, need for subsequent procedure).Results: Articles reporting results of concomitant mas-toidectomy with tympanoplasty were identified. Five articles satisfied our eligibility criteria, there was no significant heterogeneity. Compared to the conventional method tympan-oplasty with cortical mastoidectomy was found to have a significantly higher rate of healing (odds ratio of 1.762 with a 95% CI of –1.115 to 2.787, no significant difference in post-operative air bone gap (SMD of .056 with 95% CI of –0.110 to 0.222), no significant difference in rate of otorrhea (odds ratio of 1.949 with a 95% CI of 0.528 to 7.192, no significant difference in post-operative tympanometry (odds ratio of type A, Astympanometry was 0.777 and a 95% CI of 0.278 to 2.179, no significant difference in rate of revision surgery (odds ratio 2.069 and a 95% CI of 0.178 to 24.075.Conclusions: From the result s of our systematic review we advise for the use of tympanoplasty alone for treatment of non cholesteatomatous chronic otitis media.

The role of mastoidectomy in outcomes following tympanic membrane repair: A review

The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma remains controversial. Some authorities suggest that outcomes are improved by the pressure buffering contributed by a well-aerated mastoid. It is unclear, however, whether or not clinical evidence demonstrates a benefit by the addition of a mastoidectomy. Review of peer-reviewed publications. The literature on tympanoplasty and mastoidectomy was reviewed, examining the success of tympanic membrane repair, control of drainage, and hearing improvement. Twenty-six articles were reviewed examining surgical outcomes for patients with perforations resulting from chronic suppurative otitis media without cholesteatoma. Most of the literature consisted of retrospective cohort studies and case series with only a few small prospective randomized trials. Retrospective studies were commonly biased by performing mastoidectomy in ears with worse disease, and methodological differences made comparisons between studies difficult to interpret. There was no evidence of improved outcomes following mastoidectomy compared to tympanoplasty alone. Subgroup analysis, including actively discharging ears, extensive mucosal inflammation, large or repeat perforations, or sclerotic mastoids had overall worse outcomes. These patients showed a nonsignificant trend toward slightly improved results with mastoidectomy. The available literature shows no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated tympanic membrane perforations. Patients with more complicated disease may benefit from the addition of a mastoidectomy, but there is insufficient evidence to make a recommendation for this population. Further prospective controlled studies are needed.

Outcomes of Cartilage Tympanoplasty in the Pediatric Population

To justify the successful use of a patient selection algorithm based on age for primary cartilage tympanoplasty. Case series with chart review. Tertiary care pediatric hospital. We performed a retrospective chart review of patients between ages 4 and 13 years who underwent cartilage tympanoplasty for tympanic membrane perforations from August 2005 to November 2011. Demographics, complication data, and auditory outcomes were collected. Patients were subdivided into 3 age groups. Group 1 consisted of patients younger than 7 years (n = 43); group 2, ages 7 to 10 years (n = 40); and group 3, ages 10 to 13 years (n = 36). Mean follow-up was 595 days (range, 48-1742). Complication rates respective to the 3 groups were as follows: remnant perforation (6.97%, 5.00%, 2.78%), revision tympanoplasty (2.33%, 2.50%, 0%), and need for tympanostomy tubes (4.65%, 2.50%, 0%). Logistic regression models were used to evaluate complication rates between groups. No significant differences were found (remnant perforation, P = .710; repeat tympanoplasty, P = .998; tympanostomy tubes, P = .875). No significance was found among audiological outcomes between the 3 groups. These data suggest cartilage tympanoplasty can be performed effectively in young children when appropriate conditions exist.

Outcomes of Cartilage Tympanoplasty in Pediatric Patients

Objective: To determine whether a relationship exists between successful outcomes of cartilage tympanoplasty and age at repair. Method: A retrospective chart review of patients between ages 4 and 13 who underwent cartilage tympanoplasty for tympanic membrane perforations from August 2005 to November 2011 was preformed. Demographics, complication data, and auditory outcomes were collected. Results: Patients were subdivided into 3 age groups. Group 1 consisted of patients less than 7 years of age (n = 43), group 2 ages 7 to 10 (n = 40), and group 3 ages 10 to 13 (n = 36). Mean follow-up was 595 days (range = 48-1742). Complication rates respective to the 3 groups were as follows: Eustachian tube dysfunction (ETD) or fluid causing a conductive hearing loss (9.3%, 10%, 5.6%), need for tympanostomy tubes (4.7%, 2.5%, 0%), remnant perforation (7%, 5%, 2.8%), and revision tympanoplasty (2.3%, 2.5%, 0%). Resolution of ETD or fluid on subsequent visits precluded tube placement. A 1-way analysis of variance (ANOVA) was performed to evaluate complication rates between groups. No significant differences were found (remnant perforation, P = .70, repeat tympanoplasty, P = .64, tympanostomy tubes, P = .42, and ETD or fluid, P = .76). Improvement in pure tone average was 10.23, 12.5, and 3.95, respectively. Conclusion: A trend for slight increase in complications in children under the age of 10 was found but was not statistically significant. There were significant group differences in hearing improvement with younger patients demonstrating better outcomes. The implications for these findings will be discussed. These data suggest cartilage tympanoplasty can be performed effectively in young children when appropriate conditions exist.

Tympanoplasty: Best Method of Grafting, Medial, Lateral, Medio‐Lateral, or Cartilage

Program Description: Although there are well-established surgical techniques for tympanoplasty to repair chronic tympanic membrane perforation, surgical methods remain varied, often based more on local traditions than on scientific research. Successful tympanoplasty continues to pose a significant challenge to the otolaryngologist. The goal of this miniseminar is to present the best surgical technique of this common procedure. Toward these ends, we have assembled a panel of respected and experienced otologists from the East coast, Midwest, South, and West coast of the US. Following a brief introduction, each panelist will present his preferred surgical technique of tympanoplasty for tympanic membrane perforation that works best whether media, lateral, medio-lateral, or cartilage graft method. The remaining time will be devoted to case presentations to discuss on best graft method for particular cases. This miniseminar will provide information that should improve the ability of each participant to perform successful tympanoplasty for chronic tympanic membrane perforation in different clinical situations. Educational Objectives: 1) Learn best grafting method in tympanoplasty for reconstruction of chronic tympanic membrane perforation. 2) Understand to use different method grafting depending on the location of tympanic membrane perforation. 3) Be able to perform better tympanoplasty in different clinical situations.