Tympanoplasty For Chronic Otitis Media Research Articles

Endoscopic Tympanoplasty in Chronic Otitis Media with Inactive Mucosal Disease

<i>Background:</i> Chronic otitis media (COM) is a condition usually seen in patients attending the ENT department. Chronic inactive mucosal disease (CIMD) is characterized by tympanic membrane (TM) perforation with hearing loss. Endoscopic tympanoplasty (ET) is a surgical method to repair TM perforation with minimal invasion. <i>Objective:</i> The present analysis was done to find out the outcome of ET surgeries in CIMD. <i>Methods:</i> Retrospective data analysis was done in 30 patients underwent ET with endoscopic under-lay technique at Al-Ameen medical college, Vijapur, India. <i>Results:</i> Average age of patients was 34.17±9.52 years. Majority (40%) patients were from 18-30 years of age group. There were 12 (40%) males and 18 (60%) females. Right-side and left-side CIMD was equally distributed in 30 patients. Sixteen (53.3%) and 14 (46.7%) patients were having right and left TM perforation, respectively. TM perforation size was small, medium and large in 43.3%, 30% and 26.7% of patients, respectively. Twenty-eight (93.3%) patients had temporalis fascia and 2 (6.7%) patients had tragal cartilage as graft material. Two (6.7%) patients had graft rejection without improvement in hearing. No patient had complication or any miscellaneous issues. Eighteen (60.0%), 11 (36.7%) and 1 (3.3%) pre-operative patient with pure-tone average (PTA) had mild, moderate, and severe conductive hearing loss (CHL), respectively. All patients with PTA were improved after surgery. <i>Conclusion: </i>ET is an effective, minimally invasive, and less painful surgical technique for repair of central TM perforations in CIMD.

Assessment of Eustachian Tube Function for Successful Tympanoplasty in Chronic Otitis Media

Introduction: Eustachian tube function (ETF) has been the focus of attention as a prognostic factor for successful tympanoplasty surgery, due to its supposed primary pathogenic role in otitis media. Poor Eustachian tube (ET) function has been blamed to many diseases of middle ear cleft extending from serous otitis media to the squamosal type of chronic otitis media (COM). The objective of this study was to evaluate the effect of ETF on tympanoplasty outcome in the mucosal type of COM patients. Materials and Methods: An observational study was conducted for the patients admitted to the department of ENT and HNS with COM, mucosal type. The study was done from April 2021 to March 2022. ETF was assessed with the Toynbee test and saccharin time test. Results: The mean saccharin clearance time was found to be 17 min. Tympanoplasty was performed on 55 patients; 91.1% of patients showed successful outcome with good graft uptake who had normal ETF; out of 20 patients with partial dysfunction, 12 patients had successful graft uptake, and eight patients showed graft rejection. Conclusion: The automatic Toynbee test can be a practical, objective, and suitable method to assess the ventilatory function of ET. The saccharin test is an easy, cost-effective, and useful diagnostic tool to assess the mucociliary function of the ET. The ventilatory function of ET which is the single most important contributory factor in the pathogenesis of COM should be evaluated with the objective method before tympanoplasty.

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120dB which was improved to 13.387 ± 5.253dB postoperatively at 12weeks which was statistically significant. The mean postoperative ABG closure was 8.700dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials.

To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air-bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6weeks to 24months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12months (OR = 2.24, 95% CI 1.33-3.78) and 24months (OR = 2.96, 95% CI 1.18-7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6weeks to 12months). Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.

Surgical Outcomes of Type 1 Tympanoplasty in Chronic Otitis Media in Paediatric Patients: A Prospective Study.

The online version contains supplementary material available at 10.1007/s12070-023-03965-1.

A comparative study of endoscopic versus microscopic tympanoplasty in chronic otitis media

Background: To compare the results between tympanoplasty performed with transcanal endoscopic ear surgery and microscopic ear surgery for the treatment of chronic otitis media. Materials and Methods: A double-blind randomized prospective study was performed on inactive chronic otitis media patients that underwent tympanoplasty and later follow-up for at least 6 months in terms of graft uptake and hearing gain. Seventy patients were selected and randomized in Group A-endoscopic tympanoplasty and Group B-microscopic tympanoplasty. Results: In our study, we found that the graft take up rate was 94.3% (33/35) in Group A and 91.4% (32/35) in Group B. The improvements in the air-conduction levels and the air-bone gaps were not significantly different between the two groups (P > 0.05). The average hearing gains in the endoscopic group postsurgery were 10.51 ± 4.71 dB and in the microscopic group were 12.23 ± 4.72 dB (P = 0.132). The average operating time was 37.77 ± 5.33 min in the endoscopic group which was better than the microscopic group which was 45.77 ± 5.29 min, (P < 0.001). Conclusion: Endoscopic tympanoplasty technique is a feasible alternative to the conventional microscopic technique owing to the findings in terms of duration of surgery and graft uptake. In addition, the endoscopic approach provides better postoperative cosmesis, patient satisfaction, and early mobilization.

Considerations on Ossicular Reconstruction Using Lenticular Prosthesis for the Necrosed Lenticular Process During Endoscopic Tympanoplasty in Chronic Otitis Media (Mucosal) Cases.

The online version contains supplementary material available at 10.1007/s12070-022-03317-5.

Quality of Life after Surgical Treatment for Chronic Otitis Media: A Systematic Review of the Literature.

This systematic review aims to (a) define what instruments are available to measure quality of life (QoL) in patients undergoing tympanoplasty for chronic otitis media (COM) and what is the most commonly selected timing to do so; (b) compare outcomes from different surgical techniques; and (c) describe any reported correlation between subjective and functional results. This review was conducted following the PRISMA statement recommendations. Of the 151 articles screened, 24 were included. Most studies had a prospective design. The mean age at surgery was 44.5 years. A microscopic retroauricular approach was the most common surgical technique. Most articles included both primary and revision surgeries. The most commonly used questionnaire was the Glasgow Benefit Inventory (GBI), followed by the Chronic Ear Survey (CES), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Questionnaires were administered about 12 months after surgery in most studies. Ten studies reported possible associations between hearing results and QoL. QoL assessment after COM surgery variably relies on disease-specific and non-specific questionnaires. Patients are usually evaluated 12 months after surgery, and this appears to be a suitable timing to contrast the possible bias effect of different tympanoplasty techniques associated with different healing times. A comparison between QoL outcomes in different surgical approaches cannot be made, as several influencing factors have not been detailed in the included studies. Few studies have investigated the correlation between subjective and objective outcomes of tympanoplasty for COM so far.

Role of preoperative tympanometric evaluation of eustachian tube in patients undergoing type-1 tympanoplasty for chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A dysfunctional eustachian tube can cause failure of middle ear pressure regulation which leads to chronic otitis media and tympanoplasty failure. The functional status of eustachian tube can non-invasively be assessed prior to tympanoplasty by impedence audiometry. This help to predict the outcome of the procedure as well as aid surgeons to plan the surgery accordingly. The aim of the study was to determine the role of pre-operative tympanometric evaluation of eustachian tube function in patients with chronic otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted on 42 patients with chronic otitis media underwent type-1 tympanoplasty in department of otorhinolaryngology, Government Medical College, Kottayam over a period of one year. Detailed history, clinical and audiological evaluation done. Type-1 tympanoplasty performed and reassessed after 3 months. Data compiled and analysed using SPSS.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Intra-operative findings were similar to the audiometric results. Majority of patients with dysfunctional eustachian tube got a non-satisfactory hearing outcome compared to patients with good eustachian tube function, and this comparison is statistically significant with p value 0.006. The graft uptake in patients with dysfunctional eustachian tube is poor compared to patients with good eustachian tube function, which is statistically significant with p value 0.013.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Impedence audiometer can very reliably assess and ascertain eustachian tube dysfunction pre-operatively. The outcome of type-1 tympanoplasty in patients with eustachian tube dysfunction is uniformly poor. Better outcome probably would be gained by using more resilient materials like cartilage.&lt;/p&gt;

Is it useful to use computerized tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

ObjectiveCholesteatoma is an aggressive form of chronic otitis media (COM). For this reason, it is important to distinguish between COM with and without cholesteatoma. In this study, the role of artificial intelligence modelling in differentiating COM with and without cholesteatoma on computed tomography images was evaluated. MethodsThe files of 200 patients who underwent mastoidectomy and/or tympanoplasty for COM in our clinic between January 2016 and January 2021 were retrospectively reviewed. According to the presence of cholesteatoma, the patients were divided into two groups as chronic otitis with cholesteatoma (n = 100) and chronic otitis without cholesteatoma (n = 100). The control group (n = 100) consisted of patients who did not have any previous ear disease and did not have any active complaints about the ear. Temporal bone computed tomography (CT) images of all patients were analyzed. The distinction between cholesteatoma and COM was evaluated by using 80% of the CT images obtained for the training of artificial intelligence modelling and the remaining 20% for testing purposes. ResultsThe accuracy rate obtained in the hybrid model we used in our study was 95.4%. The proposed model correctly predicted 2952 out of 3093 CT images, while it predicted 141 incorrectly. It correctly predicted 936 (93.78%) of 998 images in the COM group with cholesteatoma, 835 (92.77%) of 900 images in the COM group without cholesteatoma, and 1181 (98.82%) of 1195 images in the normal group. ConclusionIn our study, it has been shown that the differentiation of COM with and without cholesteatoma with artificial intelligence modelling can be made with highly accurate diagnosis rates by using CT images. With the deep learning modelling we proposed, the highest correct diagnosis rate in the literature was obtained. According to the results of our study, we think that with the use of artificial intelligence in practice, the diagnosis of cholesteatoma can be made earlier, it will help in the selection of the most appropriate treatment approach, and the complications can be reduced.

Primární invertovaný papilom středouší – kazuistika

Inverted papilloma is a very rare finding in the middle ear. It is a benign, though locally aggressive tumour with a tendency towards malignant transformation. The dia­gnosis is usually established postoperatively, based on the histological examination, because the local finding is not specific and resembles chronically inflamed tissue in chronic otitis media. Surgery is the treatment of choice. Radiotherapy is reserved for inoperable tumours or a recurrent disease. In this case report, we present a case of a 62-year-old man, who underwent canal wall down tympanoplasty for chronic otitis media in a district hospital many years ago. A few years ago he was examined for pulsatile tinnitus and hearing impairment at our clinic. A combined-approach tympanoplasty did not reveal the expected tumour (only stiff scars) and a clearance of the middle ear cavity was performed. Histological examination revealed an inverted papilloma. A CT scan performed postoperatively proved a tumour persistence. Therefore, a radical mastoidectomy was indicated. The patient is disease-free with no signs of recurrence during 32-month follow-up. Keywords: inverted papilloma – Middle ear – radical mastoidectomy

Comparison of Surgical Outcome of Endoscopic with Microscopic Type I Tympanoplasty in Chronic Otitis Media: A Randomized Controlled Trial.

Aim of the study was to compare the surgical outcome of endoscopic with microscopic Type 1 tympanoplasty in dry, mucosal type of chronic otitis media with respect to graft uptake rate, hearing gain and duration of surgery. This randomized controlled trial of 3 years was carried out at Tertiary Care Hospital of Central India. Total 80 cases of mucosal type of chronic otitis media posted for Type I tympanoplasty were included in the study. They were randomly divided into two groups viz. Endoscopic tympanoplasty and microscopic tympanoplasty with 40 patients in each group. Chi-square test was used to compare the qualitative results and student's t-test was used to compare quantitative results with a level of significance of p ≤ 0.05. Intraoperatively, widening of external auditory canal and auxiliary incision were required in 45% and 47.5% patients of microscopic group respectively. Mean operative time for endoscopic tympanoplasty (62.5 ±14.94mins) was less as compared to microscopic tympanoplasty (74.88 ± 15.83mins). Graft uptake rate was 95% and 92.5% in endoscopic and microscopic tympanoplasty groups respectively with statistically insignificant difference (p=0.32). The preoperative mean air bone gap in both the groups was improved significantly 6 months postoperatively. Air bone gap closure was of 13.21± 4.37dB in endoscopic group and 12.54± 4.14dB in microscopic group with statistically insignificant difference. Endoscope provides superior visualization of hidden areas of middle ear cavity and has shorter operative time than microscopic tympanoplasty with comparable surgical and functional outcomes. hence endoscopic tympanoplasty can be a good option to microscopic surgery.

A retrospective study on middle ear risk indices in analysing the post-operative outcome following tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is a highly prevalent disease of middle ear. As tympanoplasty plays an important role in management of otitis media it is important to predict the outcome of surgery and give proper counselling to the patient. The objective of this study was to evaluate the effectiveness of Middle ear risk index (MERI) in determining postoperative graft uptake and postoperative air bone gap closure following tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study conducted to find the correlation between MERI and the result of tympanoplasty outcome and post-operative hearing gain. Ninety-six subjects who underwent tympanoplasty for chronic otitis media were included in the study. MERI score was calculated and was compared with postoperative graft uptake and audiogram. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study there was no statistical difference in graft uptake between the MERI categories. There was statistically significant decrease in postoperative air bone gap closure in both mild and moderate categories. Other prognostic factors associated with a favourable outcome were healthy middle ear mucosa and absence of smoking.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MERI did not have a direct impact on the outcome of surgery in terms of graft uptake and hearing results. However certain factors like Belluci’s criteria and smoking had an impact on the outcome. Hence MERI can be used for pre-operative counselling of the patients.&lt;/p&gt;

Endoscopic Tympanoplasty: Inlay Cartilage Versus Underlay Cartilage Graft

Aim: Several graft placement methods have been described in tympanoplasty. The aim of this study is to assess the surgical effects of the endoscopic tympanoplasty utilizing inlay cartilage or underlay cartilage graft. Methods: We reviewed medical records of 123 patients who experienced endoscopic tympanoplasty for chronic otitis media with a minimum twelve-month follow-up period. Perforations were divided into central, posterior, and anterior ones based on the place of the perforation to malleus handle. Graft success rate, air conduction pure tone audiometry (PTA) before surgery and after surgery, hearing gain and air bone gap (ABG) reduction were calculated following surgery. Results: No significant difference was found between the groups in terms of the distribution of the follow-up period, age, perforation location, and gender (p&gt;0.05). The average air conductions (AC) before surgery and after surgery for the inlay group were 36.3 ± 13.7 dB and 25.4 ± 12.3 dB 6 months after surgery and 22.5 ± 10.5 dB 12 months after surgery. They were 35.6 ± 13.3 dB and 24.8 ± 12.4 dB 6 months after surgery and 22.7 ± 9.7 12 months after surgery for the underlay group. A significant difference was found between the two groups in terms of ABG (P=0.037). There was no significant difference in the mean ABG in each group (small perforation P =0.473, medium perforation P=0.876 and large perforation P=0.341). Conclusion: The inlay method can be used with high graft success rate, low risk of complications among the appropriate patients, and shorter operation time as a reliable surgical option for treatment.

Tympanoplasty for chronic otitis media with both perforation and repeated otorrhea as the chief complaint

Tympanoplasty for chronic otitis media with both perforation and repeated otorrhea as the chief complaint

A Study on Tympanoplasty in Chronic Otitis Media

A Study on Tympanoplasty in Chronic Otitis Media

Hearing outcome following ossicular reconstruction for incus defects using partial ossicular replacement prosthesis

Background: Situation of incus erosion is common while performing tympanoplasties for cases of chronic otitis media. As none of the available techniques is said to be gold standard, a cost effective and easily available partial ossicular replacement prosthesis is employed and the postoperative hearing outcome is presented.&#x0D; Objectives: To assess the hearing results of ossiculoplasty using partial ossicular replacement prosthesis (PORP) during tympanoplasty.&#x0D; Methodology: A descriptive cross-sectional study was carried out in a tertiary referral hospital of Nepal from June 2018 to September 2019. Thirty consecutive patients who underwent tympanoplasty for chronic otitis media (inactive/mucosal) with incudostapedial discontinuity were operated using polytetrafluroethylene partial ossicular replacement prosthesis without removing the incus. Pure tone averages, air-bone gap (ABG) and air conduction gain were calculated pre and post-operatively.&#x0D; Results: There was no extrusion of prosthesis. The post-operative air-bone gap less than 20 dB was achieved in 23 (77%) cases. All the patients had post-operative air-bone gap of ≤25 dB. There were no major complications.&#x0D; Conclusion: Polytetrafluroethylene partial ossicular replacement prosthesis is safe, reliable and efficient alternative for ossiculoplasty when the incus is found to have eroded during tympanoplasty surgery.

Endoscopic type 3 tympanoplasty: Functional outcomes in chronic otitis media

BackgroundType 3 tympanoplasty is the surgery of choice for middle ear reconstruction in cases where an integral stapes suprastructure and mobile footplate are present. ObjectiveThe objective of this study was to obtain functional results after endoscopic type 3 tympanoplasty in chronic otitis media. Materials and methodsProspective study including 24 patients who underwent endoscopic type 3 tympanoplasty, using PORP for ossicular chain reconstruction (OCR) and cartilage graft for tympanic membrane reconstruction. Audiograms were made preoperatively, and 6 months after surgery. ResultsDry, closed, self-cleaning ears were obtained in 91.7% of the cases. Mean preoperative air-bone gap (ABG) was 30.4dB, mean postoperative ABG was 16.7dB, dB gain of 13.6dB. ABG closure rate to 20dB or less of 79.2%, and to 10dB or less of 29.2%. Conclusion and significanceEndoscopic tympanoplasty and OCR is a valid option for surgeons who are comfortable with the use of endoscopes for middle ear surgery as it allows improved visualization of the prosthesis and graft placement during middle ear reconstruction.

A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis.

Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake ( p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.

Transcanal Endoscopic Type 1 Cartilage Tympanoplasty in Children

Transcanal endoscopic type 1 tympanoplasty is a minimally invasive procedure that enables better visualization of deep and narrow spaces compared to conventional microscopic methods. In our study, we aimed to evaluate air-bone gap difference, graft success, and hearing gain according to the perforation size and location in pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty. Fifty pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty for chronic otitis media were included in the study. Tragal cartilage grafts were used in all patients. Air conduction pure tone audiometry hearing results (500, 1000, 2000, and 4000 Hz), mean air-bone gap levels, operating times, postoperative gap closure, and graft success rates were evaluated. Mean operating time was 43.34±8.56 minutes. Overall graft success was 94% (47/50). Mean hearing levels at all frequencies (500, 1000, 2000, and 4000 Hz) were found to have significantly improved after the operation (p<0.001). Mean preoperative air conduction pure tone threshold and mean air-bone gap had statistically significantly improved by the 6th postoperative month (p<0.001). Transcanal endoscopic type 1 cartilage tympanoplasty was found to be a minimally traumatic, easy and safe method with a low complication rate. In pediatric patients, this method allows for high rates of anatomic and functional recovery with optimal surgery time regardless of the location and the size of the perforation.