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Kim DJ, Lee HM, Lee SH, Lee IW. Transcanal endoscopic myringoplasty with butterfly dermal allograft. Am J Otolaryngol 2023; 44:103760. [PMID: 36708682 DOI: 10.1016/j.amjoto.2022.103760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/18/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Tympanic membrane perforation (TMP) is a common cause of visits to the otolaryngology clinic. For decades, various surgical methods and various grafts have been used to treat TMP. This study aimed to compare the efficacy of butterfly dermal allograft (BDA) and fat myringoplasty for the treatment of TMP. STUDY DESIGN A retrospective case-control study. SETTING Tertiary referral center. METHODS We retrospectively analyzed 40 patients who underwent BDA (n = 20) and fat myringoplasty (n = 20) for TMP performed by a single surgeon between January 2019 and December 2021. The hearing outcomes, graft success rate, complications, operation time, and hospital stay were recorded and compared between the two groups. Hearing outcomes were determined by pure-tone audiometry. RESULTS There was no significant difference between the BDA and fat groups regarding demographic characteristics. There was no significant difference in the pre and postoperative air conduction and bone conduction thresholds, or air-bone gap values between the two groups. A significant audiologic improvement was observed in both groups (p < 0.05), but there was no significant difference in the degree of hearing gain between the two groups. In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms; however, there was no significant difference between the groups (p > 0.05). The operation time and hospital stay were shorter in the BDA group than in the fat group (p < 0.05). CONCLUSION BDA myringoplasty is as safe and medically efficacious as fat myringoplasty and shortens the operation time and hospital stay.
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Affiliation(s)
- Dong Jo Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun Min Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Hyo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Il Woo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Mandal MM, Kapadia PB, Panchal AJ, Kumar R. Fat Myringoplasty for Small Central Perforation of Tympanic Membrane: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4388-4392. [PMID: 36742841 PMCID: PMC9895690 DOI: 10.1007/s12070-021-03055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
In fat myringoplasty, fat harvested from ear lobule is used as graft material for the closure of small size central perforation of tympanic membrane under local anaesthesia. This study was performed over a period of 5 years (January 2016-December 2020) on 67 cases who underwent surgery and were willing to participate in the study at our tertiary hospital. Closure of perforation was found in 93% of cases within 2-3 months of surgery. Hearing gain was 6.8 dB on an average and morbidity was insignificant in successful cases. Fat myringoplasty is a successful yet simple procedure for repair of small size perforations. It is a day-care procedure under local anaesthesia requiring minimal tissue handling. It is also cost effective and has minimum post-operative morbidity. The likely cause of failure are ear infections and graft displacement due to respiratory tract infections. Results of the fat myringoplasty also depend upon the experience of the operating surgeon and cooperation of the patient.
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Affiliation(s)
- Manit M. Mandal
- Department of Otorhinolaryngology (ENT), SMIMER, Surat, Gujarat India
| | - Parth B. Kapadia
- Department of Otorhinolaryngology (ENT), SMIMER, Surat, Gujarat India
| | - Ajay J. Panchal
- Department of Otorhinolaryngology (ENT), SMIMER, Surat, Gujarat India
| | - Rakesh Kumar
- Department of Otorhinolaryngology (ENT), SMIMER, Surat, Gujarat India
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Han JS, Han JJ, Park JM, Seo JH, Park KH. The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration. ORL J Otorhinolaryngol Relat Spec 2020; 83:85-92. [PMID: 33341797 DOI: 10.1159/000512084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS This study was conducted to evaluate the long-term stability of fat-graft myringoplasty (FGM) for chronic tympanic membrane perforations, analyzing the perforation closure rate and re-gained hearing outcome with respect to the size and location of the perforations. METHODS Between August 2007 and June 2018, a total of 193 patients who underwent FGM due to chronic tympanic membrane perforation at a tertiary referral center were enrolled and analyzed. RESULTS The mean follow-up was 14.6 months (range 6-39). The complete perforation closure rate after FGM was 89.6%, with no statistical difference among the perforation size groups. The mean postoperative air-bone gap (ABG) was 11.0 dB and mean ABG improvement was 4.9 dB. CONCLUSION Our FGM technique had a favorable tympanic closure rate for small to large perforations, and yielded relatively good hearing improvement in the mid-size perforation cases over long-term follow-up periods. According to the topographic evaluation of FGM, this procedure resulted in a reliable perforation closure rate and audiological results regardless of the perforation site.
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Affiliation(s)
- Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Ju Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Mee Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Republic of Korea
| | - Jae-Hyun Seo
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung Ho Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
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Diaz AR, Reina CO, Plaza G, Posadas ER, Arevalo FV, Iriarte MTG. Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter? EAR, NOSE & THROAT JOURNAL 2020; 100:229S-234S. [PMID: 33314958 DOI: 10.1177/0145561320973555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. STUDY DESIGN Prospective case series. SETTING Tertiary care facility. PATIENTS Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. INTERVENTION In-office fat graft myringoplasty technique under local anesthesia. MAIN OUTCOME MEASURES Complete perforation closure rate and audiometric outcomes. RESULTS A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air-bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. CONCLUSION In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.
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Affiliation(s)
- Alfonso Rodriguez Diaz
- Hospital Naval de San Carlos, Otorhinolaryngology Department Hospital Naval de San Carlos, San Fernando Cadiz, Spain
| | - Carlos O'Connor Reina
- Othorhinolaryngology Department, 170643Hospital Quironsalud Marbella, Marbella, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada. Universidad Rey Juan Carlos. 207202Hospital Sanitas La Zarzuela. Madrid. Spain
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Tashjian M, Ruiz A, Dinwiddie J, Greenlee C, Wine T. Cost of closure: Comparing success and spending of fat graft myringoplasties with and without hyaluronic acid. Int J Pediatr Otorhinolaryngol 2020; 135:110104. [PMID: 32502911 DOI: 10.1016/j.ijporl.2020.110104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Myringoplasties are common pediatric procedures used to surgically close a perforated tympanic membrane. While a wide variety of graft materials are available to surgeons, the cost effectiveness of these different techniques is not well studied. OBJECTIVES To compare the cost effectiveness of the fat graft myringoplasty (FGM) with the hyaluronic acid fat graft myringoplasty (HAFGM). METHODS Retrospective chart review of patients ages 31 days to 18 years who had undergone either FGM or HAFGM from 2006 to 2016. RESULTS We identified 85 patients who had undergone FGM and 51 patients who had undergone HAFGM. The two groups were statistically similar in age (CI -0.51, 1.9; p = 0.23), sex (CI 0.3, 1.4; p = 0.27), and history of prior tympanostomy tube placement (CI -0.07, 0.07; p = 0.69). Both groups had a similar number of total comorbidities (40.0% of patients in the FGM group and 27.5% of patients in the HAFGM; CI -0.04, 0.29; p = 0.19). The FGM and the HAFGM procedure did not have statistically significant differences in perforation closure rates, 82.4% and 92.2% respectively (CI 0.81, 7.3; p = 0.13). In comparing the total surgeons' cost of closing a tympanic membrane deficit, the FGM incurred a greater cost per perforation. The cost/tympanic membrane perforation closure for the FGM totaled $3011.88 per deficit, whereas the HAFGM totaled $2742.98. CONCLUSION As financial stewardship becomes more important for medical decision making, it is imperative that providers consider cost and outcomes data together when comparing similar treatment options. The FGM and the HAFGM have statistically similar rates of success in closing tympanic membrane perforations. In this study, the FGM cohort consumed more health care dollars per perforation secondary to the need for revision surgeries. As such, this study offers that the additional use of a hyaluronic disc does not increase overall cost to the healthcare system when performing a fat graft myringoplasty over a large cohort of patients.
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Affiliation(s)
- Margaret Tashjian
- University of Colorado School of Medicine, 13001 East 17th, Place, Aurora, CO, 80045, USA.
| | - Amanda Ruiz
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Jordyn Dinwiddie
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Chris Greenlee
- University of Colorado School of Medicine, 13001 East 17th, Place, Aurora, CO, 80045, USA; Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Todd Wine
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
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A Comparative Study of the Efficacy of Fat Plug Myringoplasty and Conventional Myringoplasty in Chronic Suppurative Otitis Media with Small Central Perforation. Indian J Otolaryngol Head Neck Surg 2019; 71:1197-1201. [PMID: 31750150 DOI: 10.1007/s12070-018-1265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/30/2018] [Indexed: 11/27/2022] Open
Abstract
Chronic Otitis Media (COM) is a major cause of acquired hearing impairment especially in developing countries. Persistent perforations occur either due to improper treatment of recurrent otitis media or infected traumatic perforation. Myringoplasty, repair of the Tympanic membrane using autologous temporalis fascia, is the standard procedure for COM. Other graft materials commonly used include tragal perichondrium, tragal cartilage and adipose tissue. This prospective study aims to compare the surgical and audiological outcome of fat plug myringoplasty [FPM] and conventional myringoplasty using temporalis fascia [CM-TF] in COM with small dry central perforation. A total of 60 patients of COM with small dry central perforation, aged 16-60 years, during the study period of October 2013 to August 2015 were divided into two groups of 30 cases each. The first group underwent FPM while the second group underwent CM-TF. The graft uptake and hearing outcome [pre operative and 3 months post operative PTA] were assessed. The surgical outcome of FPM with graft uptake of 86.7% was comparable to CM-TF with a graft uptake of 90%. The mean post operative hearing gain in FPM was 3.43 ± 2.81 dB which correlated well with that of CM-TF with 3.85 ± 3.05 dB. The duration of hospital stay and operative time was significantly lower in FPM group. FPM can be safely performed in cases with dry, small central perforations of the tympanic membrane with outcomes comparable to CM-TF.
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Can Fat-plug Myringoplasty Be a Good Alternative to Formal Myringoplasty? A Systematic Review and Meta-analysis. Otol Neurotol 2019. [PMID: 29533328 DOI: 10.1097/mao.0000000000001732] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study reviewed available literature to evaluate the success rate of fat myringoplasty compared with methods using other graft materials and suggests proper indications for this procedure. DATA SOURCES Studies reporting the success rate of fat myringoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2017. STUDY SELECTION The following terms were used for the literature search: ("Fat" OR "Adipose") and ("Myringoplasty" OR "Tympanoplasty"). DATA EXTRACTION Eight case series reported the data of perforation size and audiologic results. The success rate varied according to the perforation size with a cutoff value of 3 to 5 mm in length or 30% of the total tympanic membrane area. The success rate in anterior perforation was lower than that in other sites, ranging from 76.7 and 85.2% to 84.5 and 91.7%, respectively. The meta-analysis was performed on 10 articles. The overall success rate in fat myringoplasty and paper patch technique was not significantly different, while the success rate of fat myringoplasty was lower than that for the conventional myringoplasty technique using fascia or perichondrium (OR 0.63, 95% CI 0.49-0.80). Hyaluronic acid showed a significantly higher success rate than fat myringoplasty (90.1% versus 69.9%) (OR 0.20, 95% CI 0.09-0.46). CONCLUSIONS The success rate of fat myringoplasty may be associated with the perforation site and size. The success rate of fat myringoplasty was equivalent to that of the paper patch but inferior to a conventional method using perichondrium or fascia.
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Chen SL, Yang SW. Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations. Eur Arch Otorhinolaryngol 2019; 276:3005-3012. [PMID: 31377902 DOI: 10.1007/s00405-019-05583-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. METHODS The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. RESULTS A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51 years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR = 0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). CONCLUSION As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Yang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Knutsson J, Kahlin A, von Unge M. Clinical and audiological short-term and long-term outcomes of fat graft myringoplasty. Acta Otolaryngol 2017; 137:940-944. [PMID: 28537107 DOI: 10.1080/00016489.2017.1326063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Results of fat graft myringoplasty are often reported with only short-term follow-up. Audiological results are less commonly reported, as well as long-term follow-up results. MATERIALS AND METHODS One hundred consecutive patients scheduled for fat graft myringoplasty were included in a prospective cohort study. Clinical and audiological outcomes were assessed at six weeks and one year postoperatively. RESULTS Perforation sizes ranged from 0.5 to 4 mm. The six-week follow-up showed a total perforation closure rate of 72.9% with a statistically significant (p = .03) higher rate for the pediatric age group (83.0%). 64.4% of all patients were healed at one-year follow-up. Statistical analyses for background factors did not reveal any significant difference in healing rates with regard to patient sex or location or cause of the perforation. The mean preoperative air-conduction (AC) threshold was 25 dB with an air-bone gap of 12 dB. At the one-year follow-up the mean air conduction threshold for healed ears was improved to 16.6 dB, still 54.2% of them had a type B tympanogram. CONCLUSIONS Children had a higher perforation closure rate at six-week follow-up than adult patients. Recurrent tympanic membrane perforations were common after initially successful fat graft myringoplasties. Long-term hearing was improved after successful fat graft myringoplasty, resulting in a mean AC threshold of 16.6 dB.
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Affiliation(s)
- Johan Knutsson
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden
| | - Annika Kahlin
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
| | - Magnus von Unge
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden
- Department of Otorhinolaryngology, Akershus University Hospital and University of Oslo, Oslo, Norway
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10
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Fat volume is critical when performing fat-plug myringoplasty. Eur Arch Otorhinolaryngol 2017; 274:2661-2663. [DOI: 10.1007/s00405-017-4458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
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Zhengcai-Lou, Xiangming-Wang. In Reference to Growth factors expression in hyaluronic acid fat graft myringoplasty. Laryngoscope 2016; 127:E251. [PMID: 27114053 DOI: 10.1002/lary.26021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Zhengcai-Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiangming-Wang
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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12
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Lou Z. In response to: Hyaluronic acid fat graft myringoplasty vs. fat patch fat graft myringoplasty. Eur Arch Otorhinolaryngol 2016; 273:2855-6. [PMID: 26879992 DOI: 10.1007/s00405-016-3934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated Yiwu Hospital of Wenzhou Medical University, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
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A trans-well-based cellular model for the rapid pre-evaluation of tympanic membrane repair materials. Eur Arch Otorhinolaryngol 2015; 273:2027-34. [DOI: 10.1007/s00405-015-3768-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
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Virkkula P, Mäkitie AA, Vento SI. Surgical outcome and complications of nasal septal perforation repair with temporal fascia and periosteal grafts. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2015; 8:7-11. [PMID: 25987852 PMCID: PMC4416539 DOI: 10.4137/cment.s23230] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/17/2015] [Accepted: 03/04/2015] [Indexed: 11/05/2022]
Abstract
AIMS Surgical treatment of nasal septal perforation remains a challenging field of rhinology. A large variety of techniques and grafts with promising results have been introduced for perforation repair. However, the use of fascia or fascia with periosteum has not been previously evaluated for a large sample of patients. METHODS During the years 2007–2014, 105 operations were performed and 98 patients were treated for nasal septal perforation at the Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland. We performed a retrospective review of closure rates and complications. Follow-up time ranged from 1 to 62 months. RESULTS Bleeding was the most common early complication (9%), followed by postoperative infection (5%) in the whole series. Our main technique, bipedicled advancement flaps with fascia or fascia and periosteum, was performed for 81 patients. We obtained successful closure in 78% of these patients with this operative technique and the rate increased to 86% during the last 3 years of the study period. CONCLUSIONS Perforation repair with temporal fascia or fascia with periosteum requiring only one donor site seems to be a reliable option for nasal septal perforation repair.
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Affiliation(s)
- Paula Virkkula
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seija I Vento
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Habesoglu M, Oysu C, Sahin S, Sahin-Yilmaz A, Korkmaz D, Tosun A, Karaaslan A. Platelet-Rich Fibrin Plays a Role on Healing of Acute-Traumatic Ear Drum Perforation. J Craniofac Surg 2014; 25:2056-8. [DOI: 10.1097/scs.0000000000001140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gun T, Sozen T, Boztepe OF, Gur OE, Muluk NB, Cingi C. Influence of size and site of perforation on fat graft myringoplasty. Auris Nasus Larynx 2014; 41:507-12. [PMID: 25199735 DOI: 10.1016/j.anl.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results. METHODS The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium-large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients' follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year. RESULTS The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium-large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p>0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p<0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations. CONCLUSION Fat graft myringoplasty (FGM) may be used in all small and medium-large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium-large perforations; patients with small perforations had more satisfied audiological outcome than medium-large perforations.
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Affiliation(s)
- Taylan Gun
- İstanbul Bahçeşehir University, Faculty of Medicine, ENT Department, İstanbul, Turkey
| | - Tevfik Sozen
- Hacettepe University Faculty of Medicine, ENT Department, Ankara, Turkey
| | | | - Ozer Erdem Gur
- Antalya Education and Research Hospital, ENT Department, Antalya, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | - Cemal Cingi
- Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey
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Acar M, Yazıcı D, San T, Muluk NB, Cingi C. Fat-plug myringoplasty of ear lobule vs abdominal donor sites. Eur Arch Otorhinolaryngol 2014; 272:861-866. [PMID: 24469028 DOI: 10.1007/s00405-014-2890-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/13/2014] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to compare the success rates of fat-graft myringoplasties harvesting adipose grafts from different donor sites (ear lobule vs abdomen). The clinical records of 61 patients (24 males and 37 females) who underwent fat-plug myringoplasty (FPM) were reviewed retrospectively. Fat from ear lobule (FEL) and abdominal fat were used as graft materials. The impact of age, gender, systemic diseases, topography of the perforation, utilization of fat graft materials of different origin on the tympanic membrane closure rate and the effect of FPM on hearing gain was analyzed. Our tympanic membrane (TM) closure rate was 82 %. No statistical significant difference was observed regarding age, gender, comorbidities (septal deviation, hypertension and diabetes mellitus) or habits (smoking). Posterior TM perforations had significantly lower healing rate. The change in TM closure rate considering different adipose tissue donor sites was not statistically significant. The hearing gain of the patients was mostly below 20 dB. Fat-plug myringoplasty (FPM) is a safe, cost-effective and easy operation for selected patients. Abdominal fat graft is as effective as ear lobe fat graft on tympanic membrane healing, has cosmetic advantages and should be taken into consideration when planning fat as the graft source.
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Affiliation(s)
- Mustafa Acar
- ENT Department, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Demet Yazıcı
- ENT Department, Tarsus State Hospital, İsmetpaşa Mh., 33440, Tarsus, Mersin, Turkey.
| | - Turhan San
- ENT Department, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cemal Cingi
- ENT Department, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Levin B, Rajkhowa R, Redmond SL, Atlas MD. Grafts in myringoplasty: utilizing a silk fibroin scaffold as a novel device. Expert Rev Med Devices 2014; 6:653-64. [DOI: 10.1586/erd.09.47] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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de Dorlodot C, De Bie G, Deggouj N, Decat M, Gérard JM. Are bovine pericardium underlay xenograft and butterfly inlay autograft efficient for transcanal tympanoplasty? Eur Arch Otorhinolaryngol 2013; 272:327-31. [PMID: 24337878 DOI: 10.1007/s00405-013-2855-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
To evaluate the success rate and the surgical procedure of two different transcanal myringoplasty techniques using the Tutopatch(®) (Tutogen Medical, Inc., Alachua, FL, USA), a xenograft produced from bovine pericardium or the butterfly, an inlay tragal cartilage autograft. This is a retrospective study. We studied all cases of transcanal myringoplasty with Tutopatch and butterfly, performed by the same surgeon between April 2005 and May 2013. Perforations were secondary to chronic otitis media without cholesteatoma, perforation post ventilation tube or trauma. They were not exceeding one-third of the tympanic membrane surface for the Tutopatch and one quarter for the butterfly. We evaluated the anatomical success rate, complications and postoperative hearing results in both techniques. A total of 106 myringoplasties were performed: 66 with Tutopatch and 40 with butterfly with a mean follow-up of 16.5 and 5.2 months, respectively. Successful closure rates of Tutopatch and butterfly were 75.8% (P < 0.0001) and 85.0% (P < 0.0001), respectively. Myringitis controlled with topical antibiotics treatment occurred in 8 (12.1%) and 5 (12.5%) cases. Eighty percent of patients with Tutopatch had a mean residual air-bone gap within 10 dB, compared to 85.0% in patients with butterfly. When anatomically feasible, a transcanal approach myringoplasty with a Tutopatch(®) graft or butterfly appears to provide good anatomical and functional results. We show that both techniques provide good anatomical and functional results. The butterfly has the advantage to use an autograft, which is surgically easier because it does not require tympanomeatal flap elevation. We recommend the butterfly technique for non-marginal perforation not exceeding one quarter of the tympanic membrane after excision of the perforation edge and Tutopatch for bigger perforation or when standard autografts are not available. Myringitis is the only described complication without specific incidence.
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Affiliation(s)
- Clotilde de Dorlodot
- Department of ENT and Head and Neck Surgery, Saint-Luc University Hospital, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Redleaf MI. Air space reduction tympanomastoidectomy repairs difficult perforations more reliably than tympanoplasty. Laryngoscope 2013; 124 Suppl 3:S1-13. [PMID: 23553170 DOI: 10.1002/lary.23599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/11/2012] [Accepted: 06/25/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Air space reduction tympanomastoidectomy improves outcomes over tympanoplasty in repairing tympanic membrane perforations in the presence of unfavorable risk factors. STUDY DESIGN Retrospective review of 67 subjects' 87 operations. METHODS Interventions were tympanoplasty versus air space reduction tympanomastoidectomy. Risk factors were contracted mastoid air cells, previous failed operations, descent from the indigenous peoples of the Americas, and middle/ear mastoid volumes l<3 CC. Favorable outcomes were closure of the perforation, no decline in hearing, and creation of a self-cleaning mastoid bowl. RESULTS Five out of 46 air space reduction tympanomastoidectomies failed to close their perforations (11%). Pure-tone threshold (PTA) worsened in 13/46 ears (28%). Four of 46 required mastoid bowl cleaning (9%). In contrast, 21 of 41 tympanoplasties failed to close (51%). PTA worsened in 9/34 ears (26%). All four tympanoplasty failures treated with an air space reduction tympanomastoidectomy closed. Three of the seven tympanoplasty failures treated with a second tympanoplasty did not close. Statistical analysis found two risk factors more prevalent among the air space reduction tympanomastoidectomies: contracted mastoids (P = .019) and middle ear volumes <3 CC (P = .0001). Increased closure of perforations occurring after the air space reduction tympanomastoidectomy was also statistically significant (P = .0002). Descendants of indigenous peoples of the Americas trended toward better PTAs after their air space reduction tympanomastoidectomies than their tympanoplasties and showed statistically significant increases in closure of perforation (P = .0046). CONCLUSIONS Air space reduction tympanomastoidectomy is an effective and safe method for closing tympanic membrane perforations.
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Affiliation(s)
- Miriam I Redleaf
- Department of Otology/Neurotology, University of Illinois-Chicago, Chicago, Illinois, U.S.A
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21
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Koc S, Akyuz S, Gurbuzler L, Aksakal C. Fat graft myringoplasty with the newly developed surgical technique for chronic tympanic membrane perforation. Eur Arch Otorhinolaryngol 2012; 270:1629-33. [DOI: 10.1007/s00405-012-2040-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 04/24/2012] [Indexed: 11/28/2022]
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Kwong KM, Smith MM, Coticchia JM. Fat graft myringoplasty using umbilical fat. Int J Pediatr Otorhinolaryngol 2012; 76:1098-101. [PMID: 22560767 DOI: 10.1016/j.ijporl.2012.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/03/2012] [Accepted: 04/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Myringoplasty is a common procedure performed by otolaryngologists, particularly in the pediatric population. Tympanic membrane (TM) perforations can be caused by a variety of factors including retained tympanostomy tubes, infection and trauma. First described in 1878, myringoplasty has evolved to include many different materials for repair. Current materials used for myringoplasties include fascia, perichondrium, gelfoam, fat and paper. Multiple studies have looked at the success rates for these different materials. Fat graft myringoplasties in particular offer the advantage of a high success rate commonly reported in the range between 80% and 90%. Fat graft is classically harvested from ear lobe or post-auricular subcutaneous tissue. PURPOSE In this study, we described the techniques and results of harvesting umbilical fat for the use in pediatric myringoplasty. METHOD Twenty-eight cases of umbilical fat-graft myringoplasty performed between June 2008 and January 2011 was retrospectively reviewed and studied for rate of successful TM closure. RESULTS Average length of follow up was 8 months ranging from 3 months to 26 months. Overall rate for successful TM closure of 100% was achieved. Literature review was performed to compare our results with those of studies using auricular fat graft. Furthermore, a review of existing literature on various properties of fat graft was done to explain the potential advantages of using umbilical fat for myringoplasty. CONCLUSION Fat patch myringoplasty using umbilical fat is a safe and successful procedure for TM repair.
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Affiliation(s)
- Kelvin M Kwong
- Department of Otolaryngology-Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Saliba I, Woods O. Hyaluronic acid fat graft myringoplasty: A minimally invasive technique. Laryngoscope 2011; 121:375-80. [DOI: 10.1002/lary.21365] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/21/2010] [Indexed: 11/12/2022]
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Kim DK, Park SN, Yeo SW, Kim EH, Kim JE, Kim BY, Kim MJ, Park KH. Clinical efficacy of fat-graft myringoplasty for perforations of different sizes and locations. Acta Otolaryngol 2011; 131:22-6. [PMID: 20735182 DOI: 10.3109/00016489.2010.499881] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Fat-graft myringoplasty (FGM) has a reliable tympanic closure rate for small to large perforations, but yields poor hearing improvement in the latter case. A topographic evaluation of FGM showed that the procedure resulted in a reliable perforation closure rate and audiologic outcome, regardless of perforation location. OBJECTIVES This study assessed the utility of FGM in treating perforations of different sizes and locations. METHODS This retrospective study involved 45 patients (46 ears) who underwent FGM at St Mary's Hospital (Seoul, Korea) between August 2007 and February 2010. RESULTS The total perforation closure rate after FGM was 87% (40 cases), with no statistical difference among perforation size groups, even though the mean closure rates of the 10-20% and >30% perforation groups were lower than other groups. The difference in the closure rates of patients with anteriorly located perforations and those with perforations in other sites was not significant. The mean postoperative air-bone gap (ABG) was 14.3 (±7.5) dB. Mean postoperative ABG improved significantly after FGM; however, on a per-group basis, the >30% perforation group had the poorest results and the difference was statistically significant. The difference in mean postoperative ABGs of the two groups depending on the location of the perforation (anterior and other) was not significant.
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Affiliation(s)
- Dong-Kee Kim
- Department of Otolaryngology-Head & Neck Surgery, Catholic University of Korea, Seoul, Korea
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Poly(glycerol sebacate)-engineered plugs to repair chronic tympanic membrane perforations in a chinchilla model. Otolaryngol Head Neck Surg 2010; 143:127-33. [DOI: 10.1016/j.otohns.2010.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 12/22/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
Abstract
Objective: To evaluate the degree of neovascularization and efficacy of repair of chronic tympanic membrane perforations in a chinchilla model using poly(glycerol sebacate) (PGS), a novel bioengineered scaffold material. Study Design: A feasibility study in which chinchilla ears with chronic perforations were randomly assigned to repair with PGS plugs or Gelfilm overlay myringoplasty. Setting: Interventions were performed in the animal care facility of a tertiary care academic institution. Subjects and Methods: Sixteen adult female chinchillas. Perforations were established under microscopic visualization with thermal cautery. The animals were examined six weeks later, and those ears with stable perforations were randomly assigned to repair with PGS or Gelfilm. All ears were evaluated six weeks after repair, and resected membranes underwent histological evaluation. Results: Chronic perforations were established in 22 of 32 (69%) chinchilla tympanic membranes. Nineteen tympanic membranes were included in the study group (3 ears were excluded secondary to death from anesthesia during the repair); 11 were implanted with PGS, and eight underwent Gelfilm myringoplasty. Of the 11 tympanic membranes implanted with PGS, 10 were healed at six weeks, while six of the eight tympanic membranes repaired with Gelfilm had healed at six weeks. Imaging of the medial mucosal and lateral epithelial surfaces of the tympanic membranes revealed PGS plug incorporation with neovascularization. Histology demonstrated a confluent cell layer on both sides of the graft. Conclusions: PGS plugs are easily placed and allow for perforation closure and graft neovascularization in a chinchilla model.
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27
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Saliba I. Response to Lee. Clin Otolaryngol 2009. [DOI: 10.1111/j.1749-4486.2009.01937.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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