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Lou Z, Lou Z, Lv T, Chen Z. Outcomes of perichondrium graft covering the epithelium of the tympanic membrane for large-sized perforations: A 3-5-year follow-up study. Am J Otolaryngol 2024; 45:104121. [PMID: 38056195 DOI: 10.1016/j.amjoto.2023.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the graft outcomes and iatrogenic cholesteatomas for 3 years following cartilage-perichondrium over-underlay technique with perichondrial graft covering the epithelium for large-sized tympanic membrane (TM) perforations. MATERIALS AND METHODS This prospective case series enrolled patients with large-sized perforation who underwent endoscopic cartilage-perichondrium over-underlay technique. The graft success rate, hearing outcomes, and development of iatrogenic middle ear cholesteatomas and graft cholesteatomas were assessed at 3 years postoperatively. RESULTS This study included 62 ears of 62 patients. The mean follow-up duration was 47.3 ± 10.8 (38-64) months. Neovascularization was observed in the lateral perichondrium graft in 55 (88.7 %) patients, which inosculated into the TM remnant at 4-5 weeks. However, graft neovascularization was not observed in the four patients with excessive perichondrium graft that migrated into the external auditory canal and the three patients with middle ear infections. The graft failure rate was 6.5 % at 6 months, 11.3 % at 12 months, 6.5 % at 24 months, and the overall graft success rate was 91.8 % at the last follow-up. Granular myringitis developed in 11.3 % (7/62) of the patients. High-resolution computed tomography revealed well-pneumatized mastoids and middle ear at the final follow-up. However, graft cholesteatomas were observed in 3 (4.8 %) patients at 7-24 months postoperatively. CONCLUSIONS The cartilage-perichondrium over-underlay technique with perichondrial graft covering TM epithelium is safe and effective for the repair of large perforations, with good short- and long-term graft outcomes, minimal risk of graft cholesteatoma development, and no risk of iatrogenic middle ear cholesteatomas.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Ungar OJ, Demir Bajin M, Dahm V, Lin VYW, Chen JM, Le TN. Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review. Front Surg 2024; 11:1271248. [PMID: 38444902 PMCID: PMC10912332 DOI: 10.3389/fsurg.2024.1271248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
Objective To report a novel technique in Balloon Dilation of Eustachian Tube (BDET) using an endovascular balloon (EVB), in a prospective cohort. The results are compared with reported outcomes using standard balloons. Methods Demographic information and clinical parameters were collected prospectively fora series of patients with obstructive eustachian tube dysfunction (OETD). Balloon dilation Eustachian tuboplasty was performed under local anesthesia in a tertiary referral center, using the EVB. Systematic literature review was used for comparison, using Medline via "PubMed", "Embase", and "Web of Science". Results Eight OETD candidates (12 ears) were enrolled; 5 males and 3 females. Average age was 48 (range -23 to 63) years. The most common presenting symptom was aural fullness (9/12), followed by ear pressure (7/12), hearing loss (5/12) and tinnitus (4/12). Otoscopically, tympanic membrane retraction was evident in 10/12 ears, the majority of which was class II-Sade classification. Pre-operative tympanogram was type B and C in 7 and 5 ears, respectively. All BDETs were performed without complications. Post-operative tympanometry was A in 8/12 ears. Post-operatively, Eustachian Tube Dysfunction Questionnaire-7 results reduced to within normal limits (average score ≤3) in 11/12 ears (p = 0.0014). The systematic literature review included 6 papers (193 patients, 262 ETs) with comparable results, most also with little adverse effects. Conclusion BDET using an EVB is a safe and effective option for OETD. It is well tolerated under local anesthesia in properly selected individuals. The reduced procedural cost may be an important factor in certain healthcare jurisdictions.
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Affiliation(s)
- Omer J. Ungar
- Department of Otolaryngology, Head & Neck Surgery, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Grachev NS, Zyabkin IV, Polev GA, Kalinina MP, Magomedova AM. [Features of otosurgery in children after blast injuries]. Vestn Otorinolaringol 2024; 89:10-14. [PMID: 38805457 DOI: 10.17116/otorino20248902110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
An explosion is a process that rapidly releases a huge amount of energy in the form of heat, kinetic energy, and high-pressure shock waves. Since the organ of hearing is most susceptible to pressure changes, damage to the sound-conducting or sound-receiving systems is inevitable in case of an explosive injury. This article examines the mechanism of formation of explosive injuries of the middle and inner ear in children and adolescents, the features of diagnosis and tactics of surgical reconstructive treatment of explosive ear injuries based on the data available in the scientific literature and their own experience.
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Affiliation(s)
- N S Grachev
- Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical-Biological Agency, Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - I V Zyabkin
- Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical-Biological Agency, Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - G A Polev
- Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical-Biological Agency, Moscow, Russia
| | - M P Kalinina
- Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical-Biological Agency, Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - A M Magomedova
- Federal Scientific and Clinical Center for Children and Adolescents of the Federal Medical-Biological Agency, Moscow, Russia
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Lou J, Liu Y, Lou Z, Lou Z, Chen Z. Endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforations with 3 years of follow-up. Am J Otolaryngol 2023; 44:103902. [PMID: 37150123 DOI: 10.1016/j.amjoto.2023.103902] [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: 03/08/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate graft outcomes and complications of endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforation with 3 years of follow-up. MATERIAL AND METHODS Adult patients with chronic kidney-shaped perforation underwent endoscopic perichondrium-cartilage H type technique. The graft outcomes and complications were evaluated at 36 months after surgery. RESULTS The total of 51 ears were included in this study. The mean operation time was 31.5 ± 4.1 min. Residual perforation was seen in 2 patients, the graft success rate was 96.1 % (49/51) at postoperative 12 months. Granular myringitis was noted in 8.2 % (4/49) patients in 49 patients with graft success. The mean preoperative ABG was 23.6 ± 3.7 dB, while the mean postoperative ABG postoperatively 12 months was 12.9 ± 5.2 dB (P < 0.05), the functional success rate was 94.1 % (48/51). At postoperative 36 months, only 32 (62.7 %, 32/51) patients were followed up, while 19 (37.3 %, 19/51) patients lost followup. Of the 32 patients with followup of 36 months, the mean follow-up time was 38.2 ± 7.1 (37-46) months, re-perforation was seen in one. All 32 patients performed the postoperative CT examination at last followup, CT revealed the well pneumatization of mastoids and middle ear. CONCLUSIONS Endoscopic cartilage-perichondrium H type technique is an alternative method for repairing chronic kidney-shaped perforations, with a highly successful, short operation time, minimally invasive procedure, and no cholesteatoma.
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Affiliation(s)
- Jianhua Lou
- Department of Operating Theater, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China
| | - Yachao Liu
- Department of Otolaryngol Head & Neck Surgery, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China.
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis. J Craniofac Surg 2023; 34:168-172. [PMID: 36190699 DOI: 10.1097/scs.0000000000009013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/08/2022] [Indexed: 12/31/2022] Open
Abstract
The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194-6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095-12.866) and cranial vault (OR: 2.938; 95% CI: 2.647-3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.
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Liu Y, Ding Y, Li Y, Xin Y, Li D, Lin Y. Endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations. Am J Otolaryngol 2022; 43:103231. [PMID: 34537512 DOI: 10.1016/j.amjoto.2021.103231] [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: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this study was evaluate the short-and long-term graft outcome and complications of endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations. STUDY DESIGN Prospective case series. MATERIALS AND METHODS 135 patients with chronic subtotal and total perforations who underwent endoscopic modified perichondrium-cartilage sandwich graft technique. The graft success rate, hearing outcome, and complications were evaluated at postoperative 6 and 24 months. RESULTS 124 patients were finally included in this study. The graft success rate was 96.3% in subtotal perforation and 97.7% in total perforation (P = 0.874), with an overall success rate of 96.8% at postoperative 6 months. The graft success rate was 95.8% (68/71) in subtotal perforation and 94.9% (37/39) in total perforation (P = 0.795), with an overall success rate of 95.5% (105/110) at postoperative 24 months. The mean ABG improved from 28.0 ± 5.3 dB preoperatively to 14.9 ± 4.8 dB postoperatively 12 months (P < 0.05) for subtotal perforations; from 33.4 ± 7.4 dB preoperatively to 16.1 ± 2.4 dB postoperatively 12 months (P < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. Of the 110 patients, temporal bone CT revealed well pneumatization of the middle ear and mastoid region. However, graft keratin pearl was noticed in 1.8% (2/110) patients. CONCLUSIONS Endoscopic modified perichondrium-cartilage sandwich graft for repairing subtotal and total perforations had excellent short and long-term graft success rate with less time-consuming and minimal complications.
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Lou Z, Jin K, Sun J. Endoscopic inlay cartilage and perichondrium myringoplasty for repairing large perforations in teenagers. Int J Pediatr Otorhinolaryngol 2021; 151:110915. [PMID: 34507235 DOI: 10.1016/j.ijporl.2021.110915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study compared the long-term graft success rates and hearing outcomes of overlay-underlay and underly cartilage myringoplasty for repairing large perforations in Teenagers. STUDY DESIGN prospective, randomized study. SETTING Tertiary referral center. METHODS Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups:intervention group (n = 39) and control group (n = 41). The graft success rate, hearing improvement, and complications were compared between the two groups. RESULTS A total of 80 patients were included in this study. The graft success rate was 100% in the intervention group and 95.1% in the control group at postoperative 3 months, the difference wasn't significant (P = 0.496). Also, the graft success rate was not significantly different between the two groups at 12 months postoperatively (100.0% vs 87.8%, p = 0.073). However, the difference of graft success rate was significant between the two groups at 24 months postoperatively (97.4% vs 75.6%, p = 0.012). CT examination revealed well-pneumatized middle ears 24 months after surgery in both group. However, epithelial pearls near the umbo were seen at 31 months postoperatively in one patient in the observation group. CONCLUSIONS Compared to the endoscopic cartilage with perichondrium composite graft underlay technique, endoscopic perichondrial graft overlay and cartilage underlay had a better long-term graft success rate and lower rate of long-term re-perforation in teenagers. However, the graft technique had no effect on hearing outcome.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China.
| | - Kangfeng Jin
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China
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Transcanal Endoscopic Cartilage and Perichondrium Graft Myringoplasty for Large Tympanic Membrane Perforations. Otol Neurotol 2021; 42:1172-1176. [PMID: 33782256 DOI: 10.1097/mao.0000000000003141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the outcomes following transcanal endoscopic cartilage and perichondrium double-layer myringoplasty for subtotal and total tympanic membrane (TM) perforations. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. METHODS Adult patients who underwent transcanal endoscopic double-layer myringoplasty for subtotal and total TM perforations between January 2015 and December 2017 were included. The graft success rate, hearing outcomes, and complications were evaluated postoperatively. Temporal bone computed tomography or magnetic resonance imaging was performed at 24 months postoperatively. RESULTS The mean follow-up period was 28.2 ± 6.1 (range, 24-36) months. The graft success rate was in 95.7% (45/47) at 6 months, 93.6% (44/47) at 12 months, and 87.2% (41/47) at 24 months, respectively. The mean ABG improved from 32.89 ± 5.31 dB preoperatively to 10.89 ± 4.78 dB postoperatively 12 months (p < 0.05) for subtotal perforations; from 33.41 ± 7.41 dB preoperatively to 11.45 ± 2.41 dB postoperatively 12 months (p < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion) were encountered during the follow-up period. Postoperative temporal bone imaging revealed a pneumatized middle ear and mastoid in all cases with no evidence of cholesteatoma. CONCLUSIONS Transcanal endoscopic myringoplasty for large TM perforations using a double-layer perichondrium and cartilage graft is feasible with comparable rates of closure to more invasive approaches.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, the affilitaed Yiwu Hospital, Yiwu city, Zhejiang provice, China
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