Use of nasal mucosa graft in tympanoplasty

INTRODUCTION

Tympanoplasty techniques with different types of graft have been used to close tympanic perforations since the 19th century. Tragal cartilage and temporalis fascia are the most frequently used types of graft. They lead to similar functional and morphological results in most cases. Although little published evidence is present, nasal mucosa has also been shown to be a good alternative graft.

OBJECTIVE

Surgical and audiological outcomes at the six-month follow-up in type I tympanoplasty using nasal mucosa and temporalis fascia grafts were analyzed.

METHODS

A total of 40 candidates for type I tympanoplasty were randomly selected and divided into the nasal mucosa and temporalis fascia graft groups with 20 in each group. The assessed parameters included surgical success; the rate of complete closure of tympanic perforation and hearing results; the difference between post- and pre-operative mean quadritonal airway-bone gap, six months after surgery.

RESULTS

Complete closure of the tympanic perforation was achieved in 17 of 20 patients in both groups. The mean quadritonal airway-bone gap closures were11.9 and 11.1 dB for the nasal mucosa and temporalis fascia groups, respectively. There was no statistically significant difference between the groups.

CONCLUSION

The nasal mucosa graft can be considered similar to the temporal fascia when considering the surgical success rate of graft acceptance and ultimate audiological gain.

Collagen Allografts Compared With Autologous Tissue in Tympanoplasty

OBJECTIVE

There are no direct comparisons between the success of collagen allografts versus traditional autografts for tympanic membrane (TM) repair. We sought to compare success rates in a large series of patients undergoing tympanoplasty using collagen allografts versus autologous tissues.

STUDY DESIGN

Retrospective review.

SETTING

Academic medical center.

SUBJECTS AND METHODS

Single institution retrospective chart review was performed for adult subjects with TM perforation undergoing tympanoplasty. Demographic, clinical, and surgical data were collected. Statistical analysis was completed using Rstudio. Each factor was examined to assess effect on graft success rate using logistic regression.

RESULTS

Two hundred sixty-five surgeries met criteria with four main grafting materials or combinations thereof. The overall graft success rate was 81.1% with failure rate of 18.9%. There was no significant association between failure rates and: age, sex, perforation cause, size, and location, primary or revision status, middle ear status (wet or dry), concomitant procedures (mastoidectomy or ossiculoplasty), presence of active cholesteatoma, or surgical technique. Although not statistically significant, the odds of success for perichondrium + cartilage were 7.5 times higher than collagen allografts (p = 0.07, 95% confidence interval [CI] = 0.81-69.6). The odds of success for the postauricular (odds ratio [OR] = 6.4) and transcanal approaches (OR = 24.8) were significantly greater than for endaural (p = 0.007 and p = 0.008, respectively).

CONCLUSION

In tympanoplasty surgeries performed on patients with TM perforation, we found no statistically significant difference in graft failure rates between collagen allograft and other grafting materials or combinations, though the higher odds ratio of success with cartilage + perichondrium may be clinically relevant.

Chronic Ear Disease

Chronic ear disease is composed of a spectrum of otologic disorders intrinsically tied to Eustachian tube dysfunction. Presentation can range from asymptomatic findings on physical examination to critically ill patients with intracranial complications. Internists represent the first line in diagnosis of these conditions, making awareness of the common signs and symptoms essential. With surgical management often required, partnership between internal medicine and otolaryngology is fundamental in the management of patients with chronic ear disease.

Treatment of pharyngotympanic tube dysfunction

Eustachian tube dysfuntion intends to describe a variety of signs, symptoms, and physical findings that result from the impairment of ET function. A large variety of methods have been employed to assess ET function in the literature. Due to the lack of high level evidence, it is difficult to draw conclusions on the effectiveness of medical and surgical treatments. There are various medical and surgical interventions available for chronic obstructive ET dysfunction including balloon Eustachian tuboplasty (BET) and laser or microdebrider tuboplasty. Consensus on diagnostic criteria for ETD is required to define inclusion criteria of future trials. There is however emerging work with reassuring, but preliminary, results that suggest evidence for safety in the surgical management of ETD. Like many newly introduced techniques the current data remains limited to non-controlled case-series, with heterogeneous data collection methods and lacking substantial long-term outcomes. Nevertheless, short-term data provide favorable results. Current treatment options comprising BET and patulous ET surgery may be offered as a treatment possibility to selected patients.

Balloon Eustachian tuboplasty treatment of longstanding Eustachian tube dysfunction

Background:

Eustachian tube dysfunction is a poorly defined condition associated with various symptoms and it can predispose to middle-ear disease. Balloon dilation Eustachian tuboplasty has been proposed as a treatment for Eustachian tube dysfunction.

Objective:

To evaluate the subjective and objective outcomes of balloon dilation Eustachian tuboplasty in patients with recurrent, previously treated chronic Eustachian tube dysfunction.

Methods:

The study was conducted on 11 patients (13 ears) who had undergone previous unsuccessful medical and surgical treatment. Tympanometry was the primary outcome measure. Secondary outcome measures included pure tone audiogram assessment and seven-item Eustachian Tube Dysfunction Questionnaire score.

Results:

Balloon dilation Eustachian tuboplasty resulted in significant improvements in 11 patients’ subjective but not objective outcome measures.

Conclusion:

The objective abnormality and subjective symptoms in Eustachian tube dysfunction may represent two distinct pathological processes, which may nevertheless influence and exacerbate each other.

Balloon Eustachian Tuboplasty in children

Endonasal ballon dilatation of the Eustachian tube (BET) is a promising treatment for Eustachian tube dysfunction with encouraging results over the last years in adults. In addition, in children, single studies demonstrated promising results, but revealed the necessity for broader and additional studies. Our retrospective analysis presents outcomes with BET in children with chronic obstructive dysfunction of the Eustachian tube, showing resistance to the conventional therapy after adenotomy with paracentesis or grommets (ventilation tubes). The data of 52 children, having undergone BET from April 2011 to April 2016, were retrospectively evaluated. Most children in our study presented middle ear effusion (47%), adhesive (21%), chronic otitis media (13%), or recurrent acute otitis media (11%). In 24 (37%) children, we combined BET with a paracentesis, in 5 (8%) patients with a tympanoplasty type I and in 3 (5%) patients with a type III. All children were assessed using an audiogram, tympanometry, and tubomanometry (50 mbar) before and after BET. In addition, we evaluated the results of the Lübecker questionnaire, which we performed before and after BET. The childrens' ear-related and quality of life-related symptoms, such as pressure equalization, ear pressure, hearing loss, pain and limitation in daily life, and satisfaction pre- and postoperatively, were analyzed. In the majority of patients, we could see an improvement in the ear pressure, hearing loss, limitation in daily life, and satisfaction with recurrent inflammations, underlined by better outcomes in the tubomanometry and the tympanogram. BET in children is a safe, efficient, and promising method to treat chronic tube dysfunction, especially as a second line treatment, when adenotomy, paracentesis, or grommets failed before.

Effect of Type 1 Tympanoplasty on the Quality of Life of CSOM Patients

Chronic suppurative otitis media (CSOM) continues to be an important public health problem despite significant advances in medical science. Ear discharge, pain, discomfort, difficulty in hearing, limitation of routine activities and emotional problems due to CSOM cause a significant impact on the health and general well being of the patient. We have done Type 1 tympanoplasty in tubotympanic type of COM to reconstruct the tympanic membrane and alleviate the symptoms of the patients. This study presents an analysis of the impact of the surgery on the patient subjectively and its correlation with objective outcomes. 45 patients were selected to fill the chronic otitis media-5 (COM-5) questionnaire and underwent pure tone audiometry preoperatively. All the patients underwent Type 1 tympanoplasty by using temporalis fascia graft. The status of the ossicles was checked and documented intraoperatively. Patients requiring ossicular reconstruction or with attico antral disease were excluded. Patients were followed up for a period of 6 months and those with an intact graft after 6 months were included in the study. These patients were again made to fill the questionnaire and undergo pure tone audiometry postoperatively. 37 out of 45 patients (82 %) had an intact graft 6 months after surgery. Marked improvement was observed in subjective scores as documented by the questionnaire, pre- and postoperatively with the mean improvement in total scores being 7.89 ± 4.81 on a Visual Analogue Scale. Also significant improvement was achieved in closure of air-bone gap with the mean improvement being 14.73 ± 8.58 dB. Significant correlation was found between subjective and objective scores in most patients. This study showed that Type 1 tympanoplasty brings about a significant improvement in the quality of life of chronic suppurative otitis media patients. Most patients showed a marked improvement in subjective scores which correlated well with the objective findings of the status of the graft and improvement in air-bone gap. Asymptomatic patients with less preoperative scores showed less improvement in subjective scores which did not correlate with the objective outcomes.

Evaluation of tubomanometry as a routine diagnostic tool for chronic obstructive Eustachian tube dysfunction

OBJECTIVE

The objective of this study was to demonstrate the reliability of tubomanometry (TMM) described by Estéve in the diagnosis of chronic obstructive Eustachian tube (ET) dysfunction.

STUDY DESIGN

Combined prospective and retrospective clinical study.

SETTING

Tertiary referral centre, affiliated to university.

METHODS

Two hundred and fifteen healthy subjects were examined once, 25 healthy subjects underwent TMM weekly for 6 weeks, and six healthy subjects were tested three times a day on at least three different days. The results of tubomanometry in healthy subjects were compared to data obtained from 171 patients with chronic obstructive ET dysfunction.

RESULTS

In healthy subjects, there was an immediate opening of the ET at 30-50 mbar with an R-value ≤ 1 in at least 94% of the cases. In patients with chronic ET dysfunction, an opening of the ET could be registered in only 42% of patients at 30 mbar and in 58% at 50 mbar. The average of the R-value in these subjects always indicated towards a delayed opening (R > 1). When measurements are repeated in the same subject with a weekly interval, the intraclass correlation (ICC) was 0.49 for the TMM with 30 mbar, 0.51 for the TMM with 40 mbar and 0.52 for the TMM with 50 mbar in healthy people. For the patients with symptoms of ET dysfunction, the ICC for up to four repeated measures was 0.50 for the TMM with 30 mbar, 0.53 for the TMM with 40 mbar and 0.54 for the TMM with 50 mbar. A complete agreement of the results in repeated measurements within seconds was present in 86% for 30 and 40 mbar and in 79% for 50 mbar. The ICC was 0.61 for the TMM with 50 mbar, 0.62 for the TMM with 40 mbar and 0.68 for the TMM with 30 mbar.

CONCLUSIONS

Tubomanometry can support the diagnosis of ET dysfunction. An R-value ≤ 1 indicates a regular function of the ET, an R-value >1 indicates a delayed opening of the ET, and no definable R-value means no detectable opening of the ET. TMM is a reliable and valid instrument to support the diagnosis of chronic obstructive ET dysfunction.

Outcome of mobile ear surgery units in Thailand

OBJECTIVES

To evaluate the outcome of mobile ear surgery, in terms of tympanic membrane perforation closure, absence of otorrhoea and hearing threshold improvement.

STUDY DESIGN

Descriptive study.

METHODS

The study enrolled patients with chronic ear disorders requiring surgery who presented to the mobile ear surgery unit at Sakaeo Hospital, Thailand, from 1 to 4 July 2008. The following data were recorded: pre-operative audiogram, post-operative middle-ear and mastoid infection, wound infection, graft condition, any complications, and post-operative audiogram. Patients were followed up at one week, two weeks, four weeks and 24 weeks post-operatively.

RESULTS

For the 31 cases of tympanic membrane perforation, the closure rate was 90.3 per cent. For the 32 patients with otorrhoea, the rate of ear dryness was 87.5 per cent. All 35 patients had impaired hearing initially; the rate of hearing improvement was 74.3 per cent (95 per cent confidence intervals = 56.7-87.5 per cent). Patients' mean hearing improvement was 22.9 dB.

CONCLUSION

The assessed ear surgery procedures had good results.

Outcome of mobile ear surgery for chronic otitis media in remote areas

OBJECTIVES

The Inuit of Greenland, Canada and Alaska suffer from chronic otitis media (COM). In Greenland these patients used to be referred to Denmark for ear surgery. This was expensive and unsatisfactory, and the results were poor. A mobile ear surgery project was developed.

DESIGN

The study is longitudinal and prospective with follow-up.

SUBJECTS AND METHODS

The 274 patients were selected according to severity of COM and hearing loss. Only air conduction (AC) audiometry was obtained. Median age was 27 years and 55% were females.

RESULTS

Closure rates at three weeks, one year, and two years were 67 percent, 72 percent, and 76 percent, respectively. Median AC pure tone average improvement was 15 dB and 12 dB after one year and two years, and 73 percent and 67 percent were satisfied. Outcome was associated with quality of the surgical skills (P < 0.002). We found marked spontaneous fluctuations between the follow-ups.

CONCLUSION

The results of mobile ear surgery in Greenland are acceptable. Mobile ear surgery may be implemented in areas with limited access to health care, eg, in developing countries.

Miringoplastia com a utilização de um novo material biossintético

A miringoplastia é uma cirurgia com a finalidade de controlar a infecção no ouvido médio, reconstruir o mecanismo de transmissão sonora para a janela oval e proteger a janela redonda. São descritos diversos materiais para reconstruir a membrana timpânica, destacando-se a fáscia do músculo temporal, pericôndrio do tragus, cartilagem, dura-máter, tecido placentário, entre outros. OBJETIVO: Este trabalho tem objetivo de demonstrar o efeito de um novo biomaterial, a membrana de látex natural com polilisina, desenvolvida no laboratório de Neuroquímica do Departamento de Bioquímica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - USP. FORMA DE ESTUDO: Coorte Longitudinal. MATERIAL E MÉTODO: O biomaterial utilizado é estimulante da neovascularização e crescimento tecidual organizado em diferentes órgãos e tecidos, sendo um material inócuo e não rejeitado pelo organismo. Foi usada a biomembrana de látex com polilisina como um implante transitório para o fechamento da perfuração da membrana timpânica. A membrana foi colocada na face externa dos bordos da membrana timpânica e a fáscia temporal na face interna da mesma. Foram estudadas 238 orelhas com perfuração de membrana timpânica por seqüela de otite média crônica, submetidas a miringoplastia com enxerto de fáscia de músculo temporal e a membrana de látex natural, com idades de 7 a 76 anos. Apresentavam uma ou mais miringoplastias anteriores sem sucesso 41 dos casos. RESULTADO: Como ressaltamos preliminarmente, verificamos pega do enxerto em 90,5% das orelhas (181), sendo fechamento de perfuração amplas, 96; médias, 73 e 12 pequenas. Verificamos intensa vascularização em 100% dos enxertos, o que não é habitual quando não se usa a membrana de látex natural. CONCLUSÃO: Conclue-se que o biomaterial usado merece nossa atenção quanto ao seu uso como implante transitório em miringoplastias, melhorando o processo de revascularização da membrana timpânica remanescente.

Tympanoplasty with and without cortical mastoidectomy - a comparative study

Perfimttion of the tympanic membrane is nature's may of maintaining the middle far vntilation under the pressure of inflammatory process in the tempanomastoid cleft. An attempt at reconstruction with the possibility of infection lurking in and around the mastoid air cells may seem futile. Vow the quntinn arises as to whether a cortical Mastoidectomy is essential before an attempt at reconstruction is made. Our experience with one hundred and twenty patients is presented here. Our study shovn that conicul mastoidectomy does not signifieantly improve the results in well-selected ears.