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Hancı D, Çelik C, Altun H, Uyar Y. Fascia Lata-Fat Island Graft in Septal Perforation Repair. Facial Plast Surg Aesthet Med 2024. [PMID: 38215258 DOI: 10.1089/fpsam.2023.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Objective: To measure the success of the fascia lata-fat island graft technique in septal perforation repair as measured by nasal endoscopic examination. Background: This study presents the results of using fascia lata-fat island, a different graft technique, for the repair of septal perforations, offering an alternative to this challenging procedure. Methods: This retrospective study assesses nasal septal perforation repair using the fascia lata-fat island graft technique performed by a single surgeon. Inclusion criteria involved completing 12-month follow-ups within a 3-year review period. Success rates were calculated and evaluated alongside patient characteristics. Results: The median (range) age of the 25 patients included in the study was 34 (25-45) years and 72.0% were men. The septal perforation size of all patients was >2 cm and the etiological cause in all of them was previous septal surgery. All patients were followed for 12 months. The perforation was completely closed in 23 of 25 patients (92%). Conclusion: Using a different graft with an open rhinoplasty approach, we achieved a high success rate in patients with large septal perforations, followed for 1 month with nasal stenting and an average follow-up duration of 12 months.
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Affiliation(s)
- Deniz Hancı
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Cem Çelik
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Hüseyin Altun
- Department of Otorhinolaryngology, Kocaeli Technology and Health University, Kocaeli, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Nicholas Jungbauer W, Jeong S, Nguyen SA, Lambert PR. Comparing Myringoplasty to Type I Tympanoplasty in Tympanic Membrane Repair: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:922-934. [PMID: 36939595 DOI: 10.1002/ohn.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To compare the anatomic success rates of type I tympanoplasty (tympanoplasty) versus myringoplasty. By our definition, tympanoplasty involves entering the middle ear via elevation of a tympanomeatal flap, while myringoplasty involves surgery to the drumhead without middle ear exposure. DATA SOURCES PubMed, Scopus, CINAHL, Cochrane. REVIEW METHODS To be included, studies must have documented surgical technique, tympanic membrane (TM) perforation size (as % of TM), and success rate using tissue or alloplastic grafts. Exclusion criteria included series with more than 10% of patients with cholesteatoma or middle ear pathology. A meta-analysis of weighted summary proportions under the random effects model was performed, and proportion differences (PD) were calculated. A secondary analysis of hearing outcomes was performed. RESULTS Eighty-five studies met inclusion, with a tympanoplasty cohort of n = 7966 and n = 1759 for myringoplasty. For perforations, less than 50% of the TM, the success rate for tympanoplasty and myringoplasty was 90.2% and 91.4%, respectively (PD: 1.2%, p = .19). In perforations greater than 50%, tympanoplasty and myringoplasty success rates were 82.8% and 85.3%, respectively (PD: 2.5%, p = .29). For both procedures, perforations less than 50% of the TM had higher success rates than perforations greater than 50% of the TM (p < .01). Both techniques endorsed significant improvements to air-bone gap (ABG) metrics. CONCLUSION Our analysis suggests that the anatomic success rate is similar for tympanoplasty and myringoplasty, regardless of perforation size, and that smaller perforations experience higher success rates in both techniques. ABG outcomes were also similar between procedure techniques.
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Affiliation(s)
- Walter Nicholas Jungbauer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Hu H, Chen J, Li S, Xu T, Li Y. 3D printing technology and applied materials in eardrum regeneration. JOURNAL OF BIOMATERIALS SCIENCE, POLYMER EDITION 2022; 34:950-985. [PMID: 36373498 DOI: 10.1080/09205063.2022.2147350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tympanic membrane perforation is a common condition in clinical otolaryngology. Although some eardrum patients can self-heal, a long period of non-healing perforation leads to persistent otitis media, conductive deafness, and poor quality of life. Tympanic membrane repair with autologous materials requires a second incision, and the sampling site may get infected. It is challenging to repair tympanic membranes while maintaining high functionality, safety, affordability, and aesthetics. 3D bioprinting can be used to fabricate tissue patches with materials, factors, and cells in a design manner. This paper reviews 3D printing technology that is being used widely in recent years to construct eardrum stents and the utilized applied materials for tympanic membrane repair. The paper begins with an introduction of the physiological structure of the tympanic membrane, briefly reviews the current clinical method thereafter, highlights the recent 3D printing-related strategies in tympanic membrane repair, describes the materials and cells that might play an important role in 3D printing, and finally provides a perspective of this field.
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Affiliation(s)
- Haolei Hu
- Department of Otolaryngology, the 988th Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Zhengzhou City 450042, Henan Province, China
| | - Jianwei Chen
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, People’s Republic of China
| | - Shuo Li
- Xinxiang Medical College, Xinxiang,453003, Henan Province, China
| | - Tao Xu
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, People’s Republic of China
| | - Yi Li
- Department of Otolaryngology, the 988th Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Zhengzhou City 450042, Henan Province, China
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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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Iso-Mustajärvi M, Dietz A, Löppönen H. Myringoplasty Quality Control Is Necessary: Comparison of Surgical Results of Two Consecutive Series in A Single Institution. J Int Adv Otol 2018; 14:135-139. [PMID: 29764787 DOI: 10.5152/iao.2018.4276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate and compare myringoplasty results from two different consecutive series conducted at the Kuopio University Hospital during a four-decade period. MATERIALS AND METHODS We reviewed 315 patients (a total of 338 ears) who underwent myringoplasty at Kuopio University Hospital between the years 1986 and 2012. The results from this series were compared with those form a previously published series of 404 patients who underwent myringoplasty between 1970 and 1985 at the same institution. RESULTS Myringoplasty was considered to be successful whenever the tympanic membrane remained closed without atelectasis. The results were analyzed at the 1- and 3-year follow-up. The overall success rate after 1 year was 82.8% compared with 88% in the previous series. The success rate after 3 years was 87.4%. The best closure rate after 1 year (85.7%) was achieved with fascia grafts (n=272) and perichondrium (85.7%, n=14). The closure rate of 61.9% with the perichondrium/cartilage graft (n=21) and 71.0% with the fat graft (n=31) was statistically significantly lower (p < 0.05) compared with that with the fascia graft. The postoperative air-bone gap (0.5-4 kHz) was < 10 dB(HL) in 56.2% and < 20 dB(HL) in 79.6% cases compared with 61% and 87%, respectively, in previous series. CONCLUSION Myringoplasty is a safe procedure with a reasonably high success rate. We observed a slight deterioration in the overall results compared with the previous series. This study highlights the importance of systematic quality control and the results and the need for follow-up of the learning curve after the introduction of new surgical techniques and materials.
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Affiliation(s)
- Matti Iso-Mustajärvi
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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El-Anwar MW, Elnashar I, Foad YA. Platelet-rich plasma myringoplasty: A new office procedure for the repair of small tympanic membrane perforations. EAR, NOSE & THROAT JOURNAL 2018; 96:312-326. [PMID: 28846786 DOI: 10.1177/014556131709600818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a prospective study to assess the effectiveness of a platelet-rich plasma hourglass graft in the repair of small tympanic membrane perforations as an office-based procedure. Our study population was made up of 25 patients-10 men and 15 women, aged 19 to 45 years (mean: 30.4 ± 7.2)-who each underwent repair of one eardrum. After administration of topical anesthesia, a single piece of platelet-rich plasma approximately double the size of the perforation was obtained from each patient's intravenous blood sample. After the margin of the perforation was freshened, the platelet-rich plasma was placed in an hourglass configuration, with equal portions lying medial and lateral to the perforation. Successful perforation repair was achieved in 21 of the 25 ears (84%). No patient developed an infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. We conclude that office-based platelet-rich plasma myringoplasty is a safe and effective minimally invasive procedure that is suitable for repairing small tympanic membrane perforations.
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Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otolaryngology-Head and Neck Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt.
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Aksoy MA, Açıkalın MF, Gürbüz MK, Özüdoğru EN, Canaz F, Kaya E, Pınarbaşlı MÖ, İncesulu A, Çaklı H, Cingi C. Efficacy of Platelet-Rich Plasma on Fat Grafts in the Repair of Tympanic Membrane Perforations: An Experimental Study. J Int Adv Otol 2017; 14:58-62. [PMID: 29283097 DOI: 10.5152/iao.2017.3845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We investigated the use of autologous platelet-rich plasma (PRP) to improve the success rate of fat graft myringoplasty in perforated tympanic membranes of rats. MATERIALS AND METHODS A total of 20 healthy Wistar albino female rats were divided into two groups. In Group 1, the left tympanic membranes were perforated and grafted with a fat graft that was harvested from the inguinal region. In Group 2, the left tympanic membranes were perforated, and a fat graft was also harvested from the inguinal region. Then, the fat was soaked in 0.5 mL PRP and grafted at the perforation. After the procedure, the rats were examined, and the graft situation was assessed at 3, 5, 7, 10, and 14 days. All of the rats were sacrificed 21 days after perforation, and a histopathological examination was made. RESULTS We compared fat graft histopathological and otomicroscopic findings between the groups. While we did not observe graft rejections in Group 2, we saw 1 case of graft rejection in Group 1. In the histopathological examination, PRP prevents fat graft resorption by the terms of the adipocyte area, granulation tissue area, and vacuolization area. CONCLUSION This study demonstrated the efficacy of fat grafts prepared with PRP on rat tympanic membranes. The fat graft with PRP did not statistically improve the success rate compared to the graft without PRP. Histopatologic findings of the study showed that PRP prevents fat graft resorption. Further studies are needed to further examine the advantages of the graft with PRP.
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Affiliation(s)
- Mehmet Akif Aksoy
- Department of Ear Nose and Throat, Gölköy State Hospital, Ordu, Turkey
| | - Mustafa Fuat Açıkalın
- Department of Pathology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Melek Kezban Gürbüz
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Erkan Niyazi Özüdoğru
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Funda Canaz
- Department of Pathology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ercan Kaya
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Mehmet Özgür Pınarbaşlı
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Armağan İncesulu
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Hamdi Çaklı
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Cemal Cingi
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
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Reply to the letter to the editor concerning: 'Fat-plug myringoplasty of ear lobule vs abdominal donor sites'. Eur Arch Otorhinolaryngol 2017; 274:2665-2667. [PMID: 28213777 DOI: 10.1007/s00405-017-4460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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Villar-Fernandez MA, Lopez-Escamez JA. Outlook for Tissue Engineering of the Tympanic Membrane. Audiol Res 2015; 5:117. [PMID: 26557361 PMCID: PMC4627121 DOI: 10.4081/audiores.2015.117] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 01/02/2023] Open
Abstract
Tympanic membrane perforation is a common problem leading to hearing loss. Despite the autoregenerative activity of the eardrum, chronic perforations require surgery using different materials, from autologous tissue - fascia, cartilage, fat or perichondrium - to paper patch. However, both, surgical procedures (myringoplasty or tympanoplasty) and the materials employed, have a number of limitations. Therefore, the advances in this field are incorporating the principles of tissue engineering, which includes the use of scaffolds, biomolecules and cells. This discipline allows the development of new biocompatible materials that reproduce the structure and mechanical properties of the native tympanic membrane, while it seeks to implement new therapeutic approaches that can be performed in an outpatient setting. Moreover, the creation of an artificial tympanic membrane commercially available would reduce the duration of the surgery and costs. The present review analyzes the current treatment of tympanic perforations and examines the techniques of tissue engineering, either to develop bioartificial constructs, or for tympanic regeneration by using different scaffold materials, bioactive molecules and cells. Finally, it considers the aspects regarding the design of scaffolds, release of biomolecules and use of cells that must be taken into account in the tissue engineering of the eardrum. The possibility of developing new biomaterials, as well as constructs commercially available, makes tissue engineering a discipline with great potential, capable of overcoming the drawbacks of current surgical procedures.
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Affiliation(s)
| | - Jose A. Lopez-Escamez
- Otology & Neurotology Croup CTS495, Centre for Genomics and Oncological Research (CENYO) - Pfizer, University of Granada, Andalusian Regional Government, Granada, Spain
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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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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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Chondroperichondrial clip myringoplasty: a new technique for closure of tympanic membrane perforations. The Journal of Laryngology & Otology 2013; 127:562-7. [DOI: 10.1017/s0022215113000595] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:This study aimed to evaluate the feasibility and efficacy of the recently described chondroperichondrial clip myringoplasty technique, and make comparisons with conventional myringoplasty techniques.Methods:The study comprised a select group of patients with chronic otitis media (mucosal disease only), with central tympanic membrane perforations affecting less than 50 per cent of the pars tensa, and an air–bone gap below 35 dB. A modified custom-made cartilage perichondrial graft was placed using the recently described ‘clip’ technique.Results:The graft success rate was 91.3 per cent. Post-operatively, the air–bone gap was within 10 dB in 52 per cent of cases and within 10–20 dB in 48 per cent of cases. There were few minor complications.Conclusion:Chondroperichondrial clip myringoplasty can be considered as an alternative minimally invasive technique for the repair of select cases of tympanic membrane perforations. This technique, which showed impressive results, was associated with minimum morbidity and reduced operative time.
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Konstantinidis I, Malliari H, Tsakiropoulou E, Constantinidis J. Fat Myringoplasty Outcome Analysis With Otoendoscopy. Otol Neurotol 2013. [DOI: 10.1097/mao.0b013e318278c1e3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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[CO2-laser-assisted de-epithelialization of perforation margins of persistent tympanic membrane perforations. An alternative to conventional surgical procedures]. HNO 2009; 57:1185-92. [PMID: 19763523 DOI: 10.1007/s00106-009-1963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated. MATERIAL AND METHODS A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested. RESULTS Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment. CONCLUSION A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.
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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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Abstract
OBJECTIVE To evaluate the impact of patient and graft variables on the successful closure of tympanic membrane perforations treated with myringoplasty at the Children's Hospital of Pittsburgh from 2000 to 2005. STUDY DESIGN Retrospective chart review at an academic tertiary-care children's hospital. METHODS Charts were reviewed for 604 children, ages 1 to 18 years old, with complete records who underwent myringoplasty by the pediatric otolaryngology practice at Children's Hospital of Pittsburgh of UPMC from 2000 to 2005, totaling 777 procedures. RESULTS Significant variables include patient age, number of prior tubes, perforation etiology (P < .000), presence of a retained tube (P < .000) as well as tube type (P = .016), graft material (P = .001), and history of Down syndrome (P = .035). Nonsignificant variables include season of procedure (P = .599), status of adenoid tissue (P = .910), prior otorrhea (P = .175), as well as perforation location (P = .318) and duration (P = .150). CONCLUSIONS Proper patient and graft material selection can affect the outcome of myringoplasty procedures. Practical implications from these data suggest that Gelfoam myringoplasty is more successful than either paper patch or fat graft closures, with a 90.8% success rate (P = .001). Myringoplasty should not be deferred during the winter months as the season of procedure does appear to not affect the success of closure (P = .60). Similarly, the presence or absence of adenoid tissue did not affect the success of closure (P = .91).
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Paper-patch myringoplasty with CO2 laser for chronic TM perforation. Eur Arch Otorhinolaryngol 2008; 265:1161-4. [DOI: 10.1007/s00405-008-0592-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
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Ruellan K, Huy PTB. [Myringoplasty: an office procedure using a subdermal graft]. ACTA ACUST UNITED AC 2007; 125:109-11. [PMID: 18001690 DOI: 10.1016/j.aorl.2007.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 04/10/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Katell Ruellan
- Hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris, France
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Fiorino F, Barbieri F. Fat graft myringoplasty after unsuccessful tympanic membrane repair. Eur Arch Otorhinolaryngol 2007; 264:1125-8. [PMID: 17487499 DOI: 10.1007/s00405-007-0323-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 04/12/2007] [Indexed: 01/06/2023]
Abstract
The objective of the present study was to evaluate the efficacy of fat graft myringoplasty in repairing residual or recurrent tympanic membrane perforation. A retrospective analysis was performed on 31 patients, aged 25-57 years (mean 43.3), submitted to myringoplasty revision using fat graft. Fourteen were males and 17 females. Perforation size ranged from 1 to 5 mm. Follow-up time ranged from 4 to 62 months (mean 26 months). Fat graft myringoplasty was performed under local anesthesia, using ear lobe fat in 26 patients and abdominal fat in five patients closure of tympanic membrane perforation was achieved in 87.1% of ears. No modification of the hearing level was evidenced at the statistical analysis. Fat graft myringoplasty is a safe, effective and minimally invasive procedure, suitable to repair small residual/recurrent perforations of the tympanic membrane. The angiogenic properties of the fat are ideal to overcome the poor vascular supply in the vicinity of the tympanic membrane perforation.
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Affiliation(s)
- Francesco Fiorino
- Department of Otolaryngology, Civil Hospital Borgo Trento, Verona, Italy.
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