Endoscopic butterfly cartilage myringoplasty

Influence of the Size and Location of the Perforation on the Anatomical Results of Myringoplasty

INTRODUCTION

Type 1 tympanoplasty (myringoplasty) is the surgical closure of a perforated eardrum. Its purpose is to restore the integrity of the tympanic membrane and to improve hearing in the affected ear. Nowadays, we note the increasing use of cartilage as material for the reconstruction of the tympanic membrane. The main objective of our study is to evaluate the influence of size and perforation site on the results of type 1 tympanoplasties performed in our department.

MATERIALS AND METHODS

 We carried out a retrospective study of a series of myringoplasties spread over a period of four years and five months from January 1, 2017, to May 31, 2021. For every patient, we collected data regarding age, sex, perforation size, location, and closure of the tympanic membrane after myringoplasty. The audiological results for air conduction (AC) and bone conduction (BC), as well as air-bone gap reduction following surgery, were noted. Follow-up audiograms were performed at the following intervals: two months, four months, and eight months postoperatively. The frequencies tested included 250, 500, 1000, 2000, and 4000 Hz. Similarly, the air-bone gap was estimated on the mean of all frequencies. A chi-squared test and Mann-Whitney test were used to compare qualitative and quantitative variables, respectively.

RESULTS

A total of 123 myringoplasties were included in this study. Closure of the tympanic membrane was achieved successfully in 85.7% for one-quadrant-size perforations (24 cases), and in 76.2% for two-quadrant-size perforations (16 cases). When 50-75% of the tympanic membrane was absent at the time of diagnosis, full repairment was achieved in 89.6% of the patients (n = 24), and in 85.0% (n = 34) when the perforation was subtotal. Recurrences have not happened more significantly for one location of the tympanic defect compared to another. Indeed, failures for anterior quadrant perforations were 14 whereas other sites represented 19 cases of non-integrated grafts. The audition was significantly improved from pre-operatively (AC mean of 48.7 dBs with ranges from 24 to 90 dBs) to post-operatively (30.7 dBs AC with ranges from 10-80 dBs) (p = 0,002). The average postoperative audiometric Rinne was 18 dBs with a gain of 15.37 dBs.

DISCUSSION

Patients with bilateral perforations (tubal dysfunction, allergic rhinitis) are more likely to develop recurrences. Thus, the series considering many patients operated on twice has high failure rates. Good compliance with anti-allergic treatment and with hygiene rules (in particular ear sealing) is essential for the closure of anterior perforations.

CONCLUSION

 It seems through our study that there is no correlation between the size and location of the perforation and its postoperative closure. Risk factors such as smoking, anemia, intraoperative bleeding, and gastroesophageal reflux are important and determining in the healing process.

Necessities, opportunities, and challenges for tympanic membrane perforation scaffolding-based bioengineering

Tympanic membrane (TM) perforation is a global clinical dilemma. It occurs as a consequence of object penetration, blast trauma, barotrauma, and middle ear diseases. TM perforation may lead to otitis media, retraction pockets, cholesteatoma, and conductive deafness. Molecular therapies may not be suitable to treat perforation because there is no underlying tissue matrix to support epithelium bridging. Chronic perforations are usually reconstructed with autologous grafts via surgical myringoplasty. Surgical treatment is uncomfortable for the patients. The grafting materials are not perfect because they produce an opaque membrane, fail in up to 20% of cases, and are suboptimal to restore acoustic function. Millions of patients from developing parts of the world have not got access to surgical grafting due to operational complexities, lack of surgical resources, and high cost. These shortcomings emphasize bioengineering to improve placement options, healing rate, hearing outcomes, and minimize surgical procedures. This review highlights cellular, structural, pathophysiological, and perforation specific determinants that affect healing, acoustic and surgical outcomes; and integrates necessities relevant to bioengineered scaffolds. This study further summarizes scaffolding components, progress in scaffolding strategies and design, and engenders limitations and challenges for optimal bioengineering of chronic perforation.

Endoscopic Myringoplasty and Type I Tympanoplasty

Herein we provide a broad overview of the literature as it applies to endoscopic myringoplasty and type I tympanoplasty. Advantages and disadvantages of the endoscopic approach are reviewed for both the adult and pediatric populations and are compared with conventional microscopic techniques.

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4 ± 5.24 dB. The mean ABG was 9.2 ± 2.13 dB 1 month postoperatively and 8.5 ± 2.26 dB 6 months postoperatively (p < .005).Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn't require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.

Comparison of endoscopic butterfly-inlay versus endoscopic push-through myringoplasty in repairing anterior perforations of the tympanic membrane

OBJECTIVE

The aim of the present study was to evaluate the surgical and functional results of endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty in the treatment of anterior perforation of the tympanic membrane.

METHOD

This open-label randomised clinical study was conducted on 71 patients with small- and medium-sized anterior perforations of the tympanic membrane. Graft success rate, hearing results, operative time and complications were analysed.

RESULTS

Graft success rates for endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty were 94.1 and 91.8 per cent, respectively (p > 0.05). Post-operative air-bone gap values significantly improved in both the endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty groups. The average operative time was significantly shorter in the endoscopic butterfly-inlay cartilage myringoplasty group (31.5 minutes) compared to the endoscopic push-through myringoplasty group (41.7 minutes; p < 0.05).

CONCLUSION

When compared with the endoscopic push-through myringoplasty, the endoscopic butterfly-inlay cartilage myringoplasty technique, which is technically easier to perform, does not require packing and has a shorter operating time. It is a reasonable approach for repair of anterior perforations of the tympanic membrane.

Microscopic versus Endoscopic Inlay Butterfly Cartilage Tympanoplasty

BACKGROUND AND OBJECTIVES

Inlay butterfly cartilage tympanoplasty makes the graft easy, and reduces operating time. The present study aimed to investigate the outcomes of microscopic versus endoscopic inlay butterfly cartilage tympanoplasty.

SUBJECTS AND METHODS

In this retrospective study, the outcomes of 63 patients who underwent inlay butterfly cartilage tympanoplasty with small to medium chronic tympanic membrane perforation were evaluated. Twenty-four patients underwent conventional microscopic tympanoplasty and 39 underwent endoscopic tympanoplasty. The outcomes were analyzed in terms of the hearing gain and graft success rate.

RESULTS

The surgical success rate was 95.8% in the patients who underwent conventional microscopic tympanoplasty and 92.3% in those who underwent endoscopic tympanoplasty. In both groups of patients, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values in either group.

CONCLUSIONS

Endoscopic inlay tympanoplasty using the butterfly cartilage technique appears to be an effective alternative to microscopic tympanoplasty and results in excellent hearing.

Endoscopic inlay butterfly cartilage tympanoplasty in pediatric patients

OBJECTIVE

To present and to compare the results of microscopic and endoscopic inlay butterfly cartilage tympanoplasties (MIBCT and EIBCT) in pediatric patients with COM using tragal cartilage as a grafting material and to discuss the advantages and superiorities of endoscope use and IBCT in pediatric patients.

MATERIAL AND METHODS

This retrospective study was carried out to evaluate the outcomes of 79 pediatric patients up to 16 years old who underwent either EIBCT (58 children) or MIBCT (21 children) between July 2013 and August 2017 at a tertiary referral hospital. Audiometric data including air-bone gap (ABG), air-bone gap gain, and air-conduction (AC) and bone-conduction (BC) thresholds, otologic examination findings involving size, side, and site of tympanic membrane perforations, the average lengths of surgery time, hospital stay, and follow-up period, technical success (TS), and functional success (FS) were all assessed by screening hospital records. The preoperative and postoperative averages of 0.5, 1, 2, and 3 kHz of pure-tone thresholds were used for the mean AC and BC thresholds according to the guidelines of the Committee on Hearing and Equilibrium.

RESULTS

TSs of EIBCT and MIBCT were achieved in 91.4 % (53/58) and 85.7% (18/21), respectively. The overall mean of ABG of EIBCT and MIBCT improved from 21.97±7.06 dB vs 20.90±4.78 dB preoperatively to 9.84±4.31 dB vs 9.33±3.54 dB postoperatively (p<0.05) thus the ABG gain was 12.00±7.32 dB and 11.57±5.49 dB, respectively. The mean lengths of surgery time were 28.03±4.79 minutes and 40.76±3.98 minutes, the mean lengths of hospital stay were 9.24±1.4 hours and 9.42±1.32hours, the lengths of follow-up period were 21.40±9.15 months and 23.19±9.40 months, in the order given.

CONCLUSION

EIBCT is a comfortable, attractive, and safer approach in pediatric patients with COM for both otologists and patients for many reasons including children's narrower external ear canal, endoscopes' wide field of view when compared with microscopes, instead of endaural, postauricular or transcanal circumferential insicions need for just a tragal incision for graft harvesting, and literature reports of satisfactory technical and functional results.

Transcanal endoscopic type 1 tympanoplasty in children: Cartilage butterfly and fascia temporalis graft

INTRODUCTION

Endoscopic type 1 tympanoplasty is every day gaining numerous adepts for tympanic membrane repair. Due to the value of reducing postauricular approaches, decreasing postoperative morbidity and hospitalization time. The objective of this study is to present surgical results of endoscopic type 1 tympanoplasty in the pediatric population using fascia temporalis or cartilage butterfly graft.

MATERIALS AND METHODS

Prospective study regarding the pediatric population, mean age of 10.7 years old. Patients diagnosed with chronic otitis media without cholesteatoma and intact ossicular chain. Tympanic membrane reconstruction using inlay cartilage butterfly graft or underlay fascia temporalis graft according to surgical needs. Audiograms were evaluated preoperatively and 6 months after surgery. No postauricular approaches were performed.

RESULTS

A total of 54 ears were operated, 25 utilizing underlay fascia temporalis graft and 29 using inlay cartilage butterfly graft. Six months following surgery, dry and closed tympanic membranes were obtained in 54 cases (92.6%). Preoperative and postoperative air conduction (AC) thresholds, bone conduction (BC) thresholds and air-bone gaps (ABG) were assessed. Preoperative AC of 24.6 dB, BC of 8.9 dB and an ABG of 15.5 dB. Postoperative AC of 16.3 dB, BC of 8.9 and an ABG of 6.9 dB. A postoperative ABG reduction of 8.5 dB was reached.

CONCLUSION

Transcanal endoscopic type 1 tympanoplasty can be achieved in every pediatric patient with chronic otitis media without cholesteatoma, and, is a safe and efficient procedure.

Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

PURPOSE

In 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.

MATERIALS AND METHODS

Butterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap.

RESULTS

The reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%-100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB.

CONCLUSIONS

The butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.