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Success rates and predictors of outcomes of type I tympanoplasty performed by residents in a teaching tertiary hospital

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中华耳科学杂志:英文版 2023年第4期18卷 214-219页

作者： Lucas Resende Lucinda Mangia Nicole Tassia Amadeu Maurício da Silva Oliveira Lucas Santin Patzer Eduardo de Souza Somensi Rogerio Hamerschmidt Department of Otolaryngology and Head and Neck Surgery Complexo Hospital de Clínicas-Universidade Federal Do Parana(CHC-UFPR)CuritibaBrazil Complexo Hospital de Clínicas-Universidade Federal Do Parana(CHC-UFPR) Curso de MedicinaCuritibaBrazil

Several technical variations of tympanoplasty have been reported,usually involving the type of graft and/or instruments used.Few studies have focused on the outcome of type-1 tympanoplasty specifically in teaching scenarios.We aimed to describe the results of type-1 tympanoplasty performed by residents,and to investigate potential predictive factors of surgical success.To do so,we did a retrospective analysis of medical records of patients who underwent type-1 tympanoplasty in a tertiary university hospital.We evaluated the tympanic membrane closure and audiometric outcomes during the first year of follow-up,and compared the results according to some clinical and surgical factors.130 operated ears were included in the study.The closure rate reached 84.12%after one month and 72.72%after twelve months of surgery.The mean air-bone gap was 22.98 dB preoperatively,and reached 10.55 dB after surgery.Perforation closure rates were 85%and 57.14%for those operated by endoscopic and microscopic-assisted approaches,respectively(p?0.004).The use of cartilage grafts and time without otorrhea of more than three months prior to surgery were also predictors of surgical success(p?0.002 and 0.041,respectively).Gender,age,perforation size,contralateral disease,operated side,reoperation,and degree of hearing loss did not significantly interfere with outcomes.tympanoplasty showed good overall results when performed by residents,although inferior to those reported by experienced surgeons.The use of the endoscope,cartilage grafting,and longer preoperative time without otorrhea were predictors of surgical success in this scenario.

关键词： tympanoplasty Treatment outcome Video-assisted surgery

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Comparison of tragal perichondrium and COOK artificial material in endoscopic type 1 tympanoplasty

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Laparoscopic, Endoscopic and Robotic Surgery 2023年第2期6卷 63-68页

作者： Gaofei Ye Mingguang Zhou Wenya Li Xiuwen Jiang Department of Otolaryngology Head and Neck Surgery Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China

Objective:Various materials have been used for tympanic membrane reconstruction in middle ear surgery.This study aimed to evaluate the difference between the tragal perichondrium and COOK arti-ficial material in patients who underwent endoscopic type 1 tympanoplasty.Method:This retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Patients were divided into group A(tragal perichondrium)and group B(COOK artificial material)ac-cording to the material used in the operation.All patients were followed up for 6 months.The differences in age,gender,operation site,disease course,preoperative air-bone gap(ABG),operation time,blood loss,hearing gain,and wound healing rate were compared between the two groups.Results:This study enrolled 197 patients,with 120 patients in group A and 77 patients in group B.There were no significant differences in age,gender,operation site,disease course,or preoperative ABG be-tween groups A and B(p>0.05).Both groups had significant postoperative improvement in hearing(group A:30.98±9.58 dB vs.17.07±9.92 dB,ptympanoplasty,and COOK artificial material can save operation time and blood loss in surgery compared to the tragal perichondrium.

关键词： tympanoplasty Artificial material Tragal perichondium Cartilage

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Modification of closed tympanoplasty in middle ear cholesteatoma

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Chinese Medical Journal 2010年第4期123卷 447-451页

作者： ZHANG Zhi-gang LIU Xiang CHEN Sui-jun CHEN Bin ZHENG Yi-qing Department of Otorhinolaryngology Head and Neck Surgery Second Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510120 China

Background Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear cholesteatoma. Methods Eighty-three patients were recruited in this study based on the following two criteria： each patient had middle ear cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis （TORP） or partial ossicular replacement prosthesis （PORP） and membrane repair with conchal cartilage-perichondral complex. Results All the 83 cases had dry ears with membranes healed within 4-6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with cholesteatoma recurrence （6.02%）. Function tests after one postoperative year exhibited an improvement of pure tone audiometry （PTA） in 27 cases that was more than 30 dB, in 33 cases between 20-29 dB, 14 cases with improvement between 10-19 dB, and in 9 cases there was no improvement. Conclusions The modified closed tympanoplasty procedure for middle ear cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.

关键词： mastoidectomy tympanoplasty cholesteatoma cartilage middle ear

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Long-term results of type I tympanoplasty with perichondrium reinforced cartilage palisade vs temporalis fascia for large perforations:A retrospective study

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Journal of Otology 2021年第1期16卷 12-17页

作者： Dipesh Shakya Ajit Nepal Department of Otorhinolaryngology Civil Service HospitalMinbhawanKathmanduNepal Department of Otorhinolaryngology Patan Academy of Health SciencesSchool of MedicineLagankhelLalitpurNepal

Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforations over 5 years follow-up period.Materials and methods:This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations.The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade(CP group)or temporalis fascia(TF group)as the graft via a transmeatal approach and under local anesthesia.Morphological and functional results were recorded at three-and five years follow-up.Demographic profiles including age and sex,surgery side,contralateral disease and graft uptake rate,as well as hearing outcomes,were compared between the two groups.Results:At three years follow-up,graft uptake was 94.87%for perichondrium reinforced cartilage palisade and 80.7%for fascia,respectively,(p¼0.67).At five years follow-up,the uptake rate dropped to 87.17%in the CP group,but to 66.6%in the TF group(p¼0.019).Hearing improved after surgery in both groups,and showed no significant difference between the two groups.Conclusion:Over long-term,perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results.

关键词： tympanoplasty Large perforation Temporalis fascia Cartilage palisade Perichondrium

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Success rates for various graft materials in tympanoplasty e A review

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Journal of Otology 2020年第3期15卷 107-111页

作者： Ali Bayram Nuray Bayar Muluk Cemal Cingi Sameer Ali Bafaqeeh Kayseri Training and Research Hospital Department of OtorhinolaryngologyKayseriTurkey Kirikkale University Medical FacultyDepartment of OtorhinolaryngologyKirikkaleTurkey Eskisehir Osmangazi University Medical FacultyDepartment of OtorhinolaryngologyEskisehirTurkey King Saud University Department of OtorhinolaryngologyRiyadhSaudi Arabia

Objectives:The aim of this paper is to review how successful each type of grafts is in tympanoplasty.Methods:Pubmed,Google and the Proquest Central Database at Kırıkkale University were queried using the keywords“graft”,“success”“tympanoplasty”,“success rate”with the search limited to the period 1955 to 2017.Results:Various types of graft materials including temporalis fascia,cartilage,perichondrium,periosteum,vein,fat or skin have been used in the reconstruction of tympanic membrane(TM)perforation.Although temporalis fascia ensures good hearing is restored,there are significant concerns that its dimensional stability characteristics may lead to residual perforation,especially where large TM perforations are involved.The“palisade cartilage”and“cartilage island”techniques have been stated to increase the strength and stability of a tympanic graft,but they may result in a less functional outcome in terms of restoring hearing.Smoking habits,the size and site of a perforation,the expertise level of the operating surgeon,age,gender,the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is.Conclusion:Although temporal fascia is the most commonly used graft material for tympanoplasty,poor graft stability may cause failure.This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia.Cartilage grafts offer better ability to resist infection,pressure,and cope with insufficient vascular supply.This means that cartilage grafts are suitable for use in revision cases.

关键词： Graft Success tympanoplasty Success rate

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Endoscopic tympanoplasty

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Journal of Otology 2017年第2期12卷 62-67页

作者： Abdulvahap Akyigit Oner Sakallioglu Turgut Karlidag Elazig Education and Research Hospital Clinic of ENTElazigTurkey Firat University Faculty of MedicineDepartment of OtolaryngologyElazigTurkey

Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.

关键词： Endoscopic tympanoplasty Myringoplasty

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A comparative study of sequential vs.simultaneous type Ⅰ tympanoplasty in patients with bilateral chronic otitis media-Mucosal type

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Journal of Otology 2020年第2期15卷 59-61页

作者： Preethi Umamaheswaran Sanjeev Mohanty Vinoth Manimaran Sathishkumar Jayagandhi Shiva Priya Jeyabalakrishnan Department of ENT Head&Neck SurgeryPanimalar Medical College Hospital&Research InstituteChennaiTamil NaduIndia Department of ENT Head&Neck SurgeryMGM HealthcareChennaiTamil NaduIndia Department of ENT Head&Neck SurgerySri Ramachandra Institute of Higher Education&ResearchChennaiTamil NaduIndia Department of ENT Head&Neck SurgeryKarpagam Faculty of Medical Sciences&ResearchCoimbatoreTamil NaduIndia

Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss.With the advent of modern surgical instruments and surgical techniques,the risk is expected to be lower.This study compares the clinical outcomes in typeⅠtympanoplasty performed simultaneously and sequentially.Materials&methods:This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017.A total of 30 patients were divided into two groups of 15 each.This study analyzed the graft uptake,pure tone audiogram findings pre-and post-operatively,duration of surgery and number of hospital visit for each patient and the outco mes were co mpared between both the groups.Result:Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty.Graft uptake and postoperative wound infections were similar in both the groups.Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group.However,further studies are needed to authenticate this observation.None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.Conclusion:Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty,especially in terms of operating time,follow-up and overall financial implications on the patient.

关键词： tympanoplasty Chronic otitis media Bilateral tympanoplasty Simultaneous tympanoplasty Sequential tympanoplasty

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Results of pediatric endoscopic and endoscopically assisted tympanoplasty

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2017年第3期3卷 136-141页

作者： Glenn Isaacson Jonathan A.Harounian Departments of Otolaryngology-Head and Neck Surgery Lewis Katz School of Medicine Temple University Rydal Pennsylvania USA Departments of Pediatrics Lewis Katz School of Medicine Temple University Rydal PennsylvaniaUSA

Objectives:To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.Methods:Retrospective review of single surgeon experience.Results:During a 3 year period,30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts.There were 22 boys and 8 girls,ranging in age from 3.5 to 17 years (median 6 years).All tragal cartilage grafts (31/31;100％) survived.Twenty-seven surgeries (27/31;82％) resulted in an intact drum (17/31;55％) or a microperforation (10/31;32％).In four cases (4/31;13％) significant perforations formed in previously unaffected portions of the drum.Conclusion:Transcanal endoscopic cartilage inlay tympanoplasty offers a practical,minimally invasive approach to tympanoplasty for children of any age.It avoids postauricular or endaural incisions,tympanomeatal flap elevation,and canalplasty.Graft survival is uniform.Microperforation at the graft margins remained in 1/3 of children.Technical modifications may lead to higher rates of tympanic closure.

关键词： Cartilage graft Endoscopic ear surgery Minimally invasive surgery Otoendoscopy Pediatric tympanoplasty

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EXPERIENCE WITH OVERLAY tympanoplasty IN 83 CHINESE PATIENTS

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Journal of Otology 2014年第1期9卷 43-47页

作者： PENG Bengang MIAO Xutao WANG Xin ZHU Sixiang SUN Yiqing Department of Otolaryngology Jishuitan Hospital

Background In many European and American hospitals, represented by the House Ear Clinic (HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay tech-nique is used rarely. The aim of the current study was to report the authors’experience with overlay tympa-noplasty in 83 Chinese patients and study its value. Methods Eight-three patients (86 ears) underwent over-lay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane mor-phology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterio-ration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chron-ic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure, thorough disease elimination and extensive adaptation.

关键词： tympanoplasty Overlay technique External auditory canal Surgery

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Comparison of endoscopic tympanoplasty to microscopic tympanoplasty in anterior tympanic membrane perforation

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Laparoscopic, Endoscopic and Robotic Surgery 2020年第3期3卷 70-73页

作者： Jingna Zhang Sunhong Hu Department of Otolaryngology Head&Neck Surgery Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China

Objective:tympanoplasty aims to eradicate lesions and restore middle ear function in chronic otitis media.This study was conducted to compare the surgical and functional outcomes of endoscopic tympanoplasty(ET)and microscopic tympanoplasty(MT)in anterior tympanic membrane perforation.Methods:The clinical data of 42 patients undergoing tympanoplasty with anterior quadrants tympanic membrane perforation between January 2018 and July 2019 were retrospectively analyzed.Patients were classified into the ET group(n?22)or the MT group(n?20).Patients’demographics,clinical characteristics,surgical and functional outcomes were assessed between the two groups.Results:External auditory canal widening was not necessary in the ET group and was performed in 55.0%of patients in the MT group.The operation time of the ET group was significantly shorter than that of the MT group(61.23±11.48 min vs.78.65±11.79 min,p=0.034).The pain scale score of the ET group at 24 hours after surgery was significantly lower than that of the MT group(0.86±0.64 vs.2.40±1.14,p=0.029).The grafting success rate was 95.5%(21/22)in the ET group and 95.0%(19/20)in the MT group.In the ET group,the pre-and postoperative air-bone gap were 35.60±8.43 dB and 18.79±5.80 dB,respectively,which was a significant improvement(p=0.016).The respective values in the MT group(33.33±7.88 dB and 19.58±6.24 dB)also represented a significant improvement(p=0.004).Conclusion:ET is more beneficial for patients with anterior tympanic membrane perforations,which helps minimize the surgical trauma and reduces operation time and postoperative pain.

关键词： Endoscopic tympanoplasty Tympanic membrane perforation Chronic otitis media

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