Total tympanic membrane reconstruction: AlloDerm versus temporalis fascia

2005 ◽  
Vol 132 (6) ◽  
pp. 906-915 ◽  
Author(s):  
Andrew J. Fishman ◽  
Michelle S. Marrinan ◽  
Tina C. Huang ◽  
Seth J. Kanowitz
Keyword(s):  
Tympanic Membrane ◽  
Statistical Significance ◽  
Chronic Otitis Media ◽  
Healing Time ◽  
Canal Wall ◽  
Temporalis Fascia ◽  
Closure Rate ◽  
Novel Technique ◽  
Incomplete Healing ◽  
Safe Technique

BACKGROUND AND OBJECTIVE: Patients who require surgery for chronic otitis media with perforation and cholesteatoma frequently provide no residual tympanic membrane that is usable in grafting procedures. A novel technique of total tympanic membrane reconstruction (TTMR) is described that maximizes perforation closure rate in these situations while minimizing mucosalization, incomplete healing, and anterior blunting. The specific aim of this report is to assess the safety and efficacy of TTMR and to compare the results obtained with AlloDerm compared with temporalis fascia as a grafting material. METHODS: The records of 50 patients operated within the years 1999 and the 2004 were reviewed. TTMR with intact canal wall was performed in all cases. Both clinical and audiometric data were analyzed. RESULTS: Overall perforation closure rate was 92%. There was no statistical significance in closure rate when grafting with AlloDerm versus temporalis fascia. A statistically significant shortened healing time was observed with AlloDerm grafting. CONCLUSIONS: TTMR is a highly effective and safe technique.

scholarly journals Repair of Temporal Bone Encephalocele following Canal Wall Down Mastoidectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Sarantis Blioskas ◽  
Ioannis Magras ◽  
Stavros Polyzoidis ◽  
Konstantinos Kouskouras ◽  
Georgios Psillas ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Chronic Otitis Media ◽  
Base Deficit ◽  
Layer By Layer ◽  
Canal Wall ◽  
Temporalis Fascia ◽  
Dural Graft ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy

We report a rare case of a temporal bone encephalocele after a canal wall down mastoidectomy performed to treat chronic otitis media with cholesteatoma. The patient was treated successfully via an intracranial approach. An enhanced layer-by-layer repair of the encephalocele and skull base deficit was achieved from intradurally to extradurally, using temporalis fascia, nasal septum cartilage, and artificial dural graft. After a 22-month follow-up period the patient remains symptom free and no recurrence is noted.

Composite chondro-perichondrial clip myringoplasty: our experience

2016 ◽  
Vol 2 (4) ◽  
pp. 249
Author(s):  
Shrikrishna B. H. ◽  
Jyothi A. C.
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Canal Wall ◽  
Inclusion Criteria ◽  
Temporalis Fascia ◽  
Tympanic Membrane Perforations ◽  
Complete Closure ◽  
External Canal ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">There are several studies on the efficacy of the commonly used temporalis fascia for myringoplasty where the temporalis fascia is placed by underlay method after incising external canal wall skin. This study was conducted assess the success rate and efficacy of use of a composite chondro-perichondrial graft in a combined overlay-underlay fashion where the external canal wall is not incised. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective study was conducted where 30 cases of non-marginal perforation of tympanic membrane were properly selected based on the inclusion criteria. All the 30 cases underwent myringoplasty using composite chondro-perichondrial graft harvested from tragal cartilage and placed in a combined overlay-underlay fashion.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There was complete closure of the perforation in 27 of the total 30 cases. Also there was reduction in the air-bone gap post-operatively in all the 27 cases with complete closure of the tympanic membrane perforations. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Composite chondro-perichondrial clip myringoplasty is an effective method of closing non-marginal perforations of the tympanic membrane.</span></p>

scholarly journals A comparative study of hearing outcome in patients undergoing type 1 tympanoplasty using temporalis fascia versus sliced tragal cartilage

2021 ◽  
Vol 7 (2) ◽  
pp. 258
Author(s):  
Vinod Shinde ◽  
Tejal Sonar ◽  
Shikha Shah ◽  
Ashutosh Kumar ◽  
Anuja Satav
Keyword(s):  
Tympanic Membrane ◽  
Chronic Otitis Media ◽  
P Value ◽  
Temporalis Fascia ◽  
Duration Of Symptoms ◽  
Type 1 Tympanoplasty ◽  
Fascia Graft ◽  
Group A ◽  
The Mean

<p class="abstract"><strong>Background:</strong> A tympanoplasty is a surgical procedure to close a tympanic membrane perforation and reconstruct the tympanic membrane and hearing, commonly after chronic otitis media and trauma.</p><p class="abstract"><strong>Methods:</strong> 50 patients were divided into 2 groups and underwent type-1 tympanoplasty using temporalis fascia versus sliced tragal cartilage. The patient was placed in supine position. Antiseptic painting and draping was done. All cases were operated under local anaesthesia. Post aural approach with post aural Wilde’s incision with 15 number blade, the incision was made 5-10 mm posterior to post aural groove. Temporalis fascia graft was harvested. Tragal cartilage, incision was taken over the under surface of the tragus and tragal cartilage was sliced.  </p><p class="abstract"><strong>Results:</strong> The mean duration of symptoms was 12.72 and 15.84 months in group A and B respectively. Reduced hearing was noted in 21 and 24 patients, ear discharge in 21 each and giddiness in 2 and 4 patients respectively in group A and B. The difference was non-significant when the symptoms were evaluated. Improvement in AB gap was significantly better in group B with a p value of 0.042. The mean improvement was 14.2 dB and 17 dB respectively.</p><p class="abstract"><strong>Conclusions:</strong> Type-1 tympanoplasty using the sliced tragal cartilage may be associated with better improvement in AB gap and can be regularly employed compared to temporalis fascia method.</p>

Myringostapediopexy: surgical expectation

2003 ◽  
Vol 117 (3) ◽  
pp. 182-185
Author(s):  
P. J. D. Dawes
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Chronic Otitis Media ◽  
Hearing Level ◽  
Canal Wall ◽  
Similar Range ◽  
Canal Wall Down ◽  
Canal Wall Up

Myringostapediopexy may occur as a result of incus erosion with medialization of the tympanic membrane and is recognized as often producing serviceable hearing. The technique may be used as part of tympanoplasty following either canal wall up or canal wall down surgery for chronic otitis media. The use of this type of reconstruction is influenced by the anatomy of the ear after disease excision. This review of the hearing levels associated with myringostapediopexy shows that there is a similar range of hearing level both for naturally formed as well as surgically fashioned myringostapediopexy. For both ’naturally formed’ and following canal wall up surgery about 80 per cent of patients will have an air-bone gap of 20 dB or less compared to 60 per cent of those who undergo canal wall down surgery.

scholarly journals Evaluation of Graft Uptake and Hearing Assessment after Palisade Myringoplasty

2018 ◽  
Vol 56 (212) ◽  
pp. 770-773 ◽  
Author(s):  
Poonam KC
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Uptake Rate ◽  
Pure Tone ◽  
Statistical Significance ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Long Term Results ◽  
Hearing Improvement ◽  
Hearing Gain

Introduction: Cartilage as a graft for closure of tympanic membrane has got superior benefits than other usual grafts (temporalis fascia and perichondrium). Cartilage supported myringoplasty with palisade technique has good result of graft uptake rate, even under difficult conditions. This technique brings very good functional and better long-term results. This study is done to assess graft uptake rate and hearing improvement after myringoplasty with cartilage palisade technique. Methods: It is a descriptive, hospital based observational study done at Manipal Teaching Hospital, Pokhara between 2014-2017. A total of 45 patients aged between 13 years and 44 years diagnosed with chronic otitis media-mucosal were taken. Pure tone audiometry was done before and six months after surgery. Graft uptake and Post-operative hearing gain was evaluated after six months. Statistical analysis was done by Statistical Package for Social Sciences version 16.0. Statistical significance was set at P<0.05. Results: Graft uptake rate was 41 (91.1%). The mean pre-and post-operative pure tone average were 26.88dB and 8.44dB respectively. The post-operative hearing gain was 18.36dB. Hearing improvement after surgery was found to be statistically highly significant with P<0.001. Conclusions: Cartilage supported myringoplasty using palisade technique is preferred for chronic otitis media-mucosal with large and sub-total tympanic membrane perforation.

Surgical treatment of labyrinthine fistula in patients with cholesteatoma

2009 ◽  
Vol 123 (S31) ◽  
pp. 64-67 ◽  
Author(s):  
Y Ueda ◽  
T Kurita ◽  
Y Matsuda ◽  
S Ito ◽  
T Nakashima
Keyword(s):  
Surgical Treatment ◽  
Treatment Strategies ◽  
Vestibular Function ◽  
Chronic Otitis Media ◽  
Optimal Management ◽  
Canal Wall ◽  
Temporalis Fascia ◽  
Labyrinthine Fistula ◽  
Hearing Test ◽  
Canal Wall Down

AbstractLabyrinthine fistula is one of the most common complications of chronic otitis media associated with cholesteatoma. The optimal management of labyrinthine fistula, however, remains controversial. Between 1995 and 2005, labyrinthine fistulae were detected in 31 (6 per cent) patients in our institution. The canal wall down technique was used in 27 (87 per cent) patients. The cholesteatoma matrix was completely removed in the first stage in all patients. Bone dust and/or temporalis fascia was inserted to seal the fistula in 29 (94 per cent) patients. A post-operative hearing test was undertaken in 27 patients; seven (26 per cent) patients showed improved hearing, 17 (63 per cent) showed no change and three (11 per cent) showed a deterioration. The study findings indicate that there are various treatment strategies available for cholesteatoma, and that the treatment choice should be based on such criteria as auditory and vestibular function, the surgeon's ability and experience, and the location and size of the fistula.

scholarly journals A comparative study of temporalis fascia grafting techniques in cortical mastoidectomy with type 1 tympanoplasty patients in tertiary care hospital

2020 ◽  
Vol 6 (9) ◽  
pp. 1612
Author(s):  
Gowrishankar M. ◽  
Athiyaman K. ◽  
Suresh V. ◽  
Gayathiri R. ◽  
Natarajan S.
Keyword(s):  
Comparative Study ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Graft Material ◽  
Care Hospital ◽  
Temporalis Fascia ◽  
Surgical Methods

<p class="abstract"><strong>Background: </strong>Chronic otitis media is a highly prevalent middle ear disease in the developing countries which causes various pathological changes in the tympanic membrane and middle ear. Treatment of chronic otitis media involve medical and surgical methods. There are many surgical techniques followed regarding the grafts used, temporalis fascia remains the most commonly used. There are some studies debating the usefulness of dry grafts and wet grafts. Our study is aimed at comparing the both and evaluating the outcome.</p><p class="abstract"><strong>Methods: </strong>A prospective comparative study conducted in the department of Otorhinolaryngology and Head and Neck surgery, Government Stanley Medical College, Chennai, with 64 patients for the period of 1 year from July 2017 to June 2018.</p><p class="abstract"><strong>Results: </strong>Graft uptake of temporalis fascia in dry group is 93.8% and wet group has graft uptake of 87.5%, failure rate is low in dry group when compared with wet group. And also, this study showed higher graft uptake in small and medium sized perforation (95%) than the larger perforation (87.5%) and also there is no relationship between the duration of inactive stage and the graft uptake has been observed in our study.</p><p class="abstract"><strong>Conclusion: </strong>Temporalis fascia is a reliable graft material for reconstruction of tympanic membrane perforations. In our study dry graft has shown more success rate than the wet graft. Hearing improvement was the same in dry and wet group in which the grafts have been up taken well.</p>

scholarly journals Topical Application of bFGF Alone for the Regeneration of Chronic Tympanic Membrane Perforations: A Preliminary Case Series

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zihan Lou ◽  
Zhengcai Lou ◽  
Kangfeng Jin ◽  
Junzhi Sun ◽  
Zhengnong Chen
Keyword(s):  
Tympanic Membrane ◽  
Critical Role ◽  
Case Series ◽  
Chronic Otitis Media ◽  
Closure Rate ◽  
Study Materials ◽  
Tympanic Membrane Perforations ◽  
Complete Closure ◽  
Hearing Outcomes ◽  
Control Study

Background/objective. Most researchers consider that basic fibroblast growth factor (bFGF) facilitates the repair of chronic tympanic membrane (TM) perforations in chronic otitis media (COM). However, the addition of biological materials affects bFGF levels. This study was performed to compare the effects of bFGF alone and myringoplasty for the repair of chronic perforations. Study design. A prospective cohort control study. Materials and methods. Patients with chronic central perforations who met the inclusion criteria were divided into two groups, i.e., bFGF alone group and underlay myringoplasty group. In the bFGF alone group, the epithelium was removed circumferentially around the perforation edge to create fresh edges. Approximately, 0.1–0.15 mL of bFGF solution was applied twice daily for 3 months to the TM, to keep the edges moist without a scaffold. In the myringoplasty group, the perichondrium graft was placed underneath the TM remnant by endoscopy. TM closure and hearing outcomes were evaluated at 12 weeks after surgery or at the end of bFGF treatment. Results. A total of 29 patients consisting 13 in the bFGF alone group and 16 in the myringoplasty group were finally included in the analysis. Of the 13 patients in the bFGF alone group, the perforations were small in 6 and medium in 7; the etiology was secondary to COM in 11 and to trauma in 2. One patient with an unhealed perforation continued bFGF treatment until 6 months, while the others stopped at 3 months. Of the seven medium-sized perforations, none of the five COM perforations closed, while the two traumatic perforations achieved complete closure within 2 and 4 weeks, respectively. The successful closure rate was 28.6% (2/7). Successful closure was achieved in 66.7% (4/6) of the six small perforations with COM, with a mean closure time of 4.75 weeks. Of the 16 patients in the myringoplasty group, all perforations were medium-sized and were secondary to COM in 15 cases and traumatic in 1 case; all achieved complete closure. Conclusions. bFGF alone facilitated the repair of chronic traumatic perforations and small perforations with COM, but not medium-sized perforations with COM. These observations indicated that the regenerative conditions of traumatic perforations are better than those of COM perforations when using bFGF alone, and that graft materials could play a critical role in the regeneration of larger-sized chronic perforations with COM.

Traction Suture Tympanoplasty

1988 ◽  
Vol 98 (4) ◽  
pp. 291-294 ◽  
Author(s):  
George C. Swanson
Keyword(s):  
Success Rate ◽  
Tympanic Membrane ◽  
Great Distance ◽  
Canal Wall ◽  
Temporalis Fascia ◽  
Tympanic Membrane Perforations ◽  
Fascia Graft ◽  
Medical Facilities ◽  
Traction Suture ◽  
Anterior Canal

Subtotal tympanic membrane perforations are very common in Micronesia. The great distance between the islands, primitive conditions, and shortages of medical facilities and supplies must all be considered when a technique is designed for the closure of these perforations. Such a technique, using dissolvable sutures to position and support a medial temporalis fascia graft, is presented. A suture is used to place traction on the graft to assure proper placement under the anterior remnant or anterior canal wall skin. The graft is placed medial to the remnant but lateral to the malleus handle, which has been carefully dissected free of epithelium. Two hundred eighty-one cases were followed for' 6 months or more, with a success rate of slightly more than ninety-five percent. Complications of blunting, lateralization, reperforation of the graft, and cholesteatoma formation are discussed.

Sign in / Sign up

Export Citation Format

Share Document