Day-stay myringoplasty

AbstractGrafting of the tympanic membrane (myringoplasty) has traditionally been performed as an in-patient procedure in the UK. We have performed day-stay myringoplasty on 21 consecutive patients (15 adults and six children) under general anaesthesia using an underlay temporalis fascia graft. In 18 cases there was complete healing of the tympanic membrane and in three cases the patients developed perforations at four weeks. This success rate is consistent with previously reported studies. All patients were discharged on the day of admission with no major complications.We have compared the results with a group of patients having the same operation as an in-patient and have concluded that day-stay myringoplasty under general anaestheia is as safe and effective as in-patient surgery for the majority of patients.

Download Full-text

Traction Suture Tympanoplasty

Otolaryngology ◽

10.1177/019459988809800403 ◽

1988 ◽

Vol 98 (4) ◽

pp. 291-294 ◽

Cited By ~ 1

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.

Download Full-text

Comparative study between fascia lata and temporalis fascia in myringoplasty

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00052-y ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Ayman Ali Abdel Fattah ◽

Abdel Hay Rashad Elasy ◽

Ahmed Helmy Hoseini ◽

Tarek Abdel Rahman Abdel Hafez

Keyword(s):

Tympanic Membrane ◽

Good Alternative ◽

Fascia Lata ◽

The Body ◽

Temporalis Fascia ◽

Fascia Graft ◽

Fascia Lata Graft ◽

Group A ◽

The Mean ◽

Group B

Abstract Background Repair of a perforated tympanic membrane (myringoplasty) can facilitate normal middle ear function, resist infection, and help re-establish normal hearing. Autogenous graft materials are the most popular graft materials used in myringoplasty because of their easy acceptability by the body. This study is conducted to compare between temporalis fascia graft and fascia lata graft in myringoplasty for patients with tubo-tympanic dry perforation. Results A total of 60 patients with persistent dry tympanic membrane perforation were included in our study during the period from January 2018 to May 2020. Patients underwent myringoplasty with temporalis fascia (30 patients as group A) or fascia lata (30 patients as group B). Patients were scheduled for follow-up visits concerning graft status, ear discharge, and audiograms. The mean postoperative air-bone gap in group A was 17.5 ± 4 after 1 month and 8.6 ± 6.9 after 3 months, while in group B, the mean postoperative air-bone gap was 17.6 ± 4.9 after 1 month and 9.4 ± 7.5 after 3 months. There was 90% success in graft uptake in group A, while there was 80% success in group B. Conclusion Using temporalis fascia is still the best and most trustworthy technique of myringoplasty compared to fascia lata graft. However, fascia lata can be a good alternative to temporalis fascia especially in cases of revision myringoplasty, ears having large perforation, or near-total perforation where the chances of residual perforation are high because of the limited margin of remnant tympanic membrane overlapping the graft.

Download Full-text

Outcome of Myringoplasty with Temporalis Fascia and Perichondrial-Cartilage Composite Graft in High Risk Perforations

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24855 ◽

2019 ◽

Vol 21 (1) ◽

pp. 60-64

Author(s):

Anup Dhungana ◽

RR Joshi ◽

AS Rijal ◽

KK Shrestha ◽

S Maharjan

Keyword(s):

High Risk ◽

Tympanic Membrane ◽

Uptake Rate ◽

Pure Tone Audiometry ◽

Composite Graft ◽

Temporalis Fascia ◽

Fascia Graft ◽

Significant Difference ◽

The Mean ◽

And Cartilage

The objective of this study was to compare the graft uptake results and postoperative hearing of myringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high risk perforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/ eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement cases were included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80 cases were included for myringoplasty which were randomly allocated by lottery method with 40 cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptake results were assessed after 6 weeks and postoperative hearing was evaluated and compared within and between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrial composite graft group was 90% and 92.5%, respectively with no significance difference in the graft uptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalis fascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and 33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001) showing improvement in the hearing after surgery in both groups. The mean air bone gain were 14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectively with no significant difference between the groups (p=0.469). The graft uptake rate and hearing results after cartilage perichondrial composite graft are comparable to those of temporalis fascia graft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it is more resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend the use of cartilage perichondrial composite graft for tympanic membrane reconstruction in high risk perforation without concern about affecting audiometric results.

Download Full-text

Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i2.56355 ◽

2021 ◽

Vol 27 (2) ◽

pp. 104-110

Author(s):

Md Mainul Islam ◽

Kanu Lal Saha ◽

Harun Ar Rashid Talukder ◽

Md Khalid Mahmud ◽

Riashat Azim Majumder ◽

...

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Uptake Rate ◽

Cartilage Graft ◽

Temporalis Fascia ◽

Hearing Gain ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Cartilage Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge and perforation. It is the commonest ear problem in adult and children. Most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. Inactive mucosal variety of COM presents with the perforation in tympanic membrane with non-inflamed middle ear mucosa. The treatment of inactive mucosal variety of COM is Type 1tympanoplasty. It can be done by conventional temporalis fascia or cartilage graft. Both have some merits and demerits. Objective: To compare the the outcomes between reinforcement cartilage graft and temporalis fascia graft in type -1 tympanoplasty. Methods: 86 (43 patients in each group) patients with COM (inactive mucosal) who were admitted in the department of Otolaryngology – Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2018 to June 2019, and had fulfilled the inclusion and exclusion criteria were selected for the study. History, examinations, investigations were done. All patients underwent type 1 tympanoplasty. Prior to surgery relevant investigations were done and informed written consent was taken from all patients. In Group-A reinforcement cartilage tympanoplasty cases and in Group-B temporalis fascia tympanoplasty cases were placed. Post-operative graft uptake rate and hearing gain were compared in two groups Results: The surgical outcomes between reinforcement cartilage tympanoplasty in comparison with temporalis fascia tympanoplasty showed no significant difference of graft uptake rate and hearing gain. Conclusion: Cartilage tympanoplasty has been practised for reconstruction of perforated tympanic membrane in COM since long with variable results. Graft uptake rate in cartilage reinforcement is comparatively better than temporalis fascia graft. So, reinforcement cartilage graft can be adopted as an alternative to temporalis fascia graft in type- I tympanoplasty. Bangladesh J Otorhinolaryngol 2021; 27(2): 104-110

Download Full-text

Composite chondro-perichondrial clip myringoplasty: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20163475 ◽

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

Background: 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. Methods: 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. Results: 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. Conclusions: Composite chondro-perichondrial clip myringoplasty is an effective method of closing non-marginal perforations of the tympanic membrane.

Download Full-text

Ten-year myringoplasty series: does the cause of perforation affect the success rate?

The Journal of Laryngology & Otology ◽

10.1017/s0022215110002069 ◽

2010 ◽

Vol 125 (2) ◽

pp. 126-132 ◽

Cited By ~ 20

Author(s):

J Westerberg ◽

H Harder ◽

B Magnuson ◽

L Westerberg ◽

D Hydén

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Study Design ◽

Chart Review ◽

Retrospective Chart Review ◽

Temporalis Fascia ◽

Surgical Method ◽

Surgical Access ◽

Graft Take ◽

Retroauricular Approach

AbstractObjective:To present the results of primary myringoplasty procedures together with the perforation cause, perforation size and site, surgeon's experience, and surgical method, and to investigate how these factors relate to graft ‘take’ rates.Study design:Retrospective chart review of 243 consecutive patients undergoing primary myringoplasty with temporalis fascia underlay over a 10-year period from 1994 to 2004.Results:The overall graft take rate was 95 per cent. The retroauricular approach resulted in a 97 per cent graft take rate, whereas a significantly lower rate (77 per cent) was seen for surgery conducted via the endaural approach, or via an ear speculum. There was no relationship between other factors and tympanic membrane healing.Conclusion:No association was found between perforation cause and graft take rate. The underlay technique is safe and reliable, and the retroauricular approach is preferable as it enables good surgical access and has better results.

Download Full-text

Xenograft versus autograft in tympanoplasty

The Journal of Laryngology & Otology ◽

10.1017/s0022215100124715 ◽

1993 ◽

Vol 107 (10) ◽

pp. 892-894 ◽

Cited By ~ 5

Author(s):

Vincent P. Callanan ◽

Aongus J. Curran ◽

Peter K. Gormley

Keyword(s):

Retrospective Study ◽

Success Rate ◽

Tympanic Membrane ◽

Salvage Surgery ◽

Tympanic Membrane Perforation ◽

Graft Material ◽

Temporalis Fascia ◽

Membrane Perforation ◽

Contralateral Ear ◽

Autograft Group

AbstractThis retrospective study compares the tympanoplasty success rate when using a xenograft (Zenoderm) or an autograft (temporalis fascia).Fifty-three ears were operated on over a three-year period. All the tympanoplasty operations were performed by the same surgeon. There were 43 ears in the temporalis fascia autograft group and 10 ears in the Zenoderm xenograft group. Both groups were similar with respect to patient age, type of tympanoplasty, area of tympanic membrane perforation and condition of the contralateral ear.The tympanoplasty success rate in the temporalis fascia autograft group was 95 per cent. The tympanoplasty success rate in the Zenoderm xenograft group was only 40 per cent. All Zenoderm tympanoplasty failures were regrafted with temporalis fascia autograft. There was a 100 per cent success rate with this salvage surgery.In conclusion, we suggest that Zenoderm is not a suitable graft material for tympanoplasty.

Download Full-text

Prevalence of Perforated Graft in Underlay and Pop-in Technique Myringoplasty

Journal of Nepal Medical Association ◽

10.31729/jnma.4709 ◽

2019 ◽

Vol 57 (220) ◽

Author(s):

Bhuwan Raj Pandey ◽

Poonam KC

Keyword(s):

Tympanic Membrane ◽

Binary Data ◽

Sample Size Calculation ◽

Cross Sectional Study ◽

Tympanic Membrane Perforation ◽

Point Estimate ◽

Temporalis Fascia ◽

Cross Sectional ◽

Fascia Graft ◽

Flap Elevation

Introduction: Underlay technique myringoplasty is most commonly used technique to repair tympanic membrane perforation by temporalis fascia graft and Trans-tympanic pop-in technique is an another technique that allows temporalis fascia graft placement medial to tympanic membrane remnant through the perforation without the need for tympano-meatal flap elevation. This study was undertaken to find the prevalence of perforated graft in underlay and Pop-in Technique Myringoplasty. Methods: This descriptive cross-sectional study was done at Manipal teaching hospital, Pokhara, Nepal and comprises of 86 patients between January 2014 and June 2015. Patients undergoing Underlay Trans-canal approach by tympano-meatal flap elevation and Trans-canal, Trans-tympanic pop-in technique were included. Sample size calculation was done and convenient sampling method was applied. Point estimate at 95% CI was done for binary data along with frequency and proportion. The descriptive statistical analysis was done. Results: The prevalence of perforated graft was 15 (17.4%) at 95% Confidence Interval (39.75-60.25%).In underlay technique there were 8 (18.60 %) perforation and 35 (81.39%) were intact while in pop-intechnique there were 7 (16.27%) perforation and 36 (83.72%) were intact. The postoperative meanPure Tone Average (PTA) of underlay was 9.53 and pop-in was 8.31. The mean Pure Tone Average(PTA) gain after underlay technique was 16.095 and pop in technique was 16.87. Conclusions: Trans-tympanic pop-in myringoplasty gives similar hearing & graft uptake results when compared with tympano-meatal flap method of underlay myringoplasty done by trans-canal.

Download Full-text

Impact of the nature of the temporalis fascia graft on the outcome of type I underlay tympanoplasty

The Journal of Laryngology & Otology ◽

10.1017/s0022215117000615 ◽

2017 ◽

Vol 131 (6) ◽

pp. 472-475 ◽

Cited By ~ 4

Author(s):

Z Jiang ◽

Z Lou ◽

Z Lou

Keyword(s):

Success Rate ◽

Key Words ◽

Literature Search ◽

Present Review ◽

Type I ◽

Success Rates ◽

Temporalis Fascia ◽

Exclusion Criteria ◽

Fascia Graft ◽

Duration Of Surgery

AbstractObjectives:Temporalis fascia has become the most widely used graft for tympanoplasty, as it is strong, durable, and easy to procure and handle. However, the type of temporalis fascia graft to use (i.e. dry or wet) remains controversial. The present review aimed to evaluate the success rates of dry and wet temporalis fascia grafts in type I underlay tympanoplasty.Methods:A literature search was performed, using PubMed up to August 2016, to identify all studies of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. The initial search using the key words ‘temporalis fascia’ and ‘tympanoplasty’ identified 130 articles; these were screened by reviewing the titles or abstracts based on the inclusion and exclusion criteria. Ultimately, this review included seven articles.Results and conclusion:A dry or wet temporalis fascia graft did not affect the outcome of type I underlay tympanoplasty. However, using wet temporalis fascia could shorten the duration of surgery in type I underlay tympanoplasty. Concerns that the fibroblast count of temporalis fascia may beneficially affect success rate have not been substantiated in clinical reports thus far.

Download Full-text

A comparative study of temporalis fascia versus tragal perichondrium graft in myringoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212452 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1154

Author(s):

Arun A. Jose ◽

Nirmal C. Venkataramanujam ◽

Padmanabhan Karthikeyan ◽

Ramiya R. Kaipuzha ◽

Davis Thomas Pulimoottil

Keyword(s):

Success Rate ◽

Success Rates ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Female Ratio ◽

Fascia Graft ◽

Group I ◽

Group Ii ◽

Male To Female ◽

Better Than

Background: This study aimed to compare the efficacy of temporalis fascia and tragal perichondrium grafts in myringoplasty and to assess the hearing improvement following surgery.Methods: This was a clinical prospective study involving 50 patients of chronic suppurative otitis media inactive mucosal disease who were assigned to two groups. Group I was temporalis fascia group and group II was tragal perichondrium group and subsequently underwent myringoplasty. Patients were followed up at 3 and 6 months.Results: There was a preponderance of ear disease among children, with a male to female ratio of 1:1.63. Preoperative dry ear for 1-6 months was associated with 82.9% success rate (group I 76.5%, group II 87.5%). Patients with cellular mastoids were associated with 100% success rate.Conclusions: In this study we found that patients with cellular mastoids and dry ear for 1-6 months were associated with higher success rates. The study also revealed that in terms of hearing gain postoperatively, the temporalis fascia graft fared slightly better than the tragal perichondrium graft. Tragal perichondrium and temporalis fascia grafts appear to have almost similar graft take rates.

Download Full-text