Effectiveness of transperforation myringoplasty in bilateral chronic otitis media patients undergoing contralateral tympanoplasty

AbstractObjectives:Bilateral tympanic membrane perforation closure is usually performed by otosurgeons in two sittings. However, in this study, transperforation myringoplasty was performed alongside contralateral tympanoplasty in a single sitting. The effectiveness of transperforation myringoplasty procedure and the benefits of single sitting bilateral surgery were evaluated.Methods:A prospective study of 50 selected patients with mucosal-type bilateral chronic otitis media was conducted. All patients underwent transperforation myringoplasty on the side that met the inclusion criteria and tympanoplasty on the contralateral side. Graft uptake and hearing improvement were evaluated after 6 months.Results:At the 6-month follow up, the graft uptake rate was 82 per cent, the hearing gain was 11.5 dB and the air–bone gap gain was 11.6 dB.Conclusion:This procedure offers perforation closure in a single sitting to patients with bilateral chronic otitis media who meet the inclusion criteria.

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Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201277 ◽

2020 ◽

Vol 6 (4) ◽

pp. 657

Author(s):

Kiran Gangadar S. ◽

G. Priyadarshini

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Type 1 Tympanoplasty ◽

Membrane Perforation ◽

Group 2

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

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Tympanoplasty for Wet and Dry Perforation: A Prospective Comparative Study

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2020.v28i3.290 ◽

2021 ◽

Vol 28 (3) ◽

pp. 260-265

Author(s):

Amit Bikram Maiti ◽

Rupam Sinha

Keyword(s):

Prospective Study ◽

Comparative Evaluation ◽

Statistical Significance ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Mucosal Disease ◽

Membrane Perforation ◽

Prospective Comparative Study ◽

A Prospective Study

Introduction Two types of surgical procedures are performed for the treatment of Chronic otitis media (COM) mucosal disease, namely myringoplasty and tympanoplasty. In the present study, an objective, comparative evaluation between the outcomes of tympanoplasty, performed in the ‘wet ear’ and the ‘dry (non- discharging) ear’ has been undertaken. Materials and Methods A prospective study was conducted in a peripheral referral institute over a period of 37 months wherein a total of 105 patients with tympanic membrane perforation were selected, amongst which 56 patients had moist ear and 49 patients had dry ear. All of the patients underwent tympanoplasty by underlay technique. Final results were analyzed 12 months post operatively. Results In the wet ear group amongst 56 patients, 51 patients had successful graft uptake (91.07%). In dry ear group, among 49 patients, successful graft uptake was seen in 44 cases (89.79%). In the wet ear group 50 out of 56 patients had hearing improvement (89.28%). In dry ear group 44 out of 49 patients had hearing improvement (89.79%). Statistically significant results were obtained postoperatively in each group; however, inter group analyses showed no statistical significance. Conclusion Success rate of tympanoplasty does not depend upon the wet or dry state of middle ear at the time of surgery.

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Endoscopic myringoplasty: outcome and hearing gain in inactive mucosal chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185511 ◽

2019 ◽

Vol 5 (2) ◽

pp. 330

Author(s):

B. T. Subramanya ◽

S. Lohith ◽

B. Sphoorthi

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Hearing Gain ◽

Endoscopic Myringoplasty ◽

A Prospective Study ◽

Postoperative Scar ◽

Middle Ear Cleft

Background: Chronic otitis media is an inflammatory process in the middle ear cleft that poses serious health problem in developing countries. Myringoplasty is a common otological procedure to reconstruct the tympanic membrane to prevent recurrent otorrhea, and restore sound-conducting mechanism. The use of rigid endoscope in transcanal myringoplasty has significant advantage as it provides magnified, close up as well as wide angle view, less morbidity and early postoperative wound healing with better cosmetic results without compromising success rate and postoperative hearing gain. The aims and objectives of the study were to analyze the results of endoscopic transcanal interlay myringoplasty, in terms of graft uptake and hearing improvement in cases of chronic suppurative otitis media with inactive mucosal disease with central perforation.Methods: This is a prospective study conducted from January 2016 to August 2018 in 30 patients of inactive mucosal chronic otitis media (COM). All patients underwent transcanal endoscopic interlay myringoplasty and patients were called for regular follow up for 12 weeks and results were statistically analysed. Results: The graft uptake rate in the present study was found to be 93.33%. Pre operatively mean air bone gap (ABG) was 27.33 dB and post operatively after 12 weeks mean air bone gap improved to 10.5 dB. Mean ABG gain was 16.33%.Conclusions: Endoscopic transcanal interlay myringoplasty with superiorly based TM flap is an effective technique over conventional microscopic technique in terms of graft uptake, hearing improvement, better postoperative scar and less morbidity in cases of inactive mucosal COM.

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Endoscopic Type 1 Tympanoplasty in Chronic Otitis Media: Comparative Study with a Postauricular Microscopic Approach

Otolaryngology ◽

10.1177/0194599819838778 ◽

2019 ◽

Vol 161 (2) ◽

pp. 315-323 ◽

Cited By ~ 6

Author(s):

Masafumi Ohki ◽

Shigeru Kikuchi ◽

Sunao Tanaka

Keyword(s):

Success Rate ◽

Otitis Media ◽

Middle Ear ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Surgical Time ◽

Ear Surgery ◽

Surgical Success ◽

Membrane Perforation

ObjectiveTo compare surgical outcomes after tympanoplasty without ossiculoplasty for chronic otitis media between transcanal endoscopic ear surgery (TEES) and postauricular microscopic ear surgery (PAMES).Study DesignCase-control study.SettingTertiary care university hospital.Subjects and MethodsConsecutive patients ( N = 122) who had undergone tympanoplasty without ossiculoplasty for chronic otitis media were enrolled in this retrospective study and divided into 2 groups: TEES (n = 47) and PAMES (n = 75). Middle ear condition was graded with the middle ear risk index. Hearing, repair of tympanic membrane perforation, and surgical time were assessed.ResultsThe surgical success rate for hearing (air-bone gap ≤20 dB) was 95.7% in the TEES group and 84.0% in the PAMES group. Lower middle ear risk resulted in similar mean (95% CI) closure of air-bone gaps (TEES: 9.6, 6.5-12.6; PAMES: 8.0, 6.4-9.7; P = .333), whereas higher middle ear risk demonstrated significantly larger closure of air-bone gaps for the TEES group (10.1, 3.3-16.9) than the PAMES group (–0.2, –4.5 to 4.2; P = .009). The surgical success rate for repair of tympanic membrane perforation and surgical time were equivalent between TEES and PAMES.ConclusionUnder favorable conditions of the middle ear, TEES and PAMES resulted in similar hearing improvement by tympanoplasty without ossiculoplasty. However, under adverse conditions of the middle ear, TEES was a more beneficial approach for hearing improvement than PAMES.

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A multivariate analysis of chronic otitis related prognostic factors in determining hearing improvement in tympanoplasty

Acta chirurgica iugoslavica ◽

10.2298/aci1304047s ◽

2013 ◽

Vol 60 (4) ◽

pp. 47-52

Author(s):

Slobodan Spremo ◽

Sanja Spiric ◽

Dmitar Travar ◽

Predrag Spiric ◽

Mira Spremo

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Bone Erosion ◽

Chronic Otitis Media ◽

Ossicular Chain ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Membrane Perforation ◽

Tube Function ◽

Type Of Surgery

OBJECTIVE: The aim of this study was to evaluate which factors are best predictors of hearing improvement after tympanoplasty and to evaluate best functional outcome in different forms of pathology in the tympanic cavity and mastoid in chronic otitis media. METHODS: Prospective study included 120 patients who were operated for chronic suppurative otitis media and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Multiple linear regression analysis was used to measure which factors predict better hearing improvement. MAIN OUTCOME MEASURES: A model that evaluates factors related to chronic otitis media: ossicular chain integrity, tympanic tube function, tympanic membrane perforation, type of surgery and condition of tympanic and mastoid walls was used to predict postoperative hearing improvement. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Out of 120 operated patients, we performed primary surgery in 106 and revision surgery in 9 cases due to recurrent cholesteatoma. We observed high correlation and statistically significant contribution of ossicular chain pathology (b=-0.310, t=-3.01, p<0.05), and mastoid bone erosion or defects (b=2.05, t=2.05 , p<0.05), on the variance of PTA. The same variables were highly correlated with ABG closure: ossicular chain pathology (b=-0.230, t=-2.14, p<0.05), and mastoid bone erosion or defects (b= 2.05, t=2.08 , P<0.05). Variance of preoperative to postoperative PTA difference explained by the model as a whole was 24,7%, F(8,119)=4.54 , p<0.01. Variance of preoperative to postoperative ABG difference explained by the model as a whole was 18,3% F(8,119)=3.1, p<0.01. The predictive model in this study included 8 variables related to middle ear pathology proved to be superior to analyzing each variable separately. CONCLUSION: A model that evaluates factors related to chronic otitis media: ossicular chain integrity, tympanic tube function, tympanic membrane perforation, type of surgery and condition of tympanic and mastoid walls has significant predictive value for hearing assessment in tympanoplasty.

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Assessment of short term hearing improvement in patients of cartilage interposition ossiculoplasty for lenticular process of incus necrosis in cases of chronic suppurative otitis media: mucosal disease

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173202 ◽

2017 ◽

Vol 3 (4) ◽

pp. 821

Author(s):

Shashikant K. Mhashal ◽

Neeraj R. Shetty ◽

Amit S. Rathi ◽

Vinod A. Gite

Keyword(s):

Otitis Media ◽

Tympanic Membrane Perforation ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Short Term ◽

Suppurative Otitis Media ◽

Mucosal Disease ◽

Membrane Perforation ◽

Prevalent Disease

Background: Chronic suppurative otitis media is a highly prevalent disease in developing countries. Hearing loss associated with this disease is significantly more in cases associated with ossicular necrosis along with tympanic membrane perforation. Methods: We would like to present a study of such cases of mucosal chronic suppurative otitis media associated with lenticular process necrosis treated by cartilage interposition ossiculoplasty. The patients were followed up for a minimum period of 6 months and their pre op and post op hearing was documented and analyzed. Results: An average air bone gap of 39.07 decibels in pre op was reduced to 18.13 decibels in post-operative period and these improvements persisted over 6 months of follow-up. Conclusions: We have hereby concluded that the hearing improvement is comparable to other methods of ossiculoplasty with minimum disruption of natural hearing assembly in lenticular process of incus necrosis.

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Status of contralateral ear in unilateral chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20164817 ◽

2016 ◽

Vol 3 (1) ◽

pp. 135

Author(s):

Shireen Azizkutty ◽

Mubeena . ◽

Mohammed N. A.

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Contralateral Ear ◽

Spss Software ◽

Hrct Temporal Bone ◽

A Prospective Study ◽

Mastoid Antrum

<ul><li>Background: The aim of this study was to clinically, audiologically and radiologically examine the contralateral ear, and compare the findings with squamous and mucosal type of chronic otitis media. Methods: A prospective study of 15 months between April 2015 to July 2016 was conducted in the Otorhinolaryngology department, enrolling 80 patients with unilateral chronic otitis media. The contralateral ear was defined as the ear with no tympanic membrane perforation. Otoscopy, pure tone audiometry and X-ray mastoid or HRCT temporal bone were done on the patients. The results were recorded and analysed. Results: Descriptive statistical analysis was done using SPSS software version 22 in Windows 7. It was seen that most of the Tympanic membranes were abnormal, with contralateral ear of squamous disease showing more abnormality. Retraction and thinning were the most common abnormalities. And 14.3% cases of pars tensa retractions in squamous cases were grade 4 retractions. Mastoids were mostly sclerosed or diploeic, and soft tissue was present in the mastoid antrum in a few cases. Hearing loss was seen in contralateral ear of 47% of squamosal disease and in 30.5 % of mucosal disease. Conclusions: The contralateral ear is now, what the diseased ear was yesterday. The contralateral ear shows unmistakable predilection towards developing chronic otitis media in the future.</li></ul>

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A study on correlation of size and site of tympanic membrane perforation with degree of conductive hearing loss in chronic otitis media

MedPulse International Journal of ENT ◽

10.26611/10161632 ◽

2020 ◽

Vol 16 (3) ◽

pp. 29-32

Author(s):

Lavanya M ◽

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Conductive Hearing Loss ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Conductive Hearing

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Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173051 ◽

2017 ◽

Vol 3 (3) ◽

pp. 705 ◽

Cited By ~ 1

Author(s):

Yogeshwar Chandrashekar ◽

Ravishankar Chandrashekar

Keyword(s):

Otitis Media ◽

Statistical Significance ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Inflammatory Cells ◽

P Value ◽

Hearing Improvement ◽

Female Ratio ◽

Fascia Graft ◽

A Prospective Study

Background: The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.Methods: This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively. Results: Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688>0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582>0.05).Conclusions: The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement.

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