Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations

2018 ◽  
Vol 132 (06) ◽  
pp. 509-513 ◽  
Author(s):  
D E M El-Hennawi ◽  
M R Ahmed ◽  
A S Abou-Halawa ◽  
M A Al-Hamtary
Keyword(s):  
Tympanic Membrane ◽  
Operative Time ◽  
Group Versus ◽  
Pure Tone Audiometry ◽  
Randomised Clinical Trial ◽  
Endoscopic Examination ◽  
Open Label ◽  
Tympanic Membrane Perforations ◽  
Estimated Blood Loss ◽  
Endoscopic Group

AbstractBackgroundMicroscopic myringoplasty is the most frequently performed procedure for repairing tympanic membrane perforations. The endoscopic transcanal approach bypasses the narrow ear canal segment and provides a wider view.MethodsAn open-label randomised clinical trial was conducted on 56 patients with small anterior tympanic membrane perforations. Perforations were repaired with an endoscopic push-through technique (n= 28) or a microscopic underlay technique (n= 28). Follow up was conducted using endoscopic examination and pure tone audiometry three months’ post-operatively.ResultsGraft success rate was 92.9 per cent in the endoscopic group versus 85.7 per cent in the microscopic group. The corresponding pre-operative mean air–bone gaps were 17.4 dB and 18.5 dB, improving to 6.1 dB and 9.3 dB post-operatively (p> 0.05). Mean air–bone gap closure was 11.4 dB in the endoscopic group and 9.2 dB in the microscopic group (p> 0.05). Mean operative time and estimated blood loss were 37.0 minutes and 29 ml in the endoscopic group, versus 107 minutes and 153 ml in the microscopic group (bothp< 0.05).ConclusionThe endoscopic push-through technique for anterior tympanic membrane perforations is as effective as microscopic underlay myringoplasty; furthermore, it is less invasive and takes less operative time.

scholarly journals Hearing assessment and status of tympanic membrane pre and post-operated tympanoplasty in cases of CSOM.

2020 ◽  
Vol 27 (12) ◽  
pp. 2581-2585
Author(s):  
Tahir Hussain x Tahir Hussain Khan ◽  
Humaira Tahir ◽  
Imran Ali ◽  
Sohail Abdul Malik
Keyword(s):  
Tympanic Membrane ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Medium Size ◽  
P Value ◽  
Safe Procedure ◽  
Hearing Improvement ◽  
Middle Ear Mucosa ◽  
Tympanic Membrane Perforations ◽  
Hearing Assessment

Objectives: To compare assessment of hearing by PTA and status of tympanic membrane by oto-endoscope, pre-operative and post-operative tympanoplasty. Study Design: Retrospective/ Comparative study. Setting: Two different hospitals in Karachi. 1-Social Security Landhi Hospital Karachi. 2- Al-Tibri medical College & Hospital, Old Thana, Malir, Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations. Age ranges between 18 to 40 years. Made two groups A (pre-operative and B (post-operative). In group-A, examined tympanic membrane perforations. 45 patients had small size (25%) perforations, 15 medium size (50%) and 16 subtotal (75%). Hearing assessment done by Pure tone Audiometry (PTA). After 1. 2 and 3 months post-tympanoplasty, examined grafted tympanic membrane and compared pre-operated status of tympanic membrane with post-operated status of tympanic membrane. PTA done after 3 months and compared it with pre-operated PTA. Results: Examination of tympanic membrane before tympanoplasty performed, perforations noted in all patients with different sizes in their tympanic membrane. PTA (pure tone audiometry) advised before tympanoplasty to all patients. Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Post-operated 1, 2 and 3 months examined tympanic membrane with oto-endoscope. Intact grafted tympanic membrane seen in 70 patients after 1 months. After 2 months 72 patients had intact grafted tympanic membrane and after 3 months 73 patients out of 76 patients had intact grafted tympanic membrane. PTA also advised after 3 months of tympanoplasty and compared it with pre-operated pure tone audiometry (PTA). Air conduction (AC) decreased 15.39dB after tympanoplasty. AB-gap reduction 13.95dB seen in 73 patients which showed hearing improvement. P value is < 0.001 significant. Conclusion: Tympanoplasty is a good and safe procedure for hearing improvement by reduction of AB-gap as well as provide protection of middle ear mucosa from infections due to closure of perforations of tympanic membranes.

scholarly journals Traumatic tympanic membrane perforation: an overview in a tertiary care centre-Khammam

2021 ◽  
Author(s):  
Agni Vishnu Sailesh ◽  
Vivek Arumugham ◽  
Siva Subba Rao Pakanati ◽  
Shilpa Potnuru
Keyword(s):  
Tympanic Membrane ◽  
Tertiary Care ◽  
Pure Tone Audiometry ◽  
Good Prognosis ◽  
Endoscopic Examination ◽  
Tympanic Membrane Perforation ◽  
Physical Assault ◽  
Tertiary Care Centre ◽  
Female Ratio ◽  
Membrane Perforation

<p><strong>Background</strong>: Aim of the study was to distinguish traumatic tympanic membrane perforation (TTMP) by distribution, etiology and clinical presentation and to assess the prognosis and outcome of treatment and establish masterly inactivity as main treatment modality.</p><p><strong>Methods</strong>: A prospective observational study was performed on 60 cases of traumatic tympanic membrane perforation in the outpatient department of otorhinolaryngology, Mamatha medical college and general hospital, Khammam from October 2019 to March 2021. All the patients came to ENT OPD with the history of trauma to the ear and hearing loss were examined and after obtaining proper history, all the patients underwent ENT clinical examination, oto-endoscopic and audiological evaluation by pure tone audiometry. All the patients diagnosed with traumatic tympanic membrane perforation after obtaining informed written consent were included in the study. All the patients were followed at regular intervals and observations were recorded.</p><p><strong>Results</strong>: All patients were evaluated based on oto-endoscopic examination. Age ranges from 20-50 years, mean age of 33.6 years and with a male to female ratio of 1:1.4. Commonest etiology was physical assault (61.66%) followed by self-inflicted injury accounting 20%. Tinnitus (90%) was the common presenting complaint and the perforation spontaneously healing is about 90% patients.</p><p><strong>Conclusions</strong>: Traumatic perforation of tympanic membrane is under-reported otologic defect which has a good prognosis if treated at right time with a need to educate people on the consequences and about unskilled removal of wax/foreign body, early identification and apt diagnosis and management.</p>

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

2020 ◽  
Vol 134 (2) ◽  
pp. 128-134 ◽  
Author(s):  
S Gülşen ◽  
B Erden
Keyword(s):  
Tympanic Membrane ◽  
Operative Time ◽  
Operating Time ◽  
Functional Results ◽  
Success Rates ◽  
Open Label ◽  
Hearing Results ◽  
Reasonable Approach ◽  
Average Operative Time ◽  
Graft Success

AbstractObjectiveThe 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.MethodThis 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.ResultsGraft 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).ConclusionWhen 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.

Determinants of hearing loss severity in tympanic membrane perforations in a sub-Saharan African setting

2018 ◽  
Vol 132 (11) ◽  
pp. 1013-1017
Author(s):  
E Choffor-Nchinda ◽  
F Djomou ◽  
R-C Meva'a Biouele ◽  
D Mindja ◽  
A Bola ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Tympanic Membrane ◽  
Pure Tone Audiometry ◽  
Tympanic Membrane Perforation ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Tympanic Membrane Perforations ◽  
Membrane Perforation ◽  
Sub Saharan ◽  
Loss Severity

AbstractBackgroundFactors specific to sub-Saharan Africa could have an impact on tympanic membrane perforation characteristics. Obtaining precise information on these characteristics and determinants of hearing loss severity would enable better management.ObjectiveTo determine the relationship between characteristics of tympanic membrane perforation and subsequent hearing impairment.MethodsA cross-sectional study of consenting patients presenting with tympanic membrane perforation was conducted. They were examined using otoendoscopy with a digital camera to obtain precise measurements, followed by pure tone audiometry.ResultsEighty-six cases of tympanic membrane perforation were included. Mean tympanic membrane perforation proportion was 34.1 ± 18.4 per cent. Medium-sized tympanic membrane perforations were predominant (47.7 per cent). Median tympanic membrane perforation duration was 20 years. Tympanic membrane perforation size was found to be a predictor of hearing loss severity (odds ratio = 2.5, 95 per cent confidence interval = 1.02–6.13,p= 0.04).ConclusionTympanic membrane perforation size was a predictor of hearing loss severity in our setting. Site, duration and aetiology seem to have no impact on hearing loss severity.

scholarly journals Hearing loss in tympanic membrane perforations: an analytic study

2018 ◽  
Vol 4 (5) ◽  
pp. 1233 ◽  
Author(s):  
Kartik Herkal ◽  
Karthikeyan Ramasamy ◽  
Sunil Kumar Saxena ◽  
Sivaraman Ganesan ◽  
Arun Alexander
Keyword(s):  
Hearing Loss ◽  
Tympanic Membrane ◽  
Pure Tone Audiometry ◽  
Cross Sectional Study ◽  
Tympanic Membrane Perforation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tympanic Membrane Perforations ◽  
Membrane Perforation ◽  
R Value

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations are common cause of hearing loss. There are very few systematic studies that have evaluated the size and location of a perforation to the degree of hearing loss, this study correlates the size and location of tympanic membrane perforation to the pattern of hearing loss.</p><p class="abstract"><strong>Methods:</strong> The study design was based on cross sectional study. Ninety-six ears of dry tympanic membrane perforation of CSOM mucosal type were selected. Photographs of the tympanic membrane perforations were taken and size measured using the “Image J” software. The area of perforation was compared to hearing loss measured by pure tone audiometry.  </p><p class="abstract"><strong>Results:</strong> Ninety-six patients, aged 15-60 years with perforated eardrums were studied. Size of tympanic membrane perforation showed moderate level of correlation with hearing loss (Pearson r value=0.463). The various locations of perforations were: posterior (23 ears with Mean hearing loss 28.6±7.7 dB), anterior (31 ears with Mean hearing loss 26.5±7.8dB), subtotal (42 ears with Mean hearing loss 34.2±8.2 dB).</p><p class="abstract"><strong>Conclusions:</strong> The hearing loss is frequency dependent, with maximum hearing loss at lower frequencies. Irrespective of size of perforation the hearing loss was the least for frequency of 2000Hz. Magnitude of hearing loss increases with increase in size of tympanic membrane perforation. Perforation posterior to handle of malleus resulted in more hearing loss than perforations involving anterior to the handle of malleus.</p>

Hyaluronic acid ester in myringoplasty

2007 ◽  
Vol 122 (2) ◽  
Author(s):  
M Prior ◽  
N Gibbins ◽  
G John ◽  
S Rhys-Williams ◽  
P Scott
Keyword(s):  
Hyaluronic Acid ◽  
Tympanic Membrane ◽  
General Anaesthesia ◽  
General Hospital ◽  
Acid Ester ◽  
Pure Tone Audiometry ◽  
District General Hospital ◽  
Tympanic Membrane Perforation ◽  
Hearing Level ◽  
Tympanic Membrane Perforations

AbstractObjectives:To investigate the use of a new technique to close persistent tympanic membrane perforations under general anaesthesia, in patients in whom this has previously been considered impractical.Design:Twenty patients aged 50 years and over were recruited. All had a persistent, symptomatic tympanic membrane perforation in at least one ear. Pre-operatively, an audiogram was performed and the tympanic membrane was assessed in order to establish the site and size of the perforation. Under general anaesthesia, the edges of the perforation were freshened and a sheet of Epifilm, trimmed to a size roughly 2 mm larger in diameter than the perforation, was tucked through the perforation. The ear was dressed appropriately. Patients were seen two weeks post-operatively in the out-patients department and reassessed.Setting:The study was based at Poole General Hospital, a District General Hospital.Participants:Twenty patients were recruited from the out-patients clinics of Poole Hospital ENT department.Main outcome measures:(1) closure of the perforation, as a percentage of the original size; (2) improvement of hearing, as an average across all frequencies, expressed in dB hearing level; and (3) presence or absence of discharge.Results:Five patients were operated upon and assessed six weeks post-operatively. The Epifilm had dissolved but the perforations remained the same size in all five patients. There were no other adverse effects. Pure tone audiometry at this stage was redundant. The study was subsequently aborted.Conclusions:The authors conclude that repair of tympanic membrane perforations with hyaluronic acid ester films is not to be recommended.

scholarly journals Effect of Epidermal Growth Factor with Silastic Scaffold on Tympanic Membrane Perforations of Chronic Otitis Media

2021 ◽  
Author(s):  
Vikram Kemmannu Bhat ◽  
Suhas Suresh Desai ◽  
Darshan Hiremath
Keyword(s):  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Nitrate Solution ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Disease Stage ◽  
Tympanic Membrane Perforations ◽  
Epidermal Growth

Abstract Aims The burden of chronic otitis media continues to be high, especially in developing countries. The demand for corrective procedure of surgical myringoplasty, which is considered the gold standard for tympanic membrane perforations, is also growing. Hence, there is a need to innovate simpler alternative office procedures that could save effort, time, waiting period, and expenditure. Materials and Methods This prospective study of 84 patients with mucosal chronic otitis media was undertaken in a tertiary referral hospital. All patients underwent eustachian tube function test, diagnostic nasal endoscopy, and pure tone audiometry. The size of the perforation was assessed endoscopically. All perforations were freshened first with silver nitrate solution. Silastic pieces were placed medial and lateral to the perforation with epidermal growth factor gel in between. Patients were followed up for 3 months. Results The perforations were classified into three groups (healed, partially healed, and nonhealed) based on the treatment response at the end of the first and third follow-up months. Completely healed and partially healed perforations were considered as “success” and were found to be 79% in this study. Significant association was found between healing status and type of anesthesia. However, the disease stage, size of perforation, and the duration of procedure did not affect the healing status. Conclusion Silastic enhanced myringoplasty with epidermal growth factor is a simple, effective, and economical procedure that can become an alternative to surgical myringoplasty for chronic otitis media.

scholarly journals Study of effect of 1% sodium hyaluronate application on tympanic membrane perforation

2018 ◽  
Vol 4 (5) ◽  
pp. 1246
Author(s):  
Dimple Sahni ◽  
Bikramjit Singh ◽  
K. S. Uppal ◽  
Sanjeev Bhagat ◽  
Dinesh Sharma ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Sodium Hyaluronate ◽  
Pure Tone Audiometry ◽  
Tympanic Membrane Perforation ◽  
Medium Size ◽  
P Value ◽  
Beneficial Effects ◽  
Tympanic Membrane Perforations ◽  
Membrane Perforation ◽  
Traumatic Origin

<p class="abstract"><strong>Background:</strong> Topical applications of hyaluronic acid have been found to have beneficial effects on closure of tympanic membrane perforations.<strong> </strong>The aim of the study was to evaluate the role of 1% sodium hyaluronate in the repair of small or medium sized dry central tympanic membrane perforation and improvement in hearing following closure of tympanic membrane perforation.</p><p class="abstract"><strong>Methods:</strong> 50 patients with dry central perforation of inflammatory or traumatic origin were taken up. Maximum of 4 applications of 1% sodium hyaluronate were given at weekly intervals. Final mapping for closure of tympanic membrane perforation and hearing assessment was done after 3 months.  </p><p class="abstract"><strong>Results:</strong> 26 perforations closed completely while 18 perforations showed significant reduction in size. Thus 44 or 88% perforations showed positive response to 1% sodium hyaluronate application. Hearing Improvement was observed on pure tone audiometry with the average hearing gain in patients after complete closure of tympanic membrane perforation was 12.40 dB with p value of 0.001.</p><p class="abstract"><strong>Conclusions:</strong> Study showed the beneficial effects of 1% sodium hyaluronate application in closure of small and medium size perforations of tympanic membrane perforation and improvement in hearing.</p><p class="abstract"> </p>

scholarly journals Management of Traumatic Perforations of the Tympanic Membrane: A Clinical Study

2015 ◽  
Vol 7 (3) ◽  
pp. 114-116
Author(s):  
S Saimanohar ◽  
Raveendra P Gadag ◽  
Vijayalakshmi Subramaniam
Keyword(s):  
Clinical Study ◽  
Tympanic Membrane ◽  
Surgical Intervention ◽  
Bone Fractures ◽  
Pure Tone Audiometry ◽  
Complete Healing ◽  
Medical Sciences ◽  
Hearing Outcome ◽  
Tympanic Membrane Perforations ◽  
The Difference

ABSTRACT Objective To compare the outcome of conservative management vs surgical intervention (realignment of torn edges) in traumatic perforations of the tympanic membrane (TM). Design Cohort study, Interventional, Observational, Prospective. Setting Karnataka Institute of Medical Sciences, Hubli, Karnataka. Patients All patients attending the Department of Otolaryngology with otological injuries. Interventions Patients with isolated traumatic tympanic membrane perforations without evidence of temporal bone fractures were managed either conservatively or surgically by realigning the torn edges of perforation under local anesthesia and supporting with gelfoam. Main outcome measures Healing of perforation, duration taken for complete healing and hearing outcome by pure tone audiometry. Results Perforations in patients taken up for surgical intervention healed faster. Though the difference in outcome, i.e. healed TM perforation between the 2 groups was not statistically significant, the difference in duration taken for healing was observed to be statistically significant (p < 0.05). Conclusion Minimal surgical intervention involving realignment of torn edges of perforation and supporting with gelfoam enables faster healing. How to cite this article Saimanohar S, Gadag RP, Subramaniam V. Management of Traumatic Perforations of the Tympanic Membrane: A Clinical Study. Int J Otorhinolaryngol Clin 2015;7(3):114-116.

scholarly journals Traumatic perforations of tympanic membrane: a study of sixty patients

2019 ◽  
Vol 5 (6) ◽  
pp. 1684
Author(s):  
Anchal Gupta ◽  
Padam Singh Jamwal
Keyword(s):  
Hearing Loss ◽  
Tympanic Membrane ◽  
Pure Tone Audiometry ◽  
Good Prognosis ◽  
Management Approach ◽  
Physical Assault ◽  
Female Ratio ◽  
Tympanic Membrane Perforations ◽  
Common Etiology ◽  
Systemic Antibiotics

<p class="abstract"><strong>Background:</strong> Traumatic perforation of the tympanic membrane can lead to hearing loss. This study was undertaken to study the etiology of traumatic tympanic membrane perforations.</p><p class="abstract"><strong>Methods:</strong> This hospital based retrospective observational study was conducted in the department of ENT, SMGS Hospital, Jammu from January 2018 to January 2019. A detailed clinical and otoscopic examination was done and symptoms noted. Tuning fork tests and pure tone audiometry was done in all the patients. Tympanic membrane perforations were visualized using otoscope or examination under microscope was done. A conservative management approach was adopted, except for those with bloody or watery discharge who received oral/systemic antibiotics to prevent infections.  </p><p class="abstract"><strong>Results:</strong> 60 patients were included in the study. Maximum patients were in the age group of 21-40 years accounting for 56.7% patients. The male to female ratio was 1.4:1. The most common complaint was tinnitus (90%), followed by pain in ear (81.6%), hearing loss (56.7%), aural fullness (45%), ear bleed (16.7%) and vertigo (5%). The most common etiology was physical assault by slaps and blows to ear (40%), followed by instrumentation (syringing and foreign body removal). In 40 (66.67%), left ear was involved whereas in 20 (33.33%) right ear was involved. 51 (85%) patients showed spontaneous healing within 3 months whereas 9 (15%) showed no healing and these 15% patients underwent tympanoplasty at the end of 3 months.</p><p class="abstract"><strong>Conclusions:</strong> Traumatic tympanic membrane perforations have a very good prognosis if they are treated at a right time.</p>

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