The effects of everted or inverted edges on healing of traumatic-induced tympanic membrane perforations

2019 ◽  
Vol 133 (12) ◽  
pp. 1092-1096
Author(s):  
Z-C Lou
Keyword(s):  
Tympanic Membrane ◽  
Spontaneous Healing ◽  
Closure Rate ◽  
Tympanic Membrane Perforations ◽  
The Difference ◽  
Hearing Outcomes ◽  
Healing Group

AbstractObjectivesTo evaluate the healing and hearing outcomes related to the everted or inverted edge area on slap- and fist-induced large tympanic membrane perforations.MethodsA total of 120 patients with slap- or fist-induced tympanic membrane perforations, with inverted or everted edges, affecting 50–75 per cent of the entire tympanic membrane, were randomly divided into 2 groups: an edge approximation group and a spontaneous healing group. The edge approximation group was divided into subgroups A and B based on the reversed edge area (reversed edge was more or less than 50 per cent of the total perforation, respectively). Healing outcomes and hearing improvements at six months were compared.ResultsThe data of 118 patients were analysed. The closure rate of perforations in subgroup A, subgroup B, and the spontaneous healing group was 90.9 per cent, 92.1 per cent and 84.5 per cent, respectively; the difference between the three groups was not significant (p = 0.393).ConclusionThe area of reversed edges for slap- or fist-induced tympanic membrane perforations did not seem to affect healing and hearing outcomes, regardless of edge approximation and everted or inverted edges.

Efficacy of EGF and Gelatin Sponge for Traumatic Tympanic Membrane Perforations: A Randomized Controlled Study

2018 ◽  
Vol 159 (6) ◽  
pp. 1028-1036 ◽  
Author(s):  
Zheng Cai Lou ◽  
Zihan Lou
Keyword(s):  
Tympanic Membrane ◽  
Gelatin Sponge ◽  
Controlled Study ◽  
Spontaneous Healing ◽  
Related Factors ◽  
Closure Rate ◽  
Randomized Controlled ◽  
Tympanic Membrane Perforations ◽  
Closure Time ◽  
Patch Removal

Objective To compare the outcomes of epidermal growth factor (EGF) and gelatin sponge patch treatments for traumatic tympanic membrane perforations. Study Design Prospective, randomized, controlled. Setting University-affiliated teaching hospital. Subjects and Methods In total, 141 perforations encompassing >50% of the eardrum were randomly divided into 3 groups: EGF (n = 47), gelatin sponge patch (n = 47), and observation (n = 47). The edges of the perforations were not approximated. The closure rate, mean closure time, and infection rate were evaluated at 6 months and the related factors analyzed. Results A total of 135 perforations were analyzed. At 6 months, the closure rates were 97.8%, 86.7%, and 82.2% in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively ( P = .054). The mean ± SD closure time was 11.12 ± 4.60, 13.67 ± 5.37, and 25.65 ± 13.32 days in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively ( P < .001). In addition, the presence of infection was not significantly associated with rate of closure in any group. Conclusions As compared with spontaneous healing, daily application of EGF and gelatin sponge patching reduced the closure time of traumatic tympanic membrane perforations. EGF treatment had a higher closure rate and shorter closure time but resulted in otorrhea. By contrast, gelatin sponge patches did not improve the closure rate or cause otorrhea but required repeated patch removal and reapplication. Thus, the appropriate treatment should be selected according to patient need.

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.

scholarly journals Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Gamal Khafagy ◽  
Mohamed El-Begermy ◽  
Marwa Mohamed El-Begermy ◽  
Pretty O. Afifi
Keyword(s):  
Tympanic Membrane ◽  
Chronic Otitis Media ◽  
Fat Graft ◽  
Cartilage Graft ◽  
Tympanic Membrane Perforations ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hearing Outcomes ◽  
Age Range

Abstract Background This study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults. In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes. Results The success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing. Conclusions Inlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

scholarly journals Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

2021 ◽  
Vol 64 (10) ◽  
pp. 711-719
Author(s):  
Min Kyu Lee ◽  
Tae Min Kim ◽  
Sung Jin Lim ◽  
Dong Heun Park ◽  
Yoon Chan Rah ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Surgical Outcomes ◽  
Pure Tone ◽  
Current Knowledge ◽  
Tympanic Membrane Perforations ◽  
The Mean ◽  
Hearing Outcomes ◽  
Paired T Test

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, p=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

Spontaneous healing of traumatic tympanic membrane perforations in man: A century of experience

1992 ◽  
Vol 106 (12) ◽  
pp. 1037-1050 ◽  
Author(s):  
Søren Kristensen
Keyword(s):  
Tympanic Membrane ◽  
Healing Rate ◽  
Reference Value ◽  
Spontaneous Healing ◽  
Clinical Value ◽  
Post Injury ◽  
Tympanic Membrane Perforations ◽  
Pressure Changes ◽  
Perforated Tympanic Membrane

AbstractWidespread controversy exists concerning the treatment of traumatic tympanic membrane perforations. To elucidate the issue, a reference value for the rate of spontaneous tympanic membrane closure in man, to which the healing rates following different techniques of early surgical repair should be compared, was established on the basis of a review of more than 500 texts covering a century's literature on the traumatically perforated tympanic membrane. The spontaneous healing rate appeared to be close to 80 (78.7 per cent) in 760 evaluable cases of traumatic tympanic membrane perforations of all sorts diagnosed within 14 days post injury. A relative, causal-related variation of spontaneous healing could be demonstrated, and a pathogenetic classification of direct traumatic tympanic membrane perforations into ruptures induced by air-pressure changes, heat or corrosives, solids, and water pressures, is of proved clinical value and may have medico-legal validity. There is an obvious need for clinically controlled studies on the spontaneous healing of all kinds of traumatic perforations of the tympanic membrane in humans, and important elements in the design of future studies are advocated.

Spontaneous healing of various tympanic membrane perforations in the rat

2004 ◽  
Vol 124 (10) ◽  
pp. 1141-1144 ◽  
Author(s):  
Wu-qing Wang ◽  
Zheng-min Wang ◽  
Fang-lu Chi
Keyword(s):  
Tympanic Membrane ◽  
Spontaneous Healing ◽  
Tympanic Membrane Perforations

Results of inlay cartilage myringoplasty in terms of closure of central tympanic membrane perforations

2005 ◽  
Vol 119 (8) ◽  
pp. 611-613 ◽  
Author(s):  
Kamal G Effat
Keyword(s):  
Retrospective Study ◽  
Tympanic Membrane ◽  
Control Group ◽  
Temporalis Fascia ◽  
Current Effort ◽  
Hospital Records ◽  
Tympanic Membrane Perforations ◽  
The Difference ◽  
A Current

There is a current effort to perform myringoplasty for tympanic membrane perforations as a day-stay procedure. In 1998, an inlay myringoplasty using tragal cartilage/perichondrium was described. A retrospective study was performed by the author to analyse the results of inlay carilage myringoplasty, in terms of closure of simple perforations of the tympanic membrane. The results of a control group of previous cases of underlay temporalis fascia myringoplasty were retrieved from the hospital records. All the operations in both groups were performed by the same author at the same institution. The operation of inlay cartilage butterfly myringoplasty has been performed in 28 ears with simple central tympanic membrane perforations. Inconsistent results have been obtained, in that only 43 per cent showed closure of the perforation at the most recent follow-up. A control group of standard underlay temporalis fascia myringoplasty has been performed by the same author in 23 ears. Eighty-three per cent of the perforations were closed at the last follow-up. The difference is statistically highly significant (p < 0.01).

Endoscopic Lateral Cartilage Graft Tympanoplasty

2017 ◽  
Vol 157 (4) ◽  
pp. 683-689 ◽  
Author(s):  
Cameron C. Wick ◽  
Demetri Arnaoutakis ◽  
Vivian F. Kaul ◽  
Brandon Isaacson
Keyword(s):  
Tympanic Membrane ◽  
Tertiary Care ◽  
Case Series ◽  
University Hospital ◽  
Long Term Results ◽  
Lateral Cartilage ◽  
Cartilage Graft ◽  
Closure Rate ◽  
Tympanic Membrane Perforations ◽  
The Mean

Objective To describe a novel technique for lateral graft tympanoplasty. Study Design Case series with chart review. Setting Tertiary care university hospital. Subjects and Methods Pediatric and adult patients with tympanic membrane perforations deemed unfavorable for a medial graft technique due to the perforation characteristics or myringitis. Results Between 2014 and 2016, 34 ears from 31 patients underwent a transcanal endoscopic lateral cartilage graft tympanoplasty. The mean age was 24.4 years (range, 6-71 years), and 22 patients (65%) were younger than 18 years. All patients had tympanic membrane perforations. Eighteen patients (53%) had total or near-total perforations, leaving a minimal anterior remnant, and 16 patients (47%) had extensive myringitis. A bisected tragal cartilage-perichondrium shield graft was used in 33 patients (97%). The mean (SD) follow-up length was 9.8 (5.7) months. Initial perforation closure rate was 88.2% (30/34). Three of the persistent perforations underwent a revision endoscopic medial graft tympanoplasty with successful closure, leaving a final closure rate of 97.1% (33/34). Five patients (15%) required topical therapy for postoperative myringitis. Mean (SD) pure-tone average and air-bone gap significantly improved by 11.5 (10.7) dB ( P < .001) and 11.4 (10.6) dB ( P < .001), respectively. Twenty-seven patients (79%) closed their air-bone gap within 20 dB. Conclusion Transcanal endoscopic lateral cartilage graft tympanoplasty is feasible, and initial data support favorable outcomes. Further data are necessary for evaluation of long-term results and efficacy comparisons.

scholarly journals Clinical study of transcanal closure of tympanic membrane perforations using a collagen sponge

2015 ◽  
Vol 129 (S2) ◽  
pp. S21-S26 ◽  
Author(s):  
A Tamae ◽  
S Komune
Keyword(s):  
Minimally Invasive Surgery ◽  
Clinical Study ◽  
Minimally Invasive ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Low Cost ◽  
Collagen Sponge ◽  
Closure Rate ◽  
Tympanic Membrane Perforations ◽  
Initial Surgery

AbstractMaterials and methods:We used an artificial dermis (Terdermis®), which is an atero-collagen sponge covered with a sheet of silicon.Patients:Nineteen ears of 17 patients with perforation of the tympanic membrane under various conditions, including large and wet perforations, underwent operation using this collagen sponge.Results:The success rate of closure after the initial surgery was 8/19. The overall success rate of closure after initial and re-operation was 14/19. The success rate of closure was 12/14 for small-sized perforations, 1/4 for middle-sized perforations and 1/1 for a large-sized perforation. Middle- and large-sized perforations required multiple surgeries. The success rate of closure was 11/11 for dry perforations, 3/4 for perforations with light otorrhoea and 0/4 for perforations with extensive otorrhoea.Conclusion:This surgery is a low-cost and minimally invasive surgery and has a high closure rate. This surgery is effective on small-sized, dry perforations although it can also close middle- and large-sized dry perforations.

Spontaneous closure of traumatic tympanic membrane perforations: observational study

2015 ◽  
Vol 129 (10) ◽  
pp. 950-954 ◽  
Author(s):  
M E Jellinge ◽  
S Kristensen ◽  
K Larsen
Keyword(s):  
Tympanic Membrane ◽  
High Probability ◽  
Watchful Waiting ◽  
Surgical Repair ◽  
Spontaneous Closure ◽  
Closure Rate ◽  
Tympanic Membrane Perforations ◽  
Closure Time ◽  
Kaplan Meier ◽  
Determining Factor

AbstractBackground:The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy.Methods:The study comprised 133 consecutive patients with a total of 137 perforations. Data were evaluated in terms of aetiology, location and size of perforation, audiometric findings, closure rate, and closure time.Results:The overall closure rate was 97 per cent. For patients with a known closure time within three months, the median closure time was between three and four weeks. The probability of spontaneous closure over time was further analysed with Kaplan–Meier plots, for those perforations with known closure times and for all perforations including those with unknown closure times. Perforation size was the only significant determining factor for closure time.Conclusion:Small perforations had a high probability of spontaneous closure within three to four weeks, justifying a watchful waiting policy. Larger uncomplicated perforations might warrant early surgical repair, depending on the patient's needs and the availability of surgery.

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