632 Myringoplasty Outcomes from A 5 Year Single Surgeon Experience at A District General Hospital

Abstract Introduction Myringoplasty is an operation to repair a perforated tympanic membrane. A UK based myringoplasty national audit showed the overall closure rate for myringoplasty nationally was 89.5% (90.6% for primary surgery and 84.2% for revision surgery). This study sought to compare the myringoplasty outcomes in terms of achievement of tympanic membrane closure for a single surgeon over the period of 5 years against the national standard. Method Data was collected retrospectively. 68 suitable myringoplasty cases were identified as being done under a single surgeon between 2014 and 2019. Operation notes, discharge letters, audiograms and clinic letters were analysed. Results The overall closure rate was 97% (66/68) and significantly higher than the national standard (p = 0.0210), the primary closure rate was 98% (53/54) and significantly higher than the national standard (p = 0.0287) and the revision closure rate was 93% (13/14), but not significantly higher than the national standard (p = 0.1872). Conclusions This surgeon uses a posterior auricular approach, combined with mastoidectomy with temporalis fascia graft underlay. We suggest that his particular surgical technique contributed to the positive outcomes quoted.

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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.

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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.

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Audiometric evaluation of type 1 tympanoplasty for hearing results

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20171188 ◽

2017 ◽

Vol 3 (2) ◽

pp. 332

Author(s):

Mallikarjun S. Tegnoor ◽

Kazim Ali ◽

Sutrave Mithun

Keyword(s):

Uptake Rate ◽

Graft Material ◽

Temporalis Fascia ◽

Closure Rate ◽

Hearing Results ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Air Conduction

Background: To evaluate the graft uptake rate of the type1 tympanoplasty performed by underlay technique using autologous temporalis fascia graft for the last two years and to assess the hearing improvement in the successfully operated cases with respect to age, sex, size and location of perforation. Methods: This prospective Study included 50 patients, who underwent type1tympanoplasty.All operations are performed using an underlay technique and by postural approach. In all the cases, temporalis fascia is used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and location, surgical approach, graft material, pre and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results are analyzed. Results: Successful closure rate of the TM perforation is 88% and the graft failure rate is 12%. In this study, lowest and highest age of patients at presentation is 13 and 55 years respectively with a mean age of 26.6 years. Most common approaches is post aural. The mean pre and post-operative air conduction threshold in the successful cases are 33.34 dB and 20.20 dB respectively with a mean audiological improvement of around 13 dB. The improvement in the hearing is achieved in only 88% (44 out of 50) among the successful operated type 1 tympanoplasty. Conclusions: Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach is postural. The graft uptake rate is better at three months. The improvement in hearing is noted irrespective of age, sex, size and location of perforation.

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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

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Total tympanic membrane reconstruction: AlloDerm versus temporalis fascia

Otolaryngology ◽

10.1016/j.otohns.2004.12.013 ◽

2005 ◽

Vol 132 (6) ◽

pp. 906-915 ◽

Cited By ~ 38

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.

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Hearing Evaluation After Myringoplasty At Nepal Medical College And Teaching Hospital

Journal of Nobel Medical College ◽

10.3126/jonmc.v2i1.7671 ◽

2013 ◽

Vol 2 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

Rupesh Raj Joshi ◽

Anil Kumar Jha ◽

Anupama Shah Rijal ◽

Anup Dhungana ◽

Kundan Kumar Shrestha

Keyword(s):

Medium Size ◽

Graft Material ◽

Temporalis Fascia ◽

Closure Rate ◽

Medical College ◽

Fascia Graft ◽

One Year ◽

Air Conduction ◽

Hearing Evaluation

Objective: To evaluate the graft takes rate of the myringoplasties performed by underlay technique using temporalis fascia graft for the last one year and to assess the hearing improvement in the successfully operated cases. Methods: This prospective Study included 52 ears of 50 patients, who underwent myringoplasty. All operations were performed using an underlay technique and mostly by postaural approach. In all the cases, temporalis fascia was used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and localization, surgical approach, graft material, pre- and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results were analyzed. Results: Successful closure rate of the TM perforation was 82.69% and the graft failure rate was 17.30%. In this study, lowest and highest age of patients at presentation was 12 and 42 years respectively with a mean age of 25.5 years. The success rate was better with the advancing age. The most common approach was postaural. Medium size and posterior perforations were common and the graft take rate was 80.95%, and 88.89% respectively. The mean pre and post-operative air conduction threshold in the successful cases were 38.69dB and 30.35 dB respectively with a mean audiological improvement of around 8 dB. The improvement in the hearing was achieved in only 67.44% (29 out of 43) among the successful operated myringoplasties. Conclusion: Myringoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach was postaural. The graft takes rate was better with the advancing ages and with the medium size and posterior perforations. The improvement in hearing was also achieved. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 36-42 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7671

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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.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210169 ◽

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

Background: 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.Methods: 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. Results: 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.Conclusions: 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.

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Myringoplasty With an Ultrathin Cartilage-Perichondrium Complex Graft Versus Temporalis Fascia Graft: A Propensity Score–Matched Analysis

Otolaryngology ◽

10.1177/0194599820965940 ◽

2020 ◽

pp. 019459982096594

Author(s):

Yi-Bo Huang ◽

Lu-lu Hu ◽

Dong-Dong Ren ◽

Zhao Han

Keyword(s):

Propensity Score ◽

Middle Ear ◽

Test Group ◽

Control Group ◽

Temporalis Fascia ◽

Closure Rate ◽

Factors Affecting ◽

Fascia Graft ◽

Endoscopic Myringoplasty ◽

Air Conduction

Objective To compare endoscopic myringoplasty using the cartilage-perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group). Study Design A retrospective cohort study. Setting Department of Otorhinolaryngology in a tertiary Chinese hospital. Methods Data were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score–matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed. Results In the control and test groups, 90.90% and 86.36% of patients had a mean air-bone gap ≤20 dB after the surgery, respectively ( P = .843). The air conduction (AC) threshold gain at each frequency was similar in the 2 groups ( P > .05). The closure rates were 95.45% and 93.18%, respectively ( P = .645). The air-bone gap improved significantly after surgery, F(1, 61) = 6.729, P = .012. Age, group, middle ear mucosal status, and location of the perforation did not affect the change in air-bone gap or the drum closure rate ( P > .05). However, there was an interaction between the change in air-bone gap and the size of the perforation, F(1, 61) = 11.067, P = 0001. Conclusion Endoscopic myringoplasty using a cartilage-perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air-bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air-bone gap improvement.

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Day-stay myringoplasty

The Journal of Laryngology & Otology ◽

10.1017/s0022215100133870 ◽

1996 ◽

Vol 110 (5) ◽

pp. 421-424 ◽

Cited By ~ 6

Author(s):

R. Benson-Mitchell ◽

G. S. Kenyon ◽

Q. Gardiner

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

General Anaesthesia ◽

Complete Healing ◽

Temporalis Fascia ◽

Major Complications ◽

Fascia Graft ◽

The Uk

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.

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