Efficacy of Otomicroscopy Combined with Otoendoscopy Double-Lens Technology-Assisted Tympanic Membrane Repair on Elderly Patients with Chronic Suppurative Otitis Media

Objective. To investigate the effect of otomicroscopy combined with otoendoscopy double-lens technology-assisted tympanic membrane repair on elderly patients chronic suppurative otitis media (CSOM). Methods. 120 elderly CSOM patients from January 2017 to July 2019 were selected and divided into the otomicroscopy group (n = 40), the otoendoscopy group (n = 40), and the double-lens group (n = 40) by the random number method. All patients were treated with tympanic membrane repair. The otomicroscopy group was assisted by otomicroscopy, the otoendoscopy group was assisted by otoendoscopy. and the double-lens group was assisted by otomicroscopy combined with otoendoscopy. The three groups of operations status, clinical efficacy, the incidence of adverse reactions, hearing improvement rate, and satisfaction rate with incision after 6 months were compared. Results. The operation time, intraoperative blood loss, hospitalization time, and VAS score of the otoendoscopy group and the double-lens group were all lower than those of the otoendoscopy group, and the operation time of the double-lens group was lower than that of the otoendoscopy group ( P < 0.05 ). The clinical efficacy of the double-lens group was better than that of the otomicroscopy group and otoendoscopy group ( P < 0.05 ). The adverse reaction rate of the otoendoscopy group and the double-lens group was lower than that of the otomicroscopy group, and the average postoperative air-bone conductance of the double-lens group was lower than that of the otomicroscopy group and the otoendoscopy group, and the hearing improvement rate was higher than that of the otomicroscopy and otoendoscopy groups ( P < 0.05 ). The satisfaction rate with postoperative incision in the otoendoscopy group and double-lens group was higher than that in the otomicroscopy group ( P < 0.05 ). Conclusion. The double-lens technology-assisted tympanic membrane repair has an obvious effect on elderly patients with CSOM. Compared with the single-use otomicroscopy, the operation time, intraoperative blood loss, hospitalization time, patient’s dry ear condition, degree of surgical pain, clinical efficacy, adverse reaction rate, hearing improvement rate, and patient’s incision satisfaction of the double-lens technology are better. Compared with the single-use otoendoscopy, the operation time, clinical efficacy, and hearing improvement rate of the double-lens technology are better.

Download Full-text

The outcomes of endoscopic myringoplasty: elevating a tympanomeatal flap or not

The Journal of Laryngology & Otology ◽

10.1017/s002221512000198x ◽

2020 ◽

Vol 134 (9) ◽

pp. 779-783

Author(s):

D Wang ◽

W Wang

Keyword(s):

Blood Loss ◽

Tympanic Membrane ◽

Operation Time ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Membrane Repair ◽

Group A ◽

Endoscopic Myringoplasty ◽

Group B ◽

Approach Group

AbstractObjectiveThe aim of this study was to compare the differences between the no tympanomeatal flap approach and the tympanomeatal flap approach in endoscopic myringoplasty.MethodA total of 132 patients with tympanic membrane perforation were randomly divided into two groups: the no tympanomeatal flap approach group (group A, 56 ears) and the tympanomeatal flap approach group (group B, 76 ears). A comparison between the two groups was made.ResultsThe average operation time of group A was 36.00 ± 5.24 minutes, which was significantly shorter than that of group B, which was 43.89 ± 4.57 minutes (p = 0.002). The blood loss of group A was 5.08 ± 1.83 ml, which was significantly less than that of group B (9.67 ± 2.29 ml; p < 0.001). There were no differences in the degree of hearing improvement, the rate of hearing improvement, the dry ear time (when the external auditory canal and the operating cavity were dry) after operation and the success rate of tympanic membrane repair when compared between the two groups.ConclusionCompared with group B, group A (no tympanomeatal flap approach) can achieve the same effect but has the advantages of a shorter operation time and less blood loss during the operation.

Download Full-text

A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180703 ◽

2018 ◽

Vol 4 (2) ◽

pp. 432

Author(s):

Amitkumar Rathi ◽

Vinod Gite ◽

Sameer Bhargava ◽

Neeraj Shetty

Keyword(s):

Comparative Study ◽

Tympanic Membrane ◽

Otitis Media ◽

Statistical Difference ◽

Chronic Suppurative Otitis Media ◽

Age Group ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Gap Closure ◽

The Mean

Background: The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking. Methods: In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db. Results: Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db. Conclusions: Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.

Download Full-text

Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 537 ◽

Cited By ~ 1

Author(s):

Ravi Dudda ◽

Sowmya Tumkur Rangaiah ◽

M. Hanumantha Prasad ◽

Nagavara Kalegowda Balaji

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Significant Difference

Background: The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.Methods: Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. Results: Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL). There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL) and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.Conclusions: In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery.

Download Full-text

Research of Ear Endoscopic Type I Tympanoplasty——Single-institution Experiences in China

10.21203/rs.3.rs-778556/v1 ◽

2021 ◽

Author(s):

Di Ji ◽

Jun Jie Yang ◽

Xian Bai Zhu ◽

Xue Qin Zhou ◽

Xiao Jun Liang ◽

...

Keyword(s):

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Type I ◽

Hearing Level ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Mean Values ◽

Before And After ◽

The Mean ◽

Type I Tympanoplasty

Abstract Purpose: To assess outcomes of one-handed ear endoscopic Type I Tympanoplasty and summarize the experience. Methods: This study retrospectively analyzed 34 cases (23 females and 11 males) of one-handed ear Endoscopic Type I Tympanoplasty. Result: The mean values of air conduction threshold before and after surgery were 48.22+18.36dB HL and 34.34+19.83dB HL, respectively. The mean values of the air-bone gap before and after surgery were 23.60+12.18 dB HL and 11.05+6.62 dB HL, respectively. The results showed statistically significant differences in hearing improvement(P<0.05). Among 34 ears, 30 ears had effective hearing improvement. No vertigo, intracranial infection, suppuration, and any other postoperative complications occurred. Although 1 ear occurred tympanic membrane perforation again, all ears achieved dry. Conclusion: Ear endoscopic Type I Tympanoplasty with fewer complications and shorter surgery time were suitable for the chronic suppurative otitis media. Healing of the tympanic membrane and recovery of hearing level was ensured. However, the experience is still insufficient in China, so a large number of clinical workers need to exchange experience to promote the development of ear minimally invasive surgery.

Download Full-text

Factors affecting hearing improvement following successful repair of the tympanic membrane

The Journal of Laryngology & Otology ◽

10.1017/s0022215113000157 ◽

2013 ◽

Vol 127 (4) ◽

pp. 349-353 ◽

Cited By ~ 4

Author(s):

G Thiel ◽

RP Mills ◽

N Mills

Keyword(s):

Regression Analysis ◽

Tympanic Membrane ◽

Middle Ear ◽

Hearing Improvement ◽

Membrane Repair ◽

Successful Operation ◽

Factors Affecting ◽

Hearing Thresholds ◽

The Mean ◽

Successful Repair

AbstractBackground:The main aim of tympanic membrane repair is the elimination of chronic or intermittent aural discharge. Hearing improvement may or may not occur following a technically successful operation.Method:This study entailed a retrospective analysis of prospectively collected data from 203 operations that resulted in an intact tympanic membrane 6 months after surgery.Results:Complete hearing data were available for 169 operations on 160 patients. Of these, 53 per cent resulted in closure of the air–bone gap to within 10 dB, and 54 per cent of cases had post-operative hearing thresholds of at least 30 dB. The mean hearing change after surgery was +8.3 dB. Multiple regression analysis indicated that hearing improvement was more likely in large compared with small perforations. Smaller hearing gains occurred in ears with erosion of the stapes arch and/or fixation of the stapes, as well as in those with active discharge at the time of surgery and in revision cases.Conclusion:Greater hearing improvement can be expected following successful repair of perforations involving more than 50 per cent of the drum area. Poorer results are likely to occur in ears with additional middle-ear pathology and in revision cases.

Download Full-text

The outcomes of endoscopic approach for attic cholesteatoma: underwater continuous drilling versus traditional intermittent drilling

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000633 ◽

2021 ◽

pp. 1-5

Author(s):

D Wang ◽

X Zhao ◽

W Li ◽

X Li ◽

R Zhu ◽

...

Keyword(s):

Clinical Data ◽

Surgical Outcome ◽

Operation Time ◽

Endoscopic Approach ◽

Hearing Improvement ◽

Improvement Rate ◽

Hearing Recovery ◽

Operative Complications ◽

Group A ◽

Group B

Abstract Objective This study aimed to analyse the differences between underwater continuous drilling and traditional intermittent drilling for attic cholesteatoma. Methods The clinical data of 61 patients with attic cholesteatoma who underwent an endoscopic approach procedure were analysed. Forty patients underwent underwater continuous drilling (group A), and 21 patients underwent traditional intermittent drilling (group B). Results The operation time was 64.61 ± 12.90 minutes in group A and 79.60 ± 16.81 minutes in group B (p < 0.05). The anaesthesia time was 102.69 ± 17.93 minutes in group A and 119.82 ± 19.28 minutes in group B (p < 0.05). The dry ear time, the hearing improvement rate and the post-operative complications were no different in the two groups. Conclusion Group A and group B had no differences in surgical outcome or hearing recovery. However, treatment in the former group resulted in a significantly shortened operation and anaesthesia time.

Download Full-text

Comparison of Tympanic Membrane Perforation With and Without Calcification of Anterior Mallear Ligament Under Transcanal Endoscopic Type I Tympanoplasty

Ear Nose & Throat Journal ◽

10.1177/01455613211010092 ◽

2021 ◽

pp. 014556132110100

Author(s):

Cong Wu ◽

Xiaoyun Chen ◽

Yideng Huang ◽

Min Zhang ◽

Fan Ye ◽

...

Keyword(s):

Tympanic Membrane ◽

Operation Time ◽

Tympanic Membrane Perforation ◽

Type I ◽

Closure Rate ◽

Suppurative Otitis Media ◽

Low Frequencies ◽

Membrane Perforation ◽

Type I Tympanoplasty ◽

Hearing Outcomes

Objectives: Chronic suppurative otitis media (CSOM) induced tympanic membrane perforation (TMP) can be accompanied by anterior mallear ligament (AML) calcification. So far, comparative evaluations of TMP with and without AML calcification have rarely been reported. The aim of the current study is to compare the hearing outcomes of TMP with and without calcification of AML under transcanal endoscopic type I tympanoplasty. Methods: Records of 67 patients diagnosed with CSOM and receiving transcanal endoscopic type I tympanoplasty were divided into the AML calcification group (Cal group, n = 31) and the non-AML calcification group (non-Cal group, n = 36). The 31 patients in the Cal group were divided into subgroup A and B according to the severity of calcification. The operation time, closure rate, and pre- and postoperative audiometric results were retrospectively collected and analyzed. Results: Preoperatively, the Cal group had higher mean air–bone gap (ABG; P = .022), and ABGs at 250 Hz ( P = .017) and 500 Hz ( P = .008) compared with the non-Cal groups. The Cal group showed higher improvements of ABGs at 250 Hz ( P = .039) and 500 Hz ( P = .021) compared with the non-Cal groups postoperatively. Conclusions: The TMP with AML calcification leads to higher ABGs at low frequencies. The hearing outcomes are similar for TMP both with and without AML calcification after surgery. Our results suggest that transcanal endoscopic type I tympanoplasty is an appropriate surgical method for TMP with AML calcification, if the lesion can be detected and completely eliminated.

Download Full-text

Air bone closure and graft uptake, vis a vis tympanic reconstitution

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204637 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2094

Author(s):

Manish Munjal ◽

Nitin Mathur ◽

Parth Chopra ◽

Shubham Munjal ◽

Hemant Chopra ◽

...

Keyword(s):

Prospective Study ◽

Tympanic Membrane ◽

Graft Rejection ◽

Surgical Outcome ◽

Study Group ◽

Hearing Improvement ◽

Temporalis Muscle ◽

Suppurative Otitis Media ◽

Overlay Technique ◽

The Ideal

Background: Tympanoplasty involves reconstitution of the tympano-ossicular system with commonly. fascia of the temporalis muscle, situated in its proximity. The fascia is grafted on the residual tympanic membrane by placing it either over it or below it, after creating a raw surface. The former is the overlay and latter, the underlay technique. In this study on restitution of the ear drum utilizing the overlay and underlay techniques, an exhaustive analysis of the two modalities has been done, taking into consideration various variables individually. The surgical outcome wrt to graft uptake and hearing gain has been compared in "depth" with extensive studies undertaken in India and abroad. The unbiased tabulated comparison of each aspect is unique and would guide future researchers to opt the ideal modality.Methods: Tympanoplasty was undertaken in chronic safe suppurative otitis media with the underlay and overlay techniques in a study group of 40 patients in this prospective study. The patients were randomly divided into equal groups for either procedure. Results: In the cohort of 40 subjects successful graft uptake was observed in 16 (80%) with overlay technique and 17 (85%) with underlay technique. Graft rejection was reported in 4 (20%) and 3 (15%) cases with overlay and underlay techniques respectively. Hearing improvement was 56.25% in 10-20 dB range in Overlay. Whereas, with underlay it was 47.05% in 10-2 dB.Conclusions: Overlay technique is ideal for anterior and central perforations while underlay for subtotal and posterior perforations. In terms of hearing improvement, the fibrosis during graft uptake makes the results of either technique unpredictable.

Download Full-text

Single Sitting Bilateral Myringoplasty: Outcomes and Complications

QJM ◽

10.1093/qjmed/hcaa047.016 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M A Hassan ◽

M S Hassaballah ◽

P M Mikahail ◽

M S D Mahmoud

Keyword(s):

Hearing Loss ◽

Success Rate ◽

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Psychological Trauma ◽

Single Stage ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Graft Take

Abstract Background Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations. Traditionally each ear drum is taken up for grafting sequentially in two different sittings. The reluctance to deal with both sides at the same sitting has been primarily due to a theoretical risk of iatrogenic sensory-neural hearing loss, need of bilateral ear canal gauze packing and chances of graft intake failure. Chronic Suppurative Otitis Media (CSOM) is a widely prevalent public health problem presenting with discomfort, hearing loss, otorrhea and psychological trauma. CSOM is characterized by an inflammatory process of the middle ear often associated with irreversible tissue alterations. It may be further classified into safe chronic otitis media and unsafe chronic otitis media according to the absence or presence of a cholesteatoma. Aim This study aim at assessing the single stage bilateral surgical procedure in bilateral tympanic membrane perforation caused by chronic otitis media as regard the graft take and hearing improvement as outcomes. Methodology A meta-analysis study is done to assess the feasibility and the possibility of operating the bilateral perforation in tympanic membrane in chronic otitis media cases on same session rather than doing it in separate sessions. The outcomes that were selected to evaluate such approach are graft take and hearing improvement. Hospital stay, cost of the operation and time were supposed to be evaluated however, there was no sufficient data to treat such outcomes in this meta analytic study upon that these outcomes are going to be appraised and stated bases on the available data. Results The graft take was evaluated on the bases paper by ototscopic examination post operative from 3 weeks to 3 months by closure of the perforation. It was estimated in this study to be 88%. This percent is matching the result obtained by Ihsan et al 2016 “who operated on 50 patients with a graft uptake rate of 86 %”, Olusesi et al, 2017 " with a total of 38 participants underwent either bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential different-day tympanoplasty (20 patients, 40 ears). The overall graft take rate was 88 per cent (32 out of 36 ears in the same-day tympanoplasty group, 35 out of 40 ears in the different-day tympanoplasty group; p = 0.96, odds ratio = 0.984)" (88 %), and Katsura et al, 2005 who revised the SUM using a 17 patients who underwent bilateral same-day surgery with a success rate of (85%). Conclusion Simultaneous bilateral myringoplasty is safe and effective as a single-stage operation with a high success rate as regard the graft take and hearing improvement.

Download Full-text

Comparative study of type 1 tympanoplasty with and without gel-foam in the middle ear

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212824 ◽

2021 ◽

Author(s):

G. Abhinav Kiran ◽

Y. Prabhakara Rao ◽

B. Shanthi Priyanka ◽

Supreety .

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Hearing Improvement ◽

Tertiary Referral Hospital ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Hearing Assessment ◽

One Year

Background: Chronic suppurative otitis media is a widespread disease for which tympanoplasty is frequently undertaken. Gel-foam may cause adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. The objectives of this study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gel-foam in the middle ear and without gel-foam in the middle ear and to compare and assess results.Methods: This was a randomized control trial done for a period of one year conducted in the department of ENT, at a tertiary referral hospital. 40 patients with dry perforation underwent type 1 tympanoplasty without gel-foam in the middle ear and 40 patients with dry perforation underwent type 1 tympanoplasty with gel-foam in the middle ear. Post-operative follow-up was done to look for graft uptake. Hearing assessment by pure tone audiometry was done 90 days post-operatively. Results: Graft uptake was 82.5% in type 1 tympanoplasty without gel-foam in the middle ear and 85% with gel-foam in the middle ear. Both types of surgeries had significant hearing improvement.Conclusions: Graft uptake is equally good in cases with gel-foam and without gel-foam. Hearing gain is comparable in both groups of patients.

Download Full-text