Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

ORL ◽  
2021 ◽  
pp. 1-7
Author(s):  
Kemal Keseroglu ◽  
Mehmet Murat Gunay ◽  
Sibel Alicura Tokgoz ◽  
Bulent Ocal ◽  
Cem Saka ◽  
...  
Keyword(s):  
Bone Conduction ◽  
Graft Infection ◽  
Chronic Otitis Media ◽  
Hearing Preservation ◽  
Septal Cartilage ◽  
Cerebrospinal Fluid Leakage ◽  
Cartilage Graft ◽  
Hospitalization Time ◽  
Significant Difference ◽  
The Mean

<b><i>Introduction:</i></b> Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects &#x3e;1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach. <b><i>Methods:</i></b> The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed. <b><i>Results:</i></b> The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10–25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8–42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3–10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered. <b><i>Conclusion:</i></b> Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage.

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 Hearing results in modified radical mastoidectomy with type III tympanoplasty

2019 ◽  
Vol 5 (6) ◽  
pp. 1629
Author(s):  
Yash D. Lavana ◽  
Ajay J. Panchal ◽  
Vaibhav B. Hapalia ◽  
Manit M. Mandal ◽  
Shivani D. Shah
Keyword(s):  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Septal Cartilage ◽  
Mastoid Cavity ◽  
Head Group ◽  
Care Hospital ◽  
Modified Radical Mastoidectomy ◽  
Group A ◽  
The Mean ◽  
Group B

<p class="abstract" style="display: inline !important;"><strong>Background:</strong> The objective of the study was to hear the results in patients with atticoantral-chronic otitis media who undergone canal wall down mastoidectomy with different types of tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> 86 cases of CSOM-AA were included. Patients were divided in 3 groups according to intra-operative ossicular chain status and reconstruction. Group A were patients having intact stapes superstructure and the graft kept over the stapes head covering middle ear and mastoid cavity. Group B patients were with intact superstructure of stapes and graft kept over cartilage graft kept on mobile stapes head. Group C patients were with absent superstructure of stapes with intact, mobile footplate and graft kept over autologous or homologous cartilage kept on footplate of stapes. On 10<sup>th</sup> week and 24<sup>th</sup> week after surgery, PTA was carried out to compare pre and post-operative hearing status. The study was conducted at SMIMER Hospital, Surat (a tertiary health care hospital) fromSeptember 2016 to September 2017.  </p><p class="abstract"><strong>Results:</strong> In 86 patients, average mean preoperative AC threshold was 48.16 (±15.15) dB, mean pre-operative BC was 8.96 (±7.85) dB and mean pre-operative air bone gap was 40.11 (±12.92) dB. The mean post-operative AC threshold was 43.17 (±13.72) dB, mean post-operative BC was 11.34 (±9.44) dB and postoperative air bone gap was 32.06 (±11.62) dB. The mean air bone gap closure was 8.76 (±11.86). This hearing gain was statistically highly significant (p&lt;0.001). Among 86 patients, cartilage was used in total 60 patients. Mean ABG was 8.6 dB, 11.05 dB and 8.43 dB respectively for tragal, conchal and homologous septal cartilage.  </p><p class="abstract"><strong>Conclusions:</strong> Hearing improvement can be achieved with appropriate reconstruction in CWD mastoidectomy.</p>

scholarly journals A Comparative Study between Endoscopic and Microscopic Tympanoplasty

2019 ◽  
Vol 21 (3) ◽  
pp. 195-198
Author(s):  
Anup Dhungana ◽  
R. R. Joshi ◽  
A. S. Rijal ◽  
K. K. Shrestha ◽  
S. Maharjan
Keyword(s):  
Uptake Rate ◽  
Chronic Otitis Media ◽  
Endoscopic Technique ◽  
Random Allocation ◽  
Microscopic Technique ◽  
Significant Difference ◽  
The Mean ◽  
Bone Gain ◽  
Audiometric Test ◽  
Endoscopic Group

A study to compare tympanoplasty between endoscopic and microscopic approach was conducted at NMCTH. Patients diagnosed as chronic otitis media – mucosal type with age of 13 years and above were included in the study. Audiometric test was done before and 6 weeks after surgery. Seventy cases were included for the study with random allocation of cases each in endoscope group and microscopic group respectively. Graft uptake results were assessed after 6 weeks and postoperative hearing were evaluated and compared within and between the two groups. In endoscopic group and microscopic group, the graft uptake rate was 91.4% and 88.5% respectively with no significant difference (p = 0.71) in the graft uptake rate between the groups. The mean pre and post-operative air bone gap in endoscopic group and microscopic group were 34.59 dB±8.02, 21.97±8.60 dB and32.42±10.08 dB, 18.55±8.49 dB respectively. This showed a highly significant difference in both groups(p < 0.001), showing improvement in the hearing after surgery in both the groups. The mean air bone gain were 12.62 dB and 13.87 dB in endoscopic and microscopic group respectively, with no significant difference between the groups (p = 0.553). The graft uptake rate and hearing results with endoscopic technique is comparable to that of microscopic technique. However, the endoscopic technique requires shorter operative time than the microscopic technique. Therefore, we recommend the use of endoscope for tympanoplasty in hospital as well as in camps.

The late results of 4000 Hz frequency bone conduction after tympanoplasty

2017 ◽  
Vol 71 (5) ◽  
pp. 12-17
Author(s):  
Joanna Janiak-Kiszka ◽  
Wojciech Kaźmierczak
Keyword(s):  
Bone Conduction ◽  
Organ Of Corti ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Late Results ◽  
Canal Wall ◽  
Bone Conduction Threshold ◽  
Significant Difference ◽  
Canal Wall Down

Introduction: Surgical treatment of conductive hearing loss runs the risk of damage to the inner ear in the mechanism of acoustic trauma. Aim: The aim of this study was to evaluate the function of the organ of Corti, expressed as bone conduction threshold at the frequency of 4000 Hz for selected operations: mastoidectomy and canal-wall-down procedure. Material and methods: The material was collected from patients with chronic otitis media in the Department of Otolaryngology and ENT Oncology, Collegium Medicum of Nicolaus Copernicus University in Bydgoszcz in 2004–2009. All patients were examined with pure tone audiometry threshold before surgery and at least three years after surgery. The analyzed group of patients was divided into subgroups depending on the type of operation according to To classification and procedures for resection: mastoidectomy and canal-wall-down procedure. The results were statistically analyzed. Results: In the analyzed period of three years after surgery there was no statistically significant difference between groups, although there were higher values for tympanoplasty type 1 with mastoidectomy compared with tympanoplasty type 1 without mastoidectomy - respectively 25.67 dB and 18.53 dB. In the study, there was no statistically significant the difference in bone conduction threshold for frequency 4000 Hz within the type 2 tympanoplasty according to Tosa comparing canal wall-up and canal-wall-down procedure. Conclusions: Mastoidectomy or canal-wall-down procedure do not affect the bone conduction threshold for a frequency of 4000 Hz after tympanoplasty in long-term observation.

Neutrophil Elastase and its Complex with Alpha1-Antitrypsin in the Pathogenesis of Chronic Suppurative Otitis Media

1992 ◽  
Vol 101 (10_suppl) ◽  
pp. 26-31 ◽  
Author(s):  
Yukiyoshi Hamaguchi ◽  
Yasuo Sakakura
Keyword(s):  
Otitis Media ◽  
Neutrophil Elastase ◽  
Bacterial Infections ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Mean Value ◽  
Chronic Suppurative Otitis Media ◽  
Suppurative Otitis Media ◽  
Significant Difference ◽  
The Mean

Neutrophil elastase (NE) and its complex with α1-antitrypsin were quantified in ear discharges from 15 patients with chronic suppurative otitis media (CSOM), and their levels were compared to those in middle ear effusions from 10 pediatric patients with chronic otitis media with effusion (OME). The localization of immunoreactive NE was also examined by immunocytologic study. The mean value of total NE was 161.8 ± 29.5 μg/mL in CSOM, which was significantly higher than that in OME (16.5 ± 6.7 μg/mL). The mean value of NE–α1-antitrypsin complex was 13.7 ± 8.8 μg/mL in CSOM and 7.8 ± 4.0 μg/mL in OME. There was no significant difference between culture-positive and culture-negative samples in CSOM. Immunoreactive NE could be observed in the neutrophils of ear discharges, and extracellular release of NE was also observed. Ear discharges in CSOM contain a considerable amount of uncomplexed NE, of which the level does not depend on active bacterial infections. Uncomplexed NE seems to play a role in the chronicity of CSOM.

Outcomes with gold wire and hydroxyapatite partial ossicular replacement prostheses in type 2 tympanoplasty: a preliminary study

2015 ◽  
Vol 129 (2) ◽  
pp. 142-147 ◽  
Author(s):  
H Katilmis ◽  
M Songu ◽  
H Aslan ◽  
Y Ozkul ◽  
S Basoglu ◽  
...  
Keyword(s):  
Bone Conduction ◽  
Chronic Otitis Media ◽  
Gold Wire ◽  
Complication Rates ◽  
Graft Take ◽  
Ossicular Replacement ◽  
The Mean ◽  
One Year ◽  
Replacement Prosthesis

AbstractObjectives:To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media.Method:This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted.Results:The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group (p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group (p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively (p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively (p = 0.687).Conclusion:The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.

Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

2018 ◽  
Vol 16 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Sundar Dhungana ◽  
Pabina Rayamajhi ◽  
Rakesh Prakash Shrivastav
Keyword(s):  
Tympanic Membrane ◽  
Uptake Rate ◽  
Chronic Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Hearing Results ◽  
Flap Technique ◽  
Significant Difference ◽  
Membrane Perforation ◽  
Subtotal Perforation ◽  
The Mean

Background: Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between ‘U’ flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation.Methods: Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sizedanterior and subtotal perforationof tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in ‘U’ flap group and thirty twocases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.Results: Graft uptake rate was 90.3%(28/31) in‘U’ flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in ‘U’ flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504).Conclusions: The graft uptake rate and hearing results of ‘U’ flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group.

Mechanism of Hearing Loss in Irradiated Ears: A Long-Term Longitudinal Study

2001 ◽  
Vol 110 (10) ◽  
pp. 904-906 ◽  
Author(s):  
Yi-Ho Young ◽  
Ying-Chih Lu
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Bone Conduction ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Tube Function ◽  
The Mean ◽  
Air Conduction

A 10-year longitudinal follow-up study of hearing was conducted in patients with nasopharyngeal carcinoma (NPC) in order to elucidate the mechanism of hearing loss in irradiated ears. Ten NPC patients were subjected to a battery of audiological tests before irradiation and 6 months, 5 years, and 10 years after irradiation. The tests included pure tone audiometry, tympanometry, eustachian tube function testing, and myringotomy to confirm middle ear effusion. The prevalences of otitis media with effusion (OME) were 25%, 25%, 40%, and 25% at the 4 testing periods described above, respectively. The prevalences of chronic otitis media were 0%, 0%, 15%, and 25%, respectively. In myringotomized ears (n = 17), the mean hearing levels for both air conduction and bone conduction were preserved from the preirradiation period to 10 years after irradiation. In contrast, in grommeted ears (n = 3), the mean hearing levels for both air conduction and bone conduction deteriorated progressively from the preirradiation period to 10 years after irradiation. We conclude that hearing can be preserved in NPC patients 10 years after irradiation if middle ear inflammation is well controlled. We do not recommend grommet insertion in irradiated NPC patients with OME, as it may result in persistent otorrhea and hearing deterioration.

scholarly journals Is Right Sleeve Lower Lobectomy Necessary? Is It Safe?

2018 ◽  
Vol 68 (03) ◽  
pp. 235-240
Author(s):  
Celalettin Ibrahim Kocaturk ◽  
Ozkan Saydam ◽  
Celal Bugra Sezen ◽  
Cem Emrah Kalafat ◽  
Levent Cansever ◽  
...  
Keyword(s):  
Demographic Data ◽  
Total Survival ◽  
Lower Lobectomy ◽  
Hospitalization Time ◽  
Significant Difference ◽  
Prolonged Air Leak ◽  
The Mean ◽  
Group B ◽  
The Right

Abstract Objectives The right sleeve lower lobectomy is the least used of the bronchial sleeve operations. There are only case-based studies in the literature. In this study, we compared this technique to those used in patients who underwent a right lower bilobectomy. Methods We retrospectively reviewed the data of patients who had been operated on due to non-small cell lung cancer (NSCLC) from January 2005 to December 2015 from a dataset that was formed prospectively. Of the 4,166 patients who underwent resections due to NSCLC, the files of those who had a right sleeve lower lobectomy (group S) and those who had a right lower bilobectomy (group B) were evaluated. The remaining 25 patients in group B and 18 patients in group S were compared in terms of demographic data, morbidity, hospitalization time, mortality, histopathology, recurrence, and total survival. Results No significant differences in the demographic or clinical characteristics were observed between the two groups, except that group S had more female patients. Postoperative complications developed in 52% of the patients in group B and 11.1% of the patients in group S (p = 0.006). Mean hospitalization time was 9.6 ± 3.6 (range, 6–19) days in group B and 6.72 ± 1.5 (range, 4–9) days in group S (p = 0.001). All patients received complete resections. The mean patient follow-up time was 42.9 months. No significant difference was found between local and distant recurrences (p = 1, p = 0.432). Mean survival time was 89.6 months (5-year rate = 73%), which was 90.6 months (5-year rate = 75.3%) in group B and 63.1 months (5-year rate = 69.3%) in group S (p = 0.82). Conclusion This technique allows for reduced filling of the thoracic cavity by a prolonged air leak and a reduced prevalence of complications. Additionally, the hospitalization time is shortened. It does not produce any additional mortality burden, and total survival and oncological outcomes are reliable. This technique can be used in selected patients at experienced centers.

scholarly journals Endoscopic Tympanoplasty: Inlay Cartilage Versus Underlay Cartilage Graft

2021 ◽  
Author(s):  
Ahmet Doblan ◽  
Ergun Sevil
Keyword(s):  
Success Rate ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Operation Time ◽  
Cartilage Graft ◽  
Significant Difference ◽  
Graft Success ◽  
Small Perforation ◽  
Endoscopic Tympanoplasty

INTRODUCTION: Several graft placement methods have been described in tympanoplasty. The aim of this study is to assess the surgical effects of the endoscopic tympanoplasty utilizing inlay cartilage or underlay cartilage graft. METHODS: We reviewed medical records of 123 patients who experienced endoscopic tympanoplasty for chronic otitis media with a minimum twelve-month follow-up period. Perforations were divided into central, posterior, and anterior ones based on the place of the perforation to malleus handle. Graft success rate, air conduction pure tone audiometry (PTA) before surgery and after surgery, hearing gain and air bone gap (ABG) reduction were calculated following surgery. RESULTS: No significant difference was found between the groups in terms of the distribution of the follow-up period, age, perforation location, and gender (p>0.05). The average air conductions (AC) before surgery and after surgery for the inlay group were 36.3 ± 13.7 dB and 25.4 ± 12.3 dB 6 months after surgery and 22.5 ± 10.5 dB 12 months after surgery. They were 35.6 ± 13.3 dB and 24.8 ± 12.4 dB 6 months after surgery and 22.7 ± 9.7 12 months after surgery for the underlay group. A significant difference was found between the two groups in terms of ABG (P=0.037). There was no significant difference in the mean ABG in each group (small perforation P =0.473, medium perforation P=0.876 and large perforation P=0.341). DISCUSSION AND CONCLUSION: The inlay method can be used with high graft success rate, low risk of complications among the appropriate patients, and shorter operation time as a reliable surgical option for treatment.

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