Inlay butterfly versus underlay cartilage tympanoplasty

Abstract Background Tympanic membrane grafting is one of the most common otological procedures. Underlay technique of tympanoplasty was described by Shea in 1960. Utech in 1959 introduce the cartilage in middle ear surgery. The search for an ideal graft material and technique for tympanoplasty was adopted by numerous contributions from surgeons all over the world. Professor Roland Eavey in 1998 introduced a transcanal inlay technique which offers advantages of surgical ease and speed as well as patient comfort. Results This study included 46 patients; 23 patients had inlay butterfly myringoplasty (group A), and 23 patients had underlay cartilage tympanoplasty. In group A, 65 % of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 3.94 db. In underlay group B, 82.6% of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 4.7 db. These outcomes show no statistically significant difference between both groups in terms of graft take and hearing improvement (p > 0.1). Conclusions Inlay butterfly myringoplasty is an easy, reliable, and time saving procedure that should be possible as a choice to underlay procedure. Results are comparable with underlay technique in terms of graft take rate and hearing improvement. Procedure is better regarding diminishing operative time, postoperative pain, and duration before resuming usual activities.

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Impact of type of graft material on outcome of tympanoplasty: a comparison between temporalis fascia and cartilage with perichondrium

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183706 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1301

Author(s):

Kanchan Tadke ◽

Randhir Ghorpade ◽

Vaibhav Lahane ◽

P. S. Mundada

Keyword(s):

Tympanic Membrane ◽

Controlled Trial ◽

Tertiary Care ◽

Type I ◽

Graft Material ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Graft Take ◽

Significant Difference ◽

And Cartilage

Background: Various graft materials have been used to repair tympanic membrane perforations. Temporalis fascia and cartilage with or without perichondrium are the most commonly used materials. The objective of the study was to compare the anatomical and functional success in type I tympanoplasty by using cartilage- perichondrium graft with that of temporalis fascia in a homogenous group of population.Methods: 64 patients with chronic otitis media - mucosal type were included in the study. This prospective, randomized controlled trial was conducted at a tertiary care centre between December 2012 to October 2014. Patients were grouped randomly between temporalis fascia (34/64) and cartilage group (30/64). In the fascia group, the graft was placed by underlay technique. In the cartilage group, tragal cartilage was thinned by cartilage thinner keeping the perichondrium attached on one side. The graft was placed by underlay or over-underlay technique. Postoperative results i.e. graft take up (anatomical success) and hearing improvement (functional success) were evaluated at 6 months. Results: Graft take up rate was 94.11% for fascia group and 96.66% for cartilage group. The mean pure tone air bone gaps pre and postoperatively in the fascia group were 26.4±6.55 dB and 11.47±6.5 dB respectively, whereas for cartilage-perichondrium group, the values were 28.3±5.86 dB and 13.2±6.48 dB respectively. There was no statistically significant difference in the graft take up rate and postoperative hearing improvement between the two groups (p≥0.05).Conclusions: Cartilage with perichondrium can be considered as an alternative to more traditional grafting material for tympanic membrane reconstruction.

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Endoscopic 3-S Technique Tympanoplasty: Taking the Convention a Step Ahead

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i3.5 ◽

2019 ◽

Vol 27 (3) ◽

pp. 179-185

Author(s):

Mridul Janweja ◽

Sayan Hazra ◽

Arindam Das ◽

Arya Brata Dubey

Keyword(s):

Endoscopic Surgery ◽

Routine Activity ◽

Middle Ear Surgery ◽

Graft Material ◽

Operating Microscope ◽

Advantages And Disadvantages ◽

Post Operative Pain ◽

Duration Of Surgery ◽

Group A ◽

Group B

Introduction Endoscopic Surgery has immense potential for middle ear surgery and is currently favoured by many surgeons. The 3 (vascular) Strips/ 3 Flap Tympanoplasty with operating microscope is popular but Endoscopic 3-Flap Tympanoplasty remains less explored. Hence this study was conducted to compare advantages and disadvantages of Endoscopic and Microscopic 3-Flap Tympanoplasty. Materials and Methods Forty two patients with large/subtotal perforation of tympanic membrane were divided into two equal groups (Group A & B). Endoscope was used in Group A, whereas, operating microscope in Group B. Temporalis fascia was the graft material in all patients. Patients were followed up for six months. Pre and post-operative audiograms, post-operative pain, graft uptake, time taken for surgery and intra-operative visualization convenience were compared. Results Mean Air-Bone Gap closure at the end of six months was 9.23 dB (SD-0.88 dB) in the endoscope group and 8.95 dB (SD-0.66 dB) in microscope group whereas the graft uptake rate was 95.2% and 90.2% respectively. Post-operative pain, cosmesis, ease of doing surgery and time taken for surgery were better in ‘Endoscope’ as compared to ‘Microscope’ group. Conclusion The three flaps produce adequate exposure in very large or subtotal perforations, very thin anterior rim or with anterior bony overhang. Results in terms of mean hearing gain and graft uptake were comparable. In terms of morbidity (post-op pain), recovery (return to routine activity), mean duration of surgery and cosmesis, endoscopic surgery produced better outcome.

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Comparative study of endoscopic tympanoplasty and conventional tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204179 ◽

2020 ◽

Vol 6 (10) ◽

pp. 1804

Author(s):

Priyanka Aggarwal ◽

Barjinder Singh Sohal ◽

J. P. Goyal

Keyword(s):

Success Rate ◽

Cost Effective ◽

Patient Comfort ◽

Hearing Improvement ◽

Post Operation ◽

Group A ◽

Group B ◽

The Cost ◽

Results Of Surgery ◽

Endoscopic Tympanoplasty

Background: To compare the results of endoscopic tympanoplasty with that of conventional tympanoplasty and to evaluate and compare the graft uptake in both of these methods. The study was done to evaluate the improvement in hearing after tympanoplasty and the problems faced while doing the endoscope assisted tympanoplasty.Methods: Between July 2010 to June 2013, 50 patients underwent tympanoplasty, 25 were endoscope assisted (group A) and 25 were microscope assisted (group B). Results of surgery were compared at the end of three and six months post operation.Results: The success rate in terms of graft uptake rate was 88% with endoscope assisted tympanoplasty and 84% with other microscope assisted tympanoplasty. Overall success rate was 86.0%. Mean hearing improvement was (16.24±10.21 dB) and (14.28±7.10 dB) in group A and group B respectively.Conclusions: Tympanoplasty with its visualization of hidden corners, justifies tympanoplasty by using endoscope in selected cases with comparable improved results in the literature. Furthermore, the cost of the endoscope is much less (about 10%) in comparision to operating microscope, making it more cost effective in developing countries. However, the endoscope cannot be employed in every case as one hand is blocked. In terms of Patient comfort, the endoscope assisted outnumbers the benefits of other conventional methods.

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Factors affecting surgical outcome of myringoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v17i2.8846 ◽

1970 ◽

Vol 17 (2) ◽

pp. 82-87 ◽

Cited By ~ 2

Author(s):

Md Zakaria Sarker ◽

Mesbauddin Ahmed ◽

Khabiruddin Patwary ◽

Rabiul Islam ◽

Abul Hasnat Joarder

Keyword(s):

Middle Ear ◽

Surgical Outcome ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Factors Affecting ◽

Hearing Gain ◽

Graft Take ◽

Significant Difference ◽

Large Perforation ◽

Small Perforation

Introduction: This prospective study was carried out to evaluate the factors that affect the graft take rate as well as hearing improvement after myringoplasty. Method: In this study 60 patients were divided into several groups based on 4 factors like size of perforation (small, medium and large), site of perforation (anterior central, posterior central and central malleolar), Condition of the middle ear (dry & wet) and surgical approach (post auricular and transcanal). Surgical outcome of myringoplasty was measured on the basis of graft take rate and post operative hearing improvement. Results: Size of the perforation affects the graft take rate and post operative hearing gain. Post operative closure of air-bone gap was 10.45 dB, 19.21 dB and 18.86 dB in small, medium and large perforation respectively. Hearing gain was greater after closure of large perforation than the smaller one. Graft take rate was 100%, 82% and 72.73% in small, medium and large perforation respectively. Graft take rate was greater in small perforation than other. Site of perforation also affects surgical outcome after myringoplasty. Graft take rate in anterior central, posterior central and central malleolar perforation was 66.67%, 82.25% and 83.79% respectively. Graft take rate was higher in central malleolar perforation than anterior central perforation. Post operative air-bone gap closure after myringoplasty was 15.31 dB, 12.38 dB and 20.89 dB in anterior central, posterior central and central malleolar perforation respectively. Post operative improvement of hearing was greater in central malleolar perforation. Condition of middle ear at the time of operation also affects the surgical outcome. Graft take rate was 89.36% in dry perforation and 53.85% in wet perforation. Graft take rate was greater in dry perforation. Closure of air-bone gap was 18.23 dB and 7.8 dB in dry and wet perforation respectively. Hearing improvement was greater in dry perforation. No significant difference was found in post-aural and transcanal approach. Conclusion: From this study we concluded that site and size of tympanic membrane perforation and condition of middle ear effects surgical outcome after myringoplasty. Key words: Myringoplasty; hearing improvement; graft take rate. DOI: http://dx.doi.org/10.3329/bjo.v17i2.8846 BJO 2011; 17(2): 82-87

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Tympanoplasty: Long-Term Results

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947308200411 ◽

1973 ◽

Vol 82 (4) ◽

pp. 538-546 ◽

Cited By ~ 13

Author(s):

D. Thane R. Cody ◽

William F. Taylor

Keyword(s):

Tympanic Membrane ◽

Long Term Results ◽

Hearing Improvement ◽

Hearing Results ◽

Adequate Level ◽

Gap Closure ◽

Revision Operations ◽

Active Disease

Long-term results after 878 tympanoplasties using five different methods of repair were analyzed. The five groups were as follows: canal skin and fascia, single fascia, double fascia, canal skin, and canal skin and homograft tympanic membrane. Ten percent of the graft failures occurred 18 months or longer after operation. The highest percentage of graft takes (88%) and satisfactory hearing improvement (socially adequate level 87%, air-bone gap closure to within 15 dB 76%) and the lowest incidence of depression in cochlear reserve (0.7%) was in the double fascia group. Overall hearing results achieved in the 878 tympanoplasties were poorer than anticipated. Differences in results in the five groups, although occasionally large, were not statistically significant. Differences in the percentage of successful graft takes in ears that had no active disease as compared with ears that had active disease and in primary operations as compared with revision operations were not statistically significant. Complications encountered were common and varied.

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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.

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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.

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Comparative study showing relevance of prosthesis diameter and hearing outcome in stapes surgery

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203196 ◽

2020 ◽

Vol 6 (8) ◽

pp. 1464

Author(s):

Udayanila Thangavel ◽

Harish Narasing Katakdhond ◽

Deepak Dalmia ◽

Narsinha Davange ◽

Parth Patni ◽

...

Keyword(s):

Controlled Trial ◽

T Test ◽

P Value ◽

Hearing Improvement ◽

Hearing Outcome ◽

Teflon Piston ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Individual

Background: Otosclerosis presents as conductive hearing loss, stapedotomy is the treatment for otosclerosis, and different sizes of piston diameter are available for the procedure. Aims and objectives were to study and compare hearing improvement between the 0.4 and 0.6 mm sizes of teflon piston in stapedotomy.Methods: It was a prospective randomized controlled trial. Patients fulfilling inclusion criteria were subjected for small fenestra stapedotomy. Patients were divided into two groups after randomization into group A (with 0.4 mm piston diameter) and group B (with 0.6 mm piston diameter). The hearing outcome with standard audiological assessment was performed at one month and six months postoperatively. Results: Comparison of 1 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.699). Comparison of 6 month AB gap among the patients with 0.4 mm piston and 0.6 mm piston showed that there was no statistically significant difference among both the groups of patients (independent t test p value=0.54).Conclusions: There was no significant difference in hearing improvement among the individual methods (piston size 0.4 and 0.6) with each other both in 1 month post-operative and 6 month post-operative follow up. Hence, we conclude that there is no relevance of different diameter of teflon piston prosthesis (0.4 mm versus 0.6 mm) as far as hearing outcome is concerned.

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EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.7915 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S552-55

Author(s):

Saleem Asif Niazi ◽

Shahzad Maqbool ◽

Yousra Riaz ◽

Zafarullah Khan ◽

Shafaq Zaman ◽

...

Keyword(s):

Tympanic Membrane ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Military Hospital ◽

Graft Take ◽

Group A ◽

Endoscopic Myringoplasty ◽

Group B

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17. Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........

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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.

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