An insight to tympanic membrane perforation pressure through morphometry: A cadaver study

Introduction: A cadaveric experimental investigation aimed to show the rupture pressure of the tympanic membrane (TM) for otologists to evaluate its tensile strength. Methods: Twenty adult ears in 10 fresh frozen whole cadaveric heads (four males, six females) mean age 72.8 (SD 13.8) years (range 40–86) were studied. The tensile strength of the TM was evaluated with bursting pressure of the membrane. The dimensions of the membranes and perforations were measured with digital imaging software. Results: The mean bursting pressure of the TM was 97.71 (SD 36.20) kPa. The mean area, vertical and horizontal diameters of the TM were 57.46 (16.23) mm2, 9.54 (1.27) mm, 7.99 (1.08) mm respectively. The mean area, length and width of the perforations were 0.55 (0.25) mm2, 1.37 (0.50) mm, and 0.52 (0.22) mm, respectively. Comparisons of TM dimension, bursting pressure, and perforation size by laterality and gender showed no significant differences. The bursting pressure did not correlate (positively or negatively) with the TM or perforation sizes. Conclusions: The TM can rupture during activities such as freediving or scuba diving, potentially leading to serious problems including brain injuries. Studying such events via cadaveric studies and data from case studies is of fundamental importance. The minimum experimental bursting pressures might better be taken into consideration rather than average values as the danger threshold for prevention of TM damage (and complications thereof) by barotrauma.

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ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v1i1.7935 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S440-444

Author(s):

Muhammad Atif Najam ◽

Urwa Sarwar ◽

Maqbool Raza ◽

Khalid Azam Khan ◽

Humaira Saleem ◽

...

Keyword(s):

Tympanic Membrane ◽

Demographic Data ◽

Tympanic Membrane Perforation ◽

Pars Tensa ◽

Tympanic Membrane Perforations ◽

Cartilage Tympanoplasty ◽

Membrane Perforation ◽

Percent Success ◽

And Gender ◽

Endoscopic Cartilage Tympanoplasty

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018 Methodology: All patients with dry central perforations of >3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving <25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with >75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia. Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

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

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i3.21427 ◽

2018 ◽

Vol 16 (3) ◽

pp. 297-301 ◽

Cited By ~ 1

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.

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Inferior Flap Tympanoplasty: A Novel Technique for Anterior Perforation Closure

BioMed Research International ◽

10.1155/2013/758598 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Haim Gavriel ◽

Ephraim Eviatar

Keyword(s):

Tympanic Membrane ◽

Anterior Part ◽

Tympanic Membrane Perforation ◽

The Novel ◽

Posterior Flap ◽

Membrane Perforation ◽

The Mean ◽

Contralateral Ear ◽

A Prospective Study ◽

Anterior Perforation

Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure.Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support.Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB), compared to 26.5 dB (10 to 55 dB) postoperatively. All perforations were found to be closed but one (92.3% success rate).Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.

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Myringoplasty: impact of perforation size on closure and audiological improvement

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004368 ◽

2009 ◽

Vol 123 (9) ◽

pp. 973-977 ◽

Cited By ~ 28

Author(s):

J D Wasson ◽

C E Papadimitriou ◽

H Pau

Keyword(s):

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Smoking History ◽

Graft Material ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Size Grade ◽

The Mean ◽

The Impact ◽

Air Conduction

AbstractObjectives:To investigate the impact of perforation size and other variables on the success of myringoplasty, and also to determine audiological gain following successful closure of tympanic membrane perforations of various sizes.Study design:Retrospective analysis of 130 case notes.Main outcome measures:(1) Successful closure of tympanic membrane following myringoplasty, in relation to recorded variables (i.e. perforation size, grade of surgeon, surgical technique, graft material, previous myringoplasty and smoking history). (2) Mean, four-frequency, air conduction audiometric gain following successful myringoplasty for various, pre-operatively categorised tympanic membrane perforation sizes.Results and Conclusion:The collective myringoplasty success rate was 80.8 per cent (105/130); for successful patients, the mean air conduction audiometric gain was −6.8 dB (t = 5.29, p < 0.0001). Neither perforation size nor any other assessed variable was a statistically significant determinant factor for successful myringoplasty. Air conduction audiometric gains following successful myringoplasty were directly correlated with pre-operative perforation size (−4.0 dB for 0–20 per cent perforations, −5.0 dB for 21–40 per cent, −9.1 dB for 41–60 per cent, −10.8 dB for 61–80 per cent and −13.3 dB for 81–100 per cent).

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En Hamac tympanoplasty and canalplasty for optimal type 1 tympanoplasty outcomes

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001383 ◽

2020 ◽

Vol 134 (9) ◽

pp. 769-772

Author(s):

S Vandenbroeck ◽

R Kuhweide ◽

B Lerut

Keyword(s):

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Type 1 Tympanoplasty ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

The Mean ◽

Primary Type ◽

Optimal Type

AbstractObjectiveMultiple tympanoplasty techniques have been developed with numerous differences in grafting and approach. This study aimed to improve type 1 tympanoplasty outcomes by using the ‘en hamac’ technique as well as performing a complete canalplasty for anterior perforations.MethodA retrospective review was performed using the prospective Otology-Neurotology Database tool for otological surgery. All primary type 1 tympanoplasty cases performed for tympanic membrane perforations from 2010 to 2016 were selected for analysis, all performed by one author. Minimal clinical and audiometric follow up was 18 months.ResultsTympanic membrane perforation closure was achieved in 62 of the patients (96.88 per cent). None of the en hamac cases had residual or recurrent perforation (p = 0.02). The mean remaining air–bone gap was 8.50 dB. The remaining air–bone gap was less than 10 dB in 72.55 per cent, 10–20 dB in 25.49 per cent and more than 20 dB in 1.96 per cent.ConclusionUsing the en hamac technique for anterior perforations as well as systematically performing a complete canalplasty provides multiple surgical advantages with excellent post-operative results.

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Endoscopic tympanoplasty using Tutoplast versus conventional microscopic tympanoplasty

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00149-y ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Taha M. Abdelaal ◽

Ahmed A. Ibrahim

Keyword(s):

Tympanic Membrane ◽

Operative Time ◽

Tympanic Membrane Perforation ◽

Temporalis Fascia ◽

Fascia Graft ◽

Significant Difference ◽

Membrane Perforation ◽

Group A ◽

The Mean ◽

Group B

Abstract Background Temporalis fascia and perichondrium are still the most successful graft materials for primary microscopic repair of tympanic membrane perforations worldwide with 80% to 90% success rate. However, minimally invasive surgery is becoming standard in many fields and the endoscope has been largely incorporated in ear surgery over the past 10 years. This study aimed to evaluate the success rate of endoscopic transcanal closure of tympanic membrane perforation using Tutoplast® compared with the conventional post auricular approach using homologous temporalis fascia graft. Results Our study was conducted on 50 patients, were equally divided into 2 groups. Group A patients have been operated endoscopic transcanal using the Tutoplast as a graft material. Group B patients have been operated using a temporalis fascia graft through a post-auricular approach. The graft take rate, the pre- and post-operative pure tone audiogram, and operative time were compared in both the groups. The graft uptake rate was 100% in both groups. The mean of ABG showed significant improvement in both groups. In group A, the mean of ABG was 28.2 pre-operatively and became 12.12 post-operatively. In group B, the mean of ABG was 29.72 pre-operatively then became 15.2 post-operatively. Comparing the mean of post-operative ABG between both groups showed statistically significant difference as p value was 0.000496. We found a significant difference of the mean average operative time between both groups as the mean average time for group A was 48.08 min compared to 69.4 min for group B with p value 0.049772295. Conclusions Endoscopic closure of tympanic membrane perforation using Tutoplast is successful short-time procedure avoiding the postauricular or endaural incisions with shorter operative time.

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