Factors affecting surgical outcome of myringoplasty

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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Hearing Evaluation after Myringoplasty in Underlay Technique

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v22i2.45093 ◽

2020 ◽

Vol 22 (2) ◽

pp. 84-89

Author(s):

Md Khorshed Alam ◽

Mohammad Wakilur Rahman ◽

Md Abdur Razzak ◽

ABM Khorshed Alam ◽

Abu Yusuf Fakir ◽

...

Keyword(s):

Success Rate ◽

Medical College Hospital ◽

Hearing Improvement ◽

College Hospital ◽

Mean Values ◽

Hearing Gain ◽

Medical College ◽

Graft Take ◽

Significant Difference ◽

The Mean

Objective: to determine the success rate of underlay technique of myringoplasty regarding rate of graft take, complications and hearing improvement. Methods: This Cross sectional study was done in the department of ENT & Head-Neck Surgery, Dhaka Medical College Hospital & Shaheed Suhrawardy Medical college Hospital, Dhaka from July 2012 to December 2012. Sixty(60) patients who underwent myringoplasties were included in the study. All myringoplasty were performed by a postaural approach using autologous temporalis fascia and underlay technique. Results: The total success rate (graft uptake) was 88.3% and of the successful cases an overall hearing improvement was achieved in 73.58% of cases. The mean audiological improvement in air conduction threshold was 13.24 dB & mean closure of the air bone gap was 11.64 dB. The mean values of hearing gain of small perforations and subtotal perforations have shown significant difference.The mean values of hearing gain between posterior perforation and subtotal perforation have shown significant difference. Conclusion: Underlay myringoplasty is an effective technique of repairing the tympanic membrane perforation due to high rate of graft take and marked hearing improvement. Bangladesh J Otorhinolaryngol; October 2016; 22(2): 84-89

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The Relationship of Surgeon Handedness and Experience on Operative Duration and Hearing Improvement in Ipsilateral and Contralateral Otologic Surgeries

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v35i2.1505 ◽

2020 ◽

Vol 35 (2) ◽

pp. 17

Author(s):

Gillian Barzaga

Keyword(s):

Hearing Improvement ◽

Ear Surgery ◽

Hearing Gain ◽

Operative Duration ◽

Left Handed ◽

Significant Difference ◽

Surgeon Experience ◽

The Right ◽

Relationship Of ◽

The Relationship

ABSTRACT Objective: To determine the relationship of the surgeon handedness and operative site laterality on operative duration and hearing improvement in otologic surgery, and to further explore whether this relationship may be related to surgeon experience. Methods:Design: Retrospective CohortSetting: Tertiary Private Teaching HospitalParticipants: Seventy-three (73) patients aged 18 to 65 years old who underwent primary ear surgery under general anesthesia between January 2016 and December 2019 were retrospectively divided into two groups: 39 contralateral and 34 ipsilateral. The operative durations and hearing improvements were compared using independent t-tests, with consideration of surgeon experience in years further stratifying patients. Results: There was no significant difference in operative duration, t(71) = 1.14, p = .26, between the contralateral (M = 281.95 minutes, SD = 71.82) and ipsilateral (M = 261.15, SD = 79.26) groups. This same pattern was more pronounced among surgeons with 10+ years of experience although there was also no significant difference in operative time, t(33) = 1.31, p = .19 for both ipsilateral and contralateral surgeries There was no statistically significant difference, t(36) = -0.72, p = .47, in overall mean hearing gain among patients in the contralateral (M = +2.22 dB, SD = 10.54) and ipsilateral (M = +5.12 dB, SD = 14.26) groups. Although the difference was also not statistically significant, t(16) = -1.94, p = .07 for contralateral (M = 0.00, SD = 5.43) and ipsilateral (M = +7.95 dB, SD = 11.52) procedures performed by surgeons with experience of 10 years or more, a mean hearing gain of +7 dB in the ipsilateral group compared to 0 dB in the contralateral group was notable. Conclusion: This study did not prove that regardless of surgeon experience, right-handed surgeons operating on the right ear and left-handed surgeons operating on the left ear have better ear surgery outcomes of operative duration and hearing improvement compared to right- handed surgeons operating on the left ear and left-handed surgeons operating on the right ear. Future studies on larger samples with more complete data may yet demonstrate this effect.

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A Three Point Assessment Protocol for Tympanoplasty Outcomes: A Retrospective Analysis

International Archives of Otorhinolaryngology ◽

10.1055/s-0039-3402432 ◽

2020 ◽

Vol 24 (04) ◽

pp. e438-e443

Author(s):

P. Naina ◽

Apar Pokharel ◽

Kamran Asif Syed ◽

Mary John ◽

Ajoy Mathew Varghese ◽

...

Keyword(s):

Retrospective Analysis ◽

Otitis Media ◽

Surgical Outcome ◽

Pediatric Population ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Factors Affecting ◽

Assessment Protocol ◽

Membrane Perforation ◽

The Status

Abstract Introduction The surgical outcome of chronic otitis media (COM) of the mucosal type in the pediatric population with high rates of recurrent tympanic membrane perforation is indeed a concern for the attending surgeon. Objective The present study was done to evaluate the outcome of tympanoplasty in children with chronic otitis media mucosal type. Methods A retrospective analysis of the medical records of all children, aged < 16 years old, who underwent tympanoplasty for COM of the mucosal type was performed. These patients were addressed by a three-point assessment, for predicting outcome of tympanoplasty, which included the age of the patient, addressing the nasal/pharyngeal issues, and the status of the COM (discharging or dry). Surgical success was assessed in terms of graft uptake and improvement of hearing. Factors affecting the surgical outcome were also analyzed. Results A total of 90 children underwent type 1 tympanoplasty; 7 were lost to follow-up and 10 had incomplete audiometric results. In the 73 tympanoplasties analyzed, graft uptake was seen in 91.7% of the patients. Children with longer duration of ear discharge (> 8 years) had greater hearing loss. Children aged > 8 years old showed statistically significant higher chance of graft uptake (p = 0.021). Five of the six children who had graft rejection had bilateral disease. Conclusion A three-point assessment in the management of pediatric COM of the mucosal type offers good outcomes with post-tympanoplasty graft uptake rates > 90%.

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Inlay butterfly versus underlay cartilage tympanoplasty

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00174-x ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Osama Hassan ◽

Mena Esmat ◽

Mohamed Salah ◽

Mohamed El Shazly

Keyword(s):

Tympanic Membrane ◽

Patient Comfort ◽

Middle Ear Surgery ◽

Graft Material ◽

Hearing Improvement ◽

Gap Closure ◽

Graft Take ◽

Significant Difference ◽

Cartilage Tympanoplasty ◽

Group A

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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A study of surgical outcomes of myringoplasty in active and inactive ears

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175616 ◽

2017 ◽

Vol 4 (1) ◽

pp. 148

Author(s):

Vasim Ismail Patel ◽

N. H. Kulkarni ◽

Jyothi A. C. ◽

ShriKrishna B. H.

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Group Differences ◽

Hearing Improvement ◽

Ear Surgery ◽

Hearing Gain ◽

Gain Rate ◽

Graft Take ◽

Cortical Mastoidectomy ◽

Widespread Belief

Background: Chronic otitis media (COM) can present with inactive (dry) and active (wet) ear. It’s an accepted fact that an actively draining central perforation is not a contraindication for ear surgery. The discharging ear presents the otologists with the dilemma of operating on it or not, this is due to widespread belief that the success rate while doing ear surgeries on active ears is decidedly inferior. Hence the present study is intended to find the outcome of ear surgeries in inactive and active ear with objective to find the incidence of graft uptake and hearing improvement in both the groups.Methods: A total of 50 active ear (with mucoid discharge) and 52 inactive ears (not discharging at least 3 month before surgery) with mucosal chronic otitis media underwent myringoplasty with cortical mastoidectomy. Graft take and hearing gain rates 3 and 6 months after surgery were calculated for both groups and compared. Results: The graft take rate was 90% for the active ear group and 94% for the inactive ear group. The hearing gain rate was 90% for the active ear group and 94% for the inactive ear group. Differences were found to be statistically insignificant for both graft intake (p=0.461) and hearing gain (p=0.543).Conclusions: The success of myringoplasty is not adversely affected by the presence of mucoid ear discharge at time of surgery, and outcomes are comparable to those of the opration done for inactive ears.

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Endoscopic Type 1 Tympanoplasty in Chronic Otitis Media: Comparative Study with a Postauricular Microscopic Approach

Otolaryngology ◽

10.1177/0194599819838778 ◽

2019 ◽

Vol 161 (2) ◽

pp. 315-323 ◽

Cited By ~ 6

Author(s):

Masafumi Ohki ◽

Shigeru Kikuchi ◽

Sunao Tanaka

Keyword(s):

Success Rate ◽

Otitis Media ◽

Middle Ear ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Surgical Time ◽

Ear Surgery ◽

Surgical Success ◽

Membrane Perforation

ObjectiveTo compare surgical outcomes after tympanoplasty without ossiculoplasty for chronic otitis media between transcanal endoscopic ear surgery (TEES) and postauricular microscopic ear surgery (PAMES).Study DesignCase-control study.SettingTertiary care university hospital.Subjects and MethodsConsecutive patients ( N = 122) who had undergone tympanoplasty without ossiculoplasty for chronic otitis media were enrolled in this retrospective study and divided into 2 groups: TEES (n = 47) and PAMES (n = 75). Middle ear condition was graded with the middle ear risk index. Hearing, repair of tympanic membrane perforation, and surgical time were assessed.ResultsThe surgical success rate for hearing (air-bone gap ≤20 dB) was 95.7% in the TEES group and 84.0% in the PAMES group. Lower middle ear risk resulted in similar mean (95% CI) closure of air-bone gaps (TEES: 9.6, 6.5-12.6; PAMES: 8.0, 6.4-9.7; P = .333), whereas higher middle ear risk demonstrated significantly larger closure of air-bone gaps for the TEES group (10.1, 3.3-16.9) than the PAMES group (–0.2, –4.5 to 4.2; P = .009). The surgical success rate for repair of tympanic membrane perforation and surgical time were equivalent between TEES and PAMES.ConclusionUnder favorable conditions of the middle ear, TEES and PAMES resulted in similar hearing improvement by tympanoplasty without ossiculoplasty. However, under adverse conditions of the middle ear, TEES was a more beneficial approach for hearing improvement than PAMES.

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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.

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Factors affecting hearing results after stapes surgery

The Journal of Laryngology & Otology ◽

10.1017/s0022215100144123 ◽

1999 ◽

Vol 113 (5) ◽

pp. 417-421 ◽

Cited By ~ 19

Author(s):

Hiromi Ueda ◽

Takashi Miyazawa ◽

Kiyomitsu Asahi ◽

Noriyuki Yanagita

Keyword(s):

Middle Ear ◽

Oval Window ◽

Stapes Surgery ◽

Study Group ◽

Hearing Results ◽

Factors Affecting ◽

Hearing Gain ◽

Close Relationship

AbstractFactors affecting auditory improvement after stapes surgery were investigated retrospectively on a study group of 106 otosclerotic ears (86 subjects). While the closure of the air-bone (A-B) gap after surgery was good at 2 kHz and 4 kHz, it was poor at 8 kHz and at frequencies lower than 1 kHz. Under 1 kHz, the lower the frequency, the worse the A-B gap after surgery. Stapedotomy and partial stapedectomy showed better post-operative hearing gain at 4 kHz than total stapedectomy. Total stapedectomy scored significantly better at 250 Hz and 500 Hz than stapedotomy. There was a close relationship between the pre-operative and post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at these frequencies. It was speculated that otosclerotic ears with a larger pre-operative airbone gap might have another lesion in the middle ear other than the oval window.

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Evaluasi Pendengaran Pasien Pascatindakan Miringoplasti Berdasarkan Gambaran Audiometri Nada Murni di Rumah Sakit Dr. Hasan Sadikin Bandung

Journal Of Medicine & Health ◽

10.28932/jmh.v3i1.3171 ◽

2021 ◽

Vol 3 (1) ◽

pp. 9-15

Author(s):

Anggie Mutmainnah ◽

Arif Dermawan ◽

Lina Lasminingrum

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Hearing Threshold ◽

Pure Tone Audiometry ◽

Descriptive Study ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Membrane Perforation ◽

Ear Infections ◽

Age Range

Tympanic membrane perforation is one of the causes of hearing loss and can causerecurrent middle ear infections. Myringoplasty is a procedure for reconstruction of the tympanicmembrane perforation by using a ring in the ear with a complete hearing bone chain, goodmotion, and no pathological tissue in the middle ear. Myringoplasty aims to improve hearingfunction and prevent recurrent infections of the middle ear and inner ear. This study aimed tofind out the hearing characteristics of patients after myringoplasty based on an image of pure tone audiometry in the THT-KL Poli RSHS Bandung period January - December 2016. This is aretrospective descriptive study of patients undergoing myringoplasty. There were 285 new casesof tympanic membrane perforation with an age range of 15-55 years; 153 men (53.7%), 132women (46.3%), 109 (50.27%) patients had an increase in the hearing threshold of 10.1 dB - 20dB, reaching a normal hearing threshold of 249 (87, 4%) patients, and closure of perforationwere 254 (89.1%) patients. In a conclusion, there was a good hearing improvement aftermyringoplasty on tympanic membrane perforation without other abnormalities. Keywords: Myringoplasty, perforation of the tympanic membrane, increased hearing threshold.

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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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