Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, p=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

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Myringoplasty: a comparison of bismuth iodoform paraffin paste gauze pack and tri-adcortyl ointment ear dressing

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002660 ◽

2006 ◽

Vol 121 (4) ◽

pp. 329-332 ◽

Cited By ~ 13

Author(s):

V Nakhla ◽

Y M Takwoingi ◽

A Sinha

Keyword(s):

Retrospective Study ◽

Success Rate ◽

Tympanic Membrane ◽

Surgical Approach ◽

Suitable Alternative ◽

Significant Difference ◽

Study Population ◽

The Mean ◽

Gauze Pack

Objectives: To assess the myringoplasty graft take rate, comparing two methods of post-operative ear packing: bismuth iodoform paraffin paste (BIPP) gauze versus tri-adcortyl ointment (TAO).Methods: A retrospective study of patients who had undergone myringoplasty at our department within a three-year period was undertaken. Data, including age, site and size of perforation, grade of surgeon, surgical approach, use of post-operative ear dressings, complications, and audiometric outcome, were collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at six months) was noted.Results: One hundred and seventy myringoplasties were performed over the study period, but data were complete on 154 patients and these constituted the study population. Age ranged from nine to 71 years (mean age 34 years) and the mean follow-up period was seven months. Consultants performed 62 per cent of the operations, with an 85 per cent success rate, whereas trainees performed the remaining 38 per cent, with a success rate of 73 per cent (p=0.059). The overall success rate was 80 per cent; 79 per cent for BIPP and 83 per cent for TAO (p=0.55), and 87 per cent for small perforations and 75 per cent for subtotal perforations (p=0.22). There was audiometric improvement in 74 per cent of cases.Conclusion: We found no significant difference in outcome between patients packed with TAO and BIPP. Packing with TAO is therefore a suitable alternative to BIPP gauze ear dressing following myringoplasty.

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TO STUDY THE OUTCOME OF PAPER PATCH MYRINGOPLASTY IN PATIENTS WITH TYMPANIC MEMBRANE PERFORATIONS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2140 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Jairaj Kumar Vaishnav

Keyword(s):

Retrospective Study ◽

Success Rate ◽

Tympanic Membrane ◽

Outpatient Setting ◽

Tympanic Membrane Perforations

Background: The aims of our study were to evaluate the outcome of office-based paper patch grafting in tympanic membrane (TM) Methods: This is a retrospective study of 50 patients that underwent paper patch myringoplasty in an outpatient setting. Results: The long-term success rate of paper patch grafting for TM perforation was 78.00% in this study Conclusion: Paper patch grafting can also be considered before formal surgical myringoplasty in the case of small, dry, chronic TM perforations. Keywords: Myringoplasty, TM, Paper patching.

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Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00076-y ◽

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.

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Surgical results and factors affecting outcome in patients with fat-graft myringoplasty

Ear Nose & Throat Journal ◽

10.1177/01455613211063243 ◽

2021 ◽

pp. 014556132110632

Author(s):

Hong Chan Kim ◽

Kyeong Suk Park ◽

Hyung Chae Yang ◽

Chul Ho Jang

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Surgical Outcomes ◽

Underlying Disease ◽

Tertiary Hospital ◽

Tympanic Membrane Perforation ◽

Fat Graft ◽

Ear Surgery ◽

Closure Rate ◽

Diabetes Status

Objectives: We evaluated the closure rate after fat-graft myringoplasty (FGM) of perforations differing in size and location. We explored whether patient’s factors and the FGM surgical technique influenced surgical outcomes. Methods: We retrospectively studied patients with tympanic membrane perforations who underwent FGM from March 2015 to March 2019. All procedures were performed by a single senior surgeon at our tertiary hospital. The patients who followed-up for at least 6 months after surgery were enrolled. We recorded hypertension and diabetes status, age, any prior ear surgery, any calcific plaques adjacent to the perforation, and perforation size and location. Results: A total of 150 patients were enrolled. Our success rate of FGM was 90%. Hypertension, diabetes, prior ear surgery history, and eardrum calcific plaques did not affect the surgical outcomes. There was no statistical difference in the surgical success rate according to the size (< 50%) or location of perforation. The closure rate was 97.2% in patients aged 1660 and 87.5% in patients aged > 60, respectively. However, FGM was successful in only two of six children (33.3%) aged ≤ 15 years, thus significantly less than in the other groups. Conclusion: FGM is a fast, safe, and efficient method for repairing tympanic membrane perforation. The surgical outcome is not significantly affected by underlying disease, perforation size or location, or by the condition of the tympanic membrane or older age. However, it may be poor in children with dysfunctional Eustachian tube.

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Hearing assessment and status of tympanic membrane pre and post-operated tympanoplasty in cases of CSOM.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4624 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2581-2585

Author(s):

Tahir Hussain x Tahir Hussain Khan ◽

Humaira Tahir ◽

Imran Ali ◽

Sohail Abdul Malik

Keyword(s):

Tympanic Membrane ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Medium Size ◽

P Value ◽

Safe Procedure ◽

Hearing Improvement ◽

Middle Ear Mucosa ◽

Tympanic Membrane Perforations ◽

Hearing Assessment

Objectives: To compare assessment of hearing by PTA and status of tympanic membrane by oto-endoscope, pre-operative and post-operative tympanoplasty. Study Design: Retrospective/ Comparative study. Setting: Two different hospitals in Karachi. 1-Social Security Landhi Hospital Karachi. 2- Al-Tibri medical College & Hospital, Old Thana, Malir, Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations. Age ranges between 18 to 40 years. Made two groups A (pre-operative and B (post-operative). In group-A, examined tympanic membrane perforations. 45 patients had small size (25%) perforations, 15 medium size (50%) and 16 subtotal (75%). Hearing assessment done by Pure tone Audiometry (PTA). After 1. 2 and 3 months post-tympanoplasty, examined grafted tympanic membrane and compared pre-operated status of tympanic membrane with post-operated status of tympanic membrane. PTA done after 3 months and compared it with pre-operated PTA. Results: Examination of tympanic membrane before tympanoplasty performed, perforations noted in all patients with different sizes in their tympanic membrane. PTA (pure tone audiometry) advised before tympanoplasty to all patients. Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Post-operated 1, 2 and 3 months examined tympanic membrane with oto-endoscope. Intact grafted tympanic membrane seen in 70 patients after 1 months. After 2 months 72 patients had intact grafted tympanic membrane and after 3 months 73 patients out of 76 patients had intact grafted tympanic membrane. PTA also advised after 3 months of tympanoplasty and compared it with pre-operated pure tone audiometry (PTA). Air conduction (AC) decreased 15.39dB after tympanoplasty. AB-gap reduction 13.95dB seen in 73 patients which showed hearing improvement. P value is < 0.001 significant. Conclusion: Tympanoplasty is a good and safe procedure for hearing improvement by reduction of AB-gap as well as provide protection of middle ear mucosa from infections due to closure of perforations of tympanic membranes.

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Surgical outcomes of acute acquired comitant esotropia of adulthood

BMC Ophthalmology ◽

10.1186/s12886-020-01793-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dae Hyun Kim ◽

Ha Jeong Noh

Keyword(s):

Success Rate ◽

Surgical Outcomes ◽

Medical Records ◽

Large Angle ◽

Sudden Onset ◽

Prism Diopter ◽

Factors Affecting ◽

The Mean ◽

Motor Outcomes

Abstract Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

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Results of inlay cartilage myringoplasty in terms of closure of central tympanic membrane perforations

The Journal of Laryngology & Otology ◽

10.1258/0022215054516188 ◽

2005 ◽

Vol 119 (8) ◽

pp. 611-613 ◽

Cited By ~ 23

Author(s):

Kamal G Effat

Keyword(s):

Retrospective Study ◽

Tympanic Membrane ◽

Control Group ◽

Temporalis Fascia ◽

Current Effort ◽

Hospital Records ◽

Tympanic Membrane Perforations ◽

The Difference ◽

A Current

There is a current effort to perform myringoplasty for tympanic membrane perforations as a day-stay procedure. In 1998, an inlay myringoplasty using tragal cartilage/perichondrium was described. A retrospective study was performed by the author to analyse the results of inlay carilage myringoplasty, in terms of closure of simple perforations of the tympanic membrane. The results of a control group of previous cases of underlay temporalis fascia myringoplasty were retrieved from the hospital records. All the operations in both groups were performed by the same author at the same institution. The operation of inlay cartilage butterfly myringoplasty has been performed in 28 ears with simple central tympanic membrane perforations. Inconsistent results have been obtained, in that only 43 per cent showed closure of the perforation at the most recent follow-up. A control group of standard underlay temporalis fascia myringoplasty has been performed by the same author in 23 ears. Eighty-three per cent of the perforations were closed at the last follow-up. The difference is statistically highly significant (p < 0.01).

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Outcome of Myringoplasty in Underlay Technique

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i2.44173 ◽

2019 ◽

Vol 24 (2) ◽

pp. 131-136

Author(s):

Md Abdur Razzak ◽

KM Mamun Murshed ◽

AKMA Sobhan ◽

Md Rakib Hossain ◽

SM Nafeez Imtiaz

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Surgical Techniques ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

College Hospital ◽

Medical College ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Age Range

Background: Myringoplasty is one of the surgical techniques for the management of chronic supportive otitis media with permanent perforation of tympanic membrane. It is defined as simple surgical repair of tympanic membrane perforation without doing ossicular reconstruction. Objective: To determine the success rate of myringoplasty and to examine whether the hearing improvement is a potential indication for surgery. Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Shaheed Suhrawardy Medical College Hospital from January 2017 to December 2017 and 100 patients who underwent myringoplasty in this period were analyzed. About 100 patients with dry central tympanic membrane perforations of various size were included in this study Results: Myringoplasty was performed in 100 patients. Male were (45%) and females were (55%).Twenty one (7%) of them belonged to age group of 10-20 years, 31 (31%) were in the age range of 21-33 years, 38(38%) were the age range 31-40 years while 24 (24%) aged between 41-50 years with mean age of 26.32 ±S.D 9.59 years. Overall success rate of graft uptake was noted in 88 (88%) out of 100 cases Conclusion: Myringoplasty is a safe surgical procedure in achieving intact tympanic membrane and to improve the hearing loss. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 131-136

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Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i3.9434 ◽

2021 ◽

Author(s):

Matthew R. Starr ◽

Edwin H. Ryan ◽

Anthony Obeid ◽

Claire Ryan ◽

Xinxiao Gao ◽

...

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Scleral Buckling ◽

Scleral Buckle ◽

Scleral Tunnel ◽

The Mean ◽

Anatomic Success

Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.

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Non-surgical approach for repairing perforations of pars tensa in tympanic membrane using TCA cauterization

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190505 ◽

2019 ◽

Vol 5 (2) ◽

pp. 299

Author(s):

Sushil Gaur ◽

Monika Patel ◽

Prince Hirdesh ◽

Vandana Singh

Keyword(s):

Acetic Acid ◽

Success Rate ◽

Tympanic Membrane ◽

Ossicular Chain ◽

Surgical Approaches ◽

Cost Burden ◽

Surgical Interventions ◽

Pars Tensa ◽

Tympanic Membrane Perforations ◽

One Year

Background: Tympanic membrane perforations occurring due to mucosal COM usually require surgical interventions for repair (myringoplasty or tympanoplasty) depending on the size and site of the perforation and the ossicular chain continuity. Various studies have shown TCA cautery as an efficacious non surgical method for repairing small and medium sized TM perforations. This technique was successfully used and popularized for repairing small and medium sized perforations by Derlacki in 1953.Methods: In this study we included dry pars tensa perforations in 100 patients occurring due to trauma or unresolved cases after inflammation/infection of middle ear. 50% w/v trichloro acetic acid was used for a maximum number of 5 applications at the margins of the perforations which were followed up for the next one year. Results: In this study, involving a total of 125 perforations (75 unilateral and 50 bilateral), success rate was high among the patients with traumatic perforations and small sized perforations while a few number of perforations only reduced in size, which were later corrected with surgical approaches (myringoplasty/tympanoplasty). The overall success rate achieved in this study was 72.16%.Conclusions: Though there are various materials and methods available for this procedure, the principle remains the same. This technique should be attempted for patients that fit the criteria for undergoing this procedure before being undertaken for surgical approaches to minimize the risks and cost burden associated with surgery and anesthesia.

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