Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoreti...Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss.With the advent of modern surgical instruments and surgical techniques,the risk is expected to be lower.This study compares the clinical outcomes in typeⅠtympanoplasty performed simultaneously and sequentially.Materials&methods:This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017.A total of 30 patients were divided into two groups of 15 each.This study analyzed the graft uptake,pure tone audiogram findings pre-and post-operatively,duration of surgery and number of hospital visit for each patient and the outco mes were co mpared between both the groups.Result:Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty.Graft uptake and postoperative wound infections were similar in both the groups.Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group.However,further studies are needed to authenticate this observation.None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.Conclusion:Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty,especially in terms of operating time,follow-up and overall financial implications on the patient.展开更多
Several technical variations of tympanoplasty have been reported,usually involving the type of graft and/or instruments used.Few studies have focused on the outcome of type-1 tympanoplasty specifically in teaching sce...Several technical variations of tympanoplasty have been reported,usually involving the type of graft and/or instruments used.Few studies have focused on the outcome of type-1 tympanoplasty specifically in teaching scenarios.We aimed to describe the results of type-1 tympanoplasty performed by residents,and to investigate potential predictive factors of surgical success.To do so,we did a retrospective analysis of medical records of patients who underwent type-1 tympanoplasty in a tertiary university hospital.We evaluated the tympanic membrane closure and audiometric outcomes during the first year of follow-up,and compared the results according to some clinical and surgical factors.130 operated ears were included in the study.The closure rate reached 84.12%after one month and 72.72%after twelve months of surgery.The mean air-bone gap was 22.98 dB preoperatively,and reached 10.55 dB after surgery.Perforation closure rates were 85%and 57.14%for those operated by endoscopic and microscopic-assisted approaches,respectively(p?0.004).The use of cartilage grafts and time without otorrhea of more than three months prior to surgery were also predictors of surgical success(p?0.002 and 0.041,respectively).Gender,age,perforation size,contralateral disease,operated side,reoperation,and degree of hearing loss did not significantly interfere with outcomes.Tympanoplasty showed good overall results when performed by residents,although inferior to those reported by experienced surgeons.The use of the endoscope,cartilage grafting,and longer preoperative time without otorrhea were predictors of surgical success in this scenario.展开更多
Objective:Various materials have been used for tympanic membrane reconstruction in middle ear surgery.This study aimed to evaluate the difference between the tragal perichondrium and COOK arti-ficial material in patie...Objective:Various materials have been used for tympanic membrane reconstruction in middle ear surgery.This study aimed to evaluate the difference between the tragal perichondrium and COOK arti-ficial material in patients who underwent endoscopic type 1 tympanoplasty.Method:This retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Patients were divided into group A(tragal perichondrium)and group B(COOK artificial material)ac-cording to the material used in the operation.All patients were followed up for 6 months.The differences in age,gender,operation site,disease course,preoperative air-bone gap(ABG),operation time,blood loss,hearing gain,and wound healing rate were compared between the two groups.Results:This study enrolled 197 patients,with 120 patients in group A and 77 patients in group B.There were no significant differences in age,gender,operation site,disease course,or preoperative ABG be-tween groups A and B(p>0.05).Both groups had significant postoperative improvement in hearing(group A:30.98±9.58 dB vs.17.07±9.92 dB,p<0.001;group B:29.75±7.52 dB vs.14.25±9.07 dB,p<0.001).The mean hearing gain in group A and group B was comparable(14.02±11.91 dB vs.15.50±7.05 dB,p=0.609).The wound healing rates of groups A and B were no differences(93.33%vs.87.01%,p=0.133).The patients in group B had a shorter operation duration(72.57±11.32 min vs.61.86±9.27 min,p=0.045)and less blood loss(12.38±3.7 mL vs.8.10±2.43 mL,p=0.004).Conclusions:Tragal perichondrium and COOK artificial material are reliable for functional and anatomical outcomes in endoscopic type 1 tympanoplasty,and COOK artificial material can save operation time and blood loss in surgery compared to the tragal perichondrium.展开更多
Objective The aim of this article is to research the radical mastoidectomy and primary tympanoplasty to attain radical cure of the mastoid focus as well as rebuilding the sound-conducting structure of the tympanic cav...Objective The aim of this article is to research the radical mastoidectomy and primary tympanoplasty to attain radical cure of the mastoid focus as well as rebuilding the sound-conducting structure of the tympanic cavity to improve the audition. Method The autobone and temporal fascia were taken as the transplants after the radical mastoidectomy under microscopy, and then to carry out the operation of Portmann`s tempanoplasty of 2nd and 3rd types of 2nd class.Result Non of the cholesteatoma was relapsed after follow-up for 1～4 years.The efficiency rate of tympanoplasty is of 89.47%.The average audition increased was 19 dB HL. Conclussion Radical operation for cholesteatoma should be associated with tympanoplasty if having condition. We recommend that the opening tympanoplasty should be used, and use autobone as a artificial auditory ossicles.展开更多
Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area...Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.展开更多
Objectives:The aim of this paper is to review how successful each type of grafts is in tympanoplasty.Methods:Pubmed,Google and the Proquest Central Database at Kırıkkale University were queried using the keywords“gr...Objectives:The aim of this paper is to review how successful each type of grafts is in tympanoplasty.Methods:Pubmed,Google and the Proquest Central Database at Kırıkkale University were queried using the keywords“graft”,“success”“tympanoplasty”,“success rate”with the search limited to the period 1955 to 2017.Results:Various types of graft materials including temporalis fascia,cartilage,perichondrium,periosteum,vein,fat or skin have been used in the reconstruction of tympanic membrane(TM)perforation.Although temporalis fascia ensures good hearing is restored,there are significant concerns that its dimensional stability characteristics may lead to residual perforation,especially where large TM perforations are involved.The“palisade cartilage”and“cartilage island”techniques have been stated to increase the strength and stability of a tympanic graft,but they may result in a less functional outcome in terms of restoring hearing.Smoking habits,the size and site of a perforation,the expertise level of the operating surgeon,age,gender,the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is.Conclusion:Although temporal fascia is the most commonly used graft material for tympanoplasty,poor graft stability may cause failure.This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia.Cartilage grafts offer better ability to resist infection,pressure,and cope with insufficient vascular supply.This means that cartilage grafts are suitable for use in revision cases.展开更多
Tympanomastoid surgery for cholesteatoma is a procedure designed to eliminate the disease and maintain a safe and dry ear. This retrospective study was designed to evaluate the functional results of cholesteatoma pati...Tympanomastoid surgery for cholesteatoma is a procedure designed to eliminate the disease and maintain a safe and dry ear. This retrospective study was designed to evaluate the functional results of cholesteatoma patients who underwent canal wall down mastoidectomy in conjunction with a tympanoplasty. Operated ears due to chronic otitis media with cholesteatoma were considered for the study. The study was carried out in 120 ears. The choice of technique for tympanoplasty is based on the pathology encountered in the stapes superstructure. Patients were divided into three: 1) Group A, a type II TPL with stapes columella reconstruction;2) Group B, a type III TPL with major columella reconstruction;and 3) Group C, a type IV TPL using a temporalis fascia and thick cartilage to shield the round window. The operated ears of Groups A and B, as compared to Group C, presented a significant decrease in the pre-operative Air-bone gap and an increase in the number of operated ears with an Air-bone gap between 0 - 20 dB. The study emphasizes the importance of functional separation of the two acoustic windows by fascia and cartilage graft when the stapes superstructure is missing but the footplate is mobile.展开更多
Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforation...Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforations over 5 years follow-up period.Materials and methods:This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations.The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade(CP group)or temporalis fascia(TF group)as the graft via a transmeatal approach and under local anesthesia.Morphological and functional results were recorded at three-and five years follow-up.Demographic profiles including age and sex,surgery side,contralateral disease and graft uptake rate,as well as hearing outcomes,were compared between the two groups.Results:At three years follow-up,graft uptake was 94.87%for perichondrium reinforced cartilage palisade and 80.7%for fascia,respectively,(p¼0.67).At five years follow-up,the uptake rate dropped to 87.17%in the CP group,but to 66.6%in the TF group(p¼0.019).Hearing improved after surgery in both groups,and showed no significant difference between the two groups.Conclusion:Over long-term,perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results.展开更多
Background In many European and American hospitals, represented by the House Ear Clinic(HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if...Background In many European and American hospitals, represented by the House Ear Clinic(HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay technique is used rarely. The aim of the current study was to report the authors' experience with overlay tympanoplasty in 83 Chinese patients and study its value. Methods Eight-three patients(86 ears) underwent overlay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane morphology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterioration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chronic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure,thorough disease elimination and extensive adaptation.展开更多
In 1994, the American Otological Society reported favourable experience with composite cartilage shield tympanoplasty. The tragal cartilage with a grommet inserted in it was used for tympanoplasty in our patient with ...In 1994, the American Otological Society reported favourable experience with composite cartilage shield tympanoplasty. The tragal cartilage with a grommet inserted in it was used for tympanoplasty in our patient with unilateral CSOM, supposedly because of severe chronic eustachian tube dysfunction. The marriage of cartilage tympanoplasty with grommet insertion was aimed to add the advantages and abolish the disadvantages of both the procedures. In 1990 Lary Hall first introduced the “long term ventilation of the middle ear” with a T-tube placed in the tragal cartilage perichondrium composite island graft. T-tube insertion in the cartilage has been described. But insertion of the Indian Sheperds grommet (ventilation tube) in the cartilage graft as described in this case and its technique are possibly the first of its kinds in literature. The report is aimed to ignite innovation of newer and better techniques of cartilage tympanoplasty.展开更多
The triple-c cartilage tympanoplasty i.e. (composite chondroperichondrial clip) technique was devised by Fernandes in 2003. Objectives: The objective of our case series was to assess the success rate and efficacy of t...The triple-c cartilage tympanoplasty i.e. (composite chondroperichondrial clip) technique was devised by Fernandes in 2003. Objectives: The objective of our case series was to assess the success rate and efficacy of the triple-c cartilage tympanoplasty by transcanal approach. Study Design: A retrospective analysis of patients subjected to the technique was conducted. Methods: 20 cases who met the inclusion criteria were assessed by otomicroscopy and pure tone audiometry before and 2 months after the surgery. Results: All patients had complete take-up of the graft and a hearing improvement which was statistically significant. Conclusions: Thus the triple-c technique provides an effective method of closing nonmarginal perforations of the tympanic membrane.展开更多
Objective:Tympanoplasty aims to eradicate lesions and restore middle ear function in chronic otitis media.This study was conducted to compare the surgical and functional outcomes of endoscopic tympanoplasty(ET)and mic...Objective:Tympanoplasty aims to eradicate lesions and restore middle ear function in chronic otitis media.This study was conducted to compare the surgical and functional outcomes of endoscopic tympanoplasty(ET)and microscopic tympanoplasty(MT)in anterior tympanic membrane perforation.Methods:The clinical data of 42 patients undergoing tympanoplasty with anterior quadrants tympanic membrane perforation between January 2018 and July 2019 were retrospectively analyzed.Patients were classified into the ET group(n?22)or the MT group(n?20).Patients’demographics,clinical characteristics,surgical and functional outcomes were assessed between the two groups.Results:External auditory canal widening was not necessary in the ET group and was performed in 55.0%of patients in the MT group.The operation time of the ET group was significantly shorter than that of the MT group(61.23±11.48 min vs.78.65±11.79 min,p=0.034).The pain scale score of the ET group at 24 hours after surgery was significantly lower than that of the MT group(0.86±0.64 vs.2.40±1.14,p=0.029).The grafting success rate was 95.5%(21/22)in the ET group and 95.0%(19/20)in the MT group.In the ET group,the pre-and postoperative air-bone gap were 35.60±8.43 dB and 18.79±5.80 dB,respectively,which was a significant improvement(p=0.016).The respective values in the MT group(33.33±7.88 dB and 19.58±6.24 dB)also represented a significant improvement(p=0.004).Conclusion:ET is more beneficial for patients with anterior tympanic membrane perforations,which helps minimize the surgical trauma and reduces operation time and postoperative pain.展开更多
Objectives:To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.Methods:Retrospective review of single surgeon experience.Results:During a 3 year period,...Objectives:To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.Methods:Retrospective review of single surgeon experience.Results:During a 3 year period,30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts.There were 22 boys and 8 girls,ranging in age from 3.5 to 17 years (median 6 years).All tragal cartilage grafts (31/31;100％) survived.Twenty-seven surgeries (27/31;82％) resulted in an intact drum (17/31;55％) or a microperforation (10/31;32％).In four cases (4/31;13％) significant perforations formed in previously unaffected portions of the drum.Conclusion:Transcanal endoscopic cartilage inlay tympanoplasty offers a practical,minimally invasive approach to tympanoplasty for children of any age.It avoids postauricular or endaural incisions,tympanomeatal flap elevation,and canalplasty.Graft survival is uniform.Microperforation at the graft margins remained in 1/3 of children.Technical modifications may lead to higher rates of tympanic closure.展开更多
Objective: To investigate the changes of bone auditory thresholds variations in cholesteatoma middle ear surgery and its related factors and its related factors. Methods: 122 cases (122 ears) of unilateral cholesteato...Objective: To investigate the changes of bone auditory thresholds variations in cholesteatoma middle ear surgery and its related factors and its related factors. Methods: 122 cases (122 ears) of unilateral cholesteatoma otitis media were treated by mastoidectomy and/or tympanoplasty plus stage I tympanoplasty, and tragus cartilage ring-cartilage membrane (Referred to as cartilage group, 62 ears) and temporalis muscle fascia (Referred to as fascia group, 60 ears) were used as tympanic membrane grafts respectively. The changes of bone conduction hearing threshold were compared between the two groups before and 1, 3, 6 months and 1, 3 years after operation. And compare the difference in the incidence of ossicular chain fixation or necrosis, vestibular window or cochlear window dysfunction between the two groups of patients with increased (positive) and decreased (negative) bone conduction threshold before operation. Results: Compared with the healthy side, 95 ears of 122 ears in the two groups had higher bone conduction hearing threshold before operation. Among them, 48 ears were in cartilage group and 47 ears were in fascia group;In 72 ears (76.34%) of these cases, the bone conduction hearing threshold decreased after operation, and the difference between the two groups was statistically significant (P Conclusion: The improvement of bone conduction hearing threshold in patients with cholesteatoma otitis media is mainly related to the fixation or necrosis of ossicular chain and the dysfunction of two windows. The tragus cartilage ring-perichondrium tympanoplasty can not only reduce the air-bone conduction difference, but also reduce the bone conduction hearing threshold, which has the advantage of stable and lasting hearing improvement.展开更多
文摘Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss.With the advent of modern surgical instruments and surgical techniques,the risk is expected to be lower.This study compares the clinical outcomes in typeⅠtympanoplasty performed simultaneously and sequentially.Materials&methods:This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017.A total of 30 patients were divided into two groups of 15 each.This study analyzed the graft uptake,pure tone audiogram findings pre-and post-operatively,duration of surgery and number of hospital visit for each patient and the outco mes were co mpared between both the groups.Result:Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty.Graft uptake and postoperative wound infections were similar in both the groups.Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group.However,further studies are needed to authenticate this observation.None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.Conclusion:Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty,especially in terms of operating time,follow-up and overall financial implications on the patient.
文摘Several technical variations of tympanoplasty have been reported,usually involving the type of graft and/or instruments used.Few studies have focused on the outcome of type-1 tympanoplasty specifically in teaching scenarios.We aimed to describe the results of type-1 tympanoplasty performed by residents,and to investigate potential predictive factors of surgical success.To do so,we did a retrospective analysis of medical records of patients who underwent type-1 tympanoplasty in a tertiary university hospital.We evaluated the tympanic membrane closure and audiometric outcomes during the first year of follow-up,and compared the results according to some clinical and surgical factors.130 operated ears were included in the study.The closure rate reached 84.12%after one month and 72.72%after twelve months of surgery.The mean air-bone gap was 22.98 dB preoperatively,and reached 10.55 dB after surgery.Perforation closure rates were 85%and 57.14%for those operated by endoscopic and microscopic-assisted approaches,respectively(p?0.004).The use of cartilage grafts and time without otorrhea of more than three months prior to surgery were also predictors of surgical success(p?0.002 and 0.041,respectively).Gender,age,perforation size,contralateral disease,operated side,reoperation,and degree of hearing loss did not significantly interfere with outcomes.Tympanoplasty showed good overall results when performed by residents,although inferior to those reported by experienced surgeons.The use of the endoscope,cartilage grafting,and longer preoperative time without otorrhea were predictors of surgical success in this scenario.
文摘Objective:Various materials have been used for tympanic membrane reconstruction in middle ear surgery.This study aimed to evaluate the difference between the tragal perichondrium and COOK arti-ficial material in patients who underwent endoscopic type 1 tympanoplasty.Method:This retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Patients were divided into group A(tragal perichondrium)and group B(COOK artificial material)ac-cording to the material used in the operation.All patients were followed up for 6 months.The differences in age,gender,operation site,disease course,preoperative air-bone gap(ABG),operation time,blood loss,hearing gain,and wound healing rate were compared between the two groups.Results:This study enrolled 197 patients,with 120 patients in group A and 77 patients in group B.There were no significant differences in age,gender,operation site,disease course,or preoperative ABG be-tween groups A and B(p>0.05).Both groups had significant postoperative improvement in hearing(group A:30.98±9.58 dB vs.17.07±9.92 dB,p<0.001;group B:29.75±7.52 dB vs.14.25±9.07 dB,p<0.001).The mean hearing gain in group A and group B was comparable(14.02±11.91 dB vs.15.50±7.05 dB,p=0.609).The wound healing rates of groups A and B were no differences(93.33%vs.87.01%,p=0.133).The patients in group B had a shorter operation duration(72.57±11.32 min vs.61.86±9.27 min,p=0.045)and less blood loss(12.38±3.7 mL vs.8.10±2.43 mL,p=0.004).Conclusions:Tragal perichondrium and COOK artificial material are reliable for functional and anatomical outcomes in endoscopic type 1 tympanoplasty,and COOK artificial material can save operation time and blood loss in surgery compared to the tragal perichondrium.
文摘Objective The aim of this article is to research the radical mastoidectomy and primary tympanoplasty to attain radical cure of the mastoid focus as well as rebuilding the sound-conducting structure of the tympanic cavity to improve the audition. Method The autobone and temporal fascia were taken as the transplants after the radical mastoidectomy under microscopy, and then to carry out the operation of Portmann`s tempanoplasty of 2nd and 3rd types of 2nd class.Result Non of the cholesteatoma was relapsed after follow-up for 1～4 years.The efficiency rate of tympanoplasty is of 89.47%.The average audition increased was 19 dB HL. Conclussion Radical operation for cholesteatoma should be associated with tympanoplasty if having condition. We recommend that the opening tympanoplasty should be used, and use autobone as a artificial auditory ossicles.
文摘Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.
文摘Objectives:The aim of this paper is to review how successful each type of grafts is in tympanoplasty.Methods:Pubmed,Google and the Proquest Central Database at Kırıkkale University were queried using the keywords“graft”,“success”“tympanoplasty”,“success rate”with the search limited to the period 1955 to 2017.Results:Various types of graft materials including temporalis fascia,cartilage,perichondrium,periosteum,vein,fat or skin have been used in the reconstruction of tympanic membrane(TM)perforation.Although temporalis fascia ensures good hearing is restored,there are significant concerns that its dimensional stability characteristics may lead to residual perforation,especially where large TM perforations are involved.The“palisade cartilage”and“cartilage island”techniques have been stated to increase the strength and stability of a tympanic graft,but they may result in a less functional outcome in terms of restoring hearing.Smoking habits,the size and site of a perforation,the expertise level of the operating surgeon,age,gender,the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is.Conclusion:Although temporal fascia is the most commonly used graft material for tympanoplasty,poor graft stability may cause failure.This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia.Cartilage grafts offer better ability to resist infection,pressure,and cope with insufficient vascular supply.This means that cartilage grafts are suitable for use in revision cases.
文摘Tympanomastoid surgery for cholesteatoma is a procedure designed to eliminate the disease and maintain a safe and dry ear. This retrospective study was designed to evaluate the functional results of cholesteatoma patients who underwent canal wall down mastoidectomy in conjunction with a tympanoplasty. Operated ears due to chronic otitis media with cholesteatoma were considered for the study. The study was carried out in 120 ears. The choice of technique for tympanoplasty is based on the pathology encountered in the stapes superstructure. Patients were divided into three: 1) Group A, a type II TPL with stapes columella reconstruction;2) Group B, a type III TPL with major columella reconstruction;and 3) Group C, a type IV TPL using a temporalis fascia and thick cartilage to shield the round window. The operated ears of Groups A and B, as compared to Group C, presented a significant decrease in the pre-operative Air-bone gap and an increase in the number of operated ears with an Air-bone gap between 0 - 20 dB. The study emphasizes the importance of functional separation of the two acoustic windows by fascia and cartilage graft when the stapes superstructure is missing but the footplate is mobile.
文摘Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforations over 5 years follow-up period.Materials and methods:This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations.The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade(CP group)or temporalis fascia(TF group)as the graft via a transmeatal approach and under local anesthesia.Morphological and functional results were recorded at three-and five years follow-up.Demographic profiles including age and sex,surgery side,contralateral disease and graft uptake rate,as well as hearing outcomes,were compared between the two groups.Results:At three years follow-up,graft uptake was 94.87%for perichondrium reinforced cartilage palisade and 80.7%for fascia,respectively,(p¼0.67).At five years follow-up,the uptake rate dropped to 87.17%in the CP group,but to 66.6%in the TF group(p¼0.019).Hearing improved after surgery in both groups,and showed no significant difference between the two groups.Conclusion:Over long-term,perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results.
文摘Background In many European and American hospitals, represented by the House Ear Clinic(HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay technique is used rarely. The aim of the current study was to report the authors' experience with overlay tympanoplasty in 83 Chinese patients and study its value. Methods Eight-three patients(86 ears) underwent overlay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane morphology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterioration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chronic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure,thorough disease elimination and extensive adaptation.
文摘In 1994, the American Otological Society reported favourable experience with composite cartilage shield tympanoplasty. The tragal cartilage with a grommet inserted in it was used for tympanoplasty in our patient with unilateral CSOM, supposedly because of severe chronic eustachian tube dysfunction. The marriage of cartilage tympanoplasty with grommet insertion was aimed to add the advantages and abolish the disadvantages of both the procedures. In 1990 Lary Hall first introduced the “long term ventilation of the middle ear” with a T-tube placed in the tragal cartilage perichondrium composite island graft. T-tube insertion in the cartilage has been described. But insertion of the Indian Sheperds grommet (ventilation tube) in the cartilage graft as described in this case and its technique are possibly the first of its kinds in literature. The report is aimed to ignite innovation of newer and better techniques of cartilage tympanoplasty.
文摘The triple-c cartilage tympanoplasty i.e. (composite chondroperichondrial clip) technique was devised by Fernandes in 2003. Objectives: The objective of our case series was to assess the success rate and efficacy of the triple-c cartilage tympanoplasty by transcanal approach. Study Design: A retrospective analysis of patients subjected to the technique was conducted. Methods: 20 cases who met the inclusion criteria were assessed by otomicroscopy and pure tone audiometry before and 2 months after the surgery. Results: All patients had complete take-up of the graft and a hearing improvement which was statistically significant. Conclusions: Thus the triple-c technique provides an effective method of closing nonmarginal perforations of the tympanic membrane.
文摘Objective:Tympanoplasty aims to eradicate lesions and restore middle ear function in chronic otitis media.This study was conducted to compare the surgical and functional outcomes of endoscopic tympanoplasty(ET)and microscopic tympanoplasty(MT)in anterior tympanic membrane perforation.Methods:The clinical data of 42 patients undergoing tympanoplasty with anterior quadrants tympanic membrane perforation between January 2018 and July 2019 were retrospectively analyzed.Patients were classified into the ET group(n?22)or the MT group(n?20).Patients’demographics,clinical characteristics,surgical and functional outcomes were assessed between the two groups.Results:External auditory canal widening was not necessary in the ET group and was performed in 55.0%of patients in the MT group.The operation time of the ET group was significantly shorter than that of the MT group(61.23±11.48 min vs.78.65±11.79 min,p=0.034).The pain scale score of the ET group at 24 hours after surgery was significantly lower than that of the MT group(0.86±0.64 vs.2.40±1.14,p=0.029).The grafting success rate was 95.5%(21/22)in the ET group and 95.0%(19/20)in the MT group.In the ET group,the pre-and postoperative air-bone gap were 35.60±8.43 dB and 18.79±5.80 dB,respectively,which was a significant improvement(p=0.016).The respective values in the MT group(33.33±7.88 dB and 19.58±6.24 dB)also represented a significant improvement(p=0.004).Conclusion:ET is more beneficial for patients with anterior tympanic membrane perforations,which helps minimize the surgical trauma and reduces operation time and postoperative pain.
文摘Objectives:To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.Methods:Retrospective review of single surgeon experience.Results:During a 3 year period,30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts.There were 22 boys and 8 girls,ranging in age from 3.5 to 17 years (median 6 years).All tragal cartilage grafts (31/31;100％) survived.Twenty-seven surgeries (27/31;82％) resulted in an intact drum (17/31;55％) or a microperforation (10/31;32％).In four cases (4/31;13％) significant perforations formed in previously unaffected portions of the drum.Conclusion:Transcanal endoscopic cartilage inlay tympanoplasty offers a practical,minimally invasive approach to tympanoplasty for children of any age.It avoids postauricular or endaural incisions,tympanomeatal flap elevation,and canalplasty.Graft survival is uniform.Microperforation at the graft margins remained in 1/3 of children.Technical modifications may lead to higher rates of tympanic closure.
文摘Objective: To investigate the changes of bone auditory thresholds variations in cholesteatoma middle ear surgery and its related factors and its related factors. Methods: 122 cases (122 ears) of unilateral cholesteatoma otitis media were treated by mastoidectomy and/or tympanoplasty plus stage I tympanoplasty, and tragus cartilage ring-cartilage membrane (Referred to as cartilage group, 62 ears) and temporalis muscle fascia (Referred to as fascia group, 60 ears) were used as tympanic membrane grafts respectively. The changes of bone conduction hearing threshold were compared between the two groups before and 1, 3, 6 months and 1, 3 years after operation. And compare the difference in the incidence of ossicular chain fixation or necrosis, vestibular window or cochlear window dysfunction between the two groups of patients with increased (positive) and decreased (negative) bone conduction threshold before operation. Results: Compared with the healthy side, 95 ears of 122 ears in the two groups had higher bone conduction hearing threshold before operation. Among them, 48 ears were in cartilage group and 47 ears were in fascia group;In 72 ears (76.34%) of these cases, the bone conduction hearing threshold decreased after operation, and the difference between the two groups was statistically significant (P Conclusion: The improvement of bone conduction hearing threshold in patients with cholesteatoma otitis media is mainly related to the fixation or necrosis of ossicular chain and the dysfunction of two windows. The tragus cartilage ring-perichondrium tympanoplasty can not only reduce the air-bone conduction difference, but also reduce the bone conduction hearing threshold, which has the advantage of stable and lasting hearing improvement.
