Perforación timpánica y colesteatoma, una patología de niños y adultos / Tympanic perforation and cholesteatoma, a pathology of children and adults

INTRODUCCIÓN. La patología de oído es una enfermedad frecuente en nuestro medio, asociada a infecciones a repetición del oído, con la presencia de perforación timpánica y colesteatoma, que determinará la presencia de lesiones mucho más acentuadas en cuanto a la evolución auditiva o complicaciones locales o sistémicas. OBJETIVO. Determinar la asociación existente entre la presencia de colesteatoma y perforación timpánica en pacientes con otitis media crónica. MATERIALES Y MÉTODOS. Estudio epidemiológico analítico retrospectivo. Población de 4 733 y muestra de 75 pacientes para casos y 75 para controles basados en historias clínicas tomadas del sistema informático AS 400, que acudieron a la consulta externa de torrinolaringología del Hospital de Especialidades Carlos Andrade Marín en el periodo de enero de 2018 a diciembre de 2019; Criterios de inclusión para grupo de casos: Hombres y mujeres de 20 a 65 años de edad, diagnóstico de otitis media crónica, diagnóstico de colesteatoma ótico. Criterios de inclusión para grupo controles: Hombres y mujeres de 20 a 65 años de edad, no presentar diagnóstico de colesteatoma. RESULTADOS. Se observó una relación fuerte entre el poseer perforación timpánica y el desarrollo de colesteatoma con un valor de OR 33,14 con un IC al 95% de 31,94 ­ 34,34, con lo que se comprobó la hipótesis del estudio. Se determinó que la perforación timpánica es un factor de riesgo asociado con el desarrollo de colesteatoma en pacientes con otitis media crónica, la prevalencia de colesteatoma en relación a la edad estuvo en un 72% en pacientes de 41 a 65 años, con mayor predominancia en mujeres en un 57,3%. DISCUSIÓN. La presencia de perforación timpánica de acuerdo a lo observado es un factor de riesgo para el desarrollo de colesteatoma, ligado en su mayoría a cuadros de Otitis Media Crónica. CONCLUSIONES. Se confirmó que la perforación timpánica, es un factor de riesgo en el desarrollo del colesteatoma en los pacientes que tienen otitis media crónica, lo que demuestra la necesidad de manejo actualizado y continuo en pacientes con esta patología de oído. Se requieren estudios con muestras más amplias para determinar otros factores de riesgo como sexo, nivel de educación y edad que podrían influir en el desarrollo de colesteatoma.

INTRODUCTION. Ear pathology is a frequent disease in our environment, associated with repeated ear infections, with the presence of tympanic perforation and cholesteatoma, which will determine the presence of much more accentuated lesions in terms of auditory evolution or local or systemic complications. OBJECTIVE. To determine the association between the presence of cholesteatoma and tympanic perforation in patients with chronic otitis media. MATERIALS AND METHODS. Retrospective analytical epidemiological study. Population of 4 733 and sample of 75 patients for cases and 75 for controls based on clinical histories taken from the AS 400 computer system, who attended the Otorhinolaryngology outpatient clinic of the Carlos Andrade Marín Specialties Hospital in the period from January 2018 to December 2019; Inclusion criteria for case group: Men and women aged 20 to 65 years, diagnosis of chronic otitis media, diagnosis of otic cholesteatoma. Inclusion criteria for controls group: men and women aged 20 to 65 years, no diagnosis of cholesteatoma. RESULTS. A strong relationship was observed between having tympanic perforation and the development of cholesteatoma with an OR value of 33,14 with a 95% CI of 31,94 - 34,34, thus proving the study hypothesis. It was determined that tympanic perforation is a risk factor associated with the development of cholesteatoma in patients with chronic otitis media, the prevalence of cholesteatoma in relation to age was 72% in patients aged 41 to 65 years, with greater predominance in women in 57,3%. DISCUSSION. The presence of tympanic perforation according to what was observed is a risk factor for the development of cholesteatoma, mostly linked to Chronic Otitis Media. CONCLUSIONS. It was confirmed that tympanic perforation is a risk factor in the development of cholesteatoma in patients with chronic otitis media, which demonstrates the need for updated and continuous management in patients with this ear pathology. Studies with larger samples are required to determine other risk factors such as sex, education level and age that could influence the development of cholesteatoma.

Epidermal Growth Factor Application versus Observation on Healing of Acute Tympanic Membrane Perforations: A Randomized Open Label Clinical Trial

ABSTRACTObjective: To compare the effect of topical epidermal growth factor (EGF) instillation versus observation alone on healing of acute tympanic membrane perforations in terms of closure and hearing test results.Methods: Design: Randomized, Open label, Clinical TrialSetting: Tertiary Government Training HospitalParticipants: Seventeen (17) ENT-HNS OPD patients aged between 18 to 65 years old diagnosed with acute tympanic membrane perforation were included in the study. Group A underwent observation while group B was treated with recombinant human EGF solution. Follow- up was on a weekly basis (7th, 14th, 21st and 28th days) where video otoscopy for documentation and measurement of perforation using ImageJTM software was done. Pure tone audiometry was used to compare hearing improvement pre and post study in both observation and treatment groups.Results: At baseline, there was no significant difference in the sizes of perforations: 24.20 ± 9.95 (treatment) vs. 32.64 ± 11.62 (observation) with a p-value of .131. Following treatment, mean changes in perforation size were significantly greater in the treatment group compared to the observation group from baseline to day 7 (M = -9.08, n = 15.11 vs. M = -1.06, n = 31.58); p = .009; day 7 to 14 (M = -6.37, n = 13.78 vs. M = -0.79, n = 30.79); p = .003; and from day 14 to 21 (M = -5.65, n = 10.89 vs. M = -0.72, n = 30.07); p = .004 but not from day 21 to 28 (M = -4.16, n = 13.99 vs. M = -0.36, n = 29.71; p = .021. From baseline pure tone averages, four participants with mild hearing loss and two with moderate hearing loss achieved normal hearing in the treatment group (while one each with moderate and severe hearing loss did not improve). None of the observation group participants had improved hearing.Conclusion: Based on our limited experience, topical EGF can be used for traumatic tympanic membrane perforation and otitis media with dry ear perforation during the acute phase or within 3 months of perforation.

Epidermal growth factor application versus observation on healing of acute tympanic membrane perforations: A randomized open label clinical trial

Objective@#To compare the effect of topical epidermal growth factor (EGF) instillation versus observation alone on healing of acute tympanic membrane perforations in terms of closure and hearing test results. @*Methods@#Design: Randomized, Open label, Clinical Trial. Setting: Tertiary Government Training Hospital. Participants: Seventeen (17) ENT-HNS OPD patients aged between 18 to 65 years old diagnosed with acute tympanic membrane perforation were included in the study. Group A underwent observation while group B was treated with recombinant human EGF solution. Follow- up was on a weekly basis (7th, 14th, 21st and 28th days) where video otoscopy for documentation and measurement of perforation using ImageJTM software was done. Pure tone audiometry was used to compare hearing improvement pre and post study in both observation and treatment groups.@*Results@#At baseline, there was no significant difference in the sizes of perforations: 24.20 ± 9.95 (treatment) vs. 32.64 ± 11.62 (observation) with a p-value of .131. Following treatment, mean changes in perforation size were significantly greater in the treatment group compared to the observation group from baseline to day 7 (M = -9.08, n = 15.11 vs. M = -1.06, n = 31.58); p = .009; day 7 to 14 (M = -6.37, n = 13.78 vs. M = -0.79, n = 30.79); p = .003; and from day 14 to 21 (M = -5.65, n = 10.89 vs. M = -0.72, n = 30.07); p = .004 but not from day 21 to 28 (M = -4.16, n = 13.99 vs. M = -0.36, n = 29.71; p = .021. From baseline pure tone averages, four participants with mild hearing loss and two with moderate hearing loss achieved normal hearing in the treatment group (while one each with moderate and severe hearing loss did not improve). None of the observation group participants had improved hearing. @*Conclusion@#Based on our limited experience, topical EGF can be used for traumatic tympanic membrane perforation and otitis media with dry ear perforation during the acute phase or within 3 months of perforation.

Rates of success in hearing and grafting in the perichondrium-preserved palisade island graft technique / Taxas de sucesso na audição e em timpanoplastias com a técnica de enxerto de cartilagem em ilha e paliçada preservado em pericôndrio

Abstract Introduction Various graft materials have been used in the tympanoplasty technique. Cartilage grafts are being used increasingly in recent years. Objective The aim of this study was to present the comparative outcomes of the perichondrium-preserved palisade island graft technique previously defined by ourselves. Methods We retrospectively compared the hearing and graft success rates in 108 patients with chronic otitis media, who had undergone cartilage tympanoplasty, where both island and perichondrium-preserved palisade graft techniques were used. Results The success rates among the study and the control groups with regard to graft take were 97% and 93%, respectively. No significant difference was observed between the groups with regard to the postoperative mean pure tone values, improvement in air-bone gaps and reduction in air-bone gaps to under 20 dB. However, better results were observed in the study group. Conclusion The perichondrium-preserved palisade island graft technique is an easy method with high graft success rates and hearing outcomes.

Resumo Introdução Vários materiais de enxerto têm sido usados na realização de timpanoplastias. Nos últimos anos, os enxertos de cartilagem têm sido cada vez mais usados. Objetivo Apresentar os resultados comparativos da técnica de enxerto de cartilagem em ilha associada e paliçada preservado em pericôndrio previamente descrita pelos autores. Método Foram comparadas retrospectivamente as taxas de sucesso auditivo e na "pega" do enxerto em 108 pacientes com otite média crônica, submetidos a timpanoplastia com cartilagem, na qual foram usadas ambas as técnicas, de enxerto em ilha e paliçada preservado em pericôndrio. Resultados As taxas de sucesso entre os grupos de estudo e controle em relação à "pega" do enxerto foram de 97% e 93%, respectivamente. Não foi observada diferença significante entre os grupos em relação aos valores médios dos tons puros, melhoria do gap ou redução do aéreo-ósseo para menos de 20 dB no pós-operatório. No entanto, melhores resultados foram observados no grupo de estudo. Conclusão A técnica de enxerto em ilha associada e paliçada preservado em pericôndrio é um métodofácil, com altas taxas de sucesso tanto do enxerto quanto dos resultados auditivos.

Comparação da abordagem endoscópica transcanal e microscópica na timpanoplastia tipo 1

Resumo Introdução: A timpanoplastia endoscópica é uma cirurgia minimamente invasiva que pode ser feita através de uma abordagem exclusivamente transcanal. O uso de endoscópios em procedimentos otológicos tem aumentado no mundo todo. A abordagem endoscópica facilita a timpanoplastia transcanal mesmo em pacientes com canal auditivo externo estreito e com uma protrusão da parede anterior. Objetivos: O presente estudo teve como objetivo comparar os resultados cirúrgicos e audiológicos das abordagens endoscópica transcanal e microscópica convencional na timpanoplastia tipo 1. Método: As taxas de sucesso do enxerto, os resultados auditivos, as complicações e a duração da cirurgia em pacientes submetidos a timpanoplastia endoscópica e microscópica entre outubro de 2015 e abril de 2018 foram analisados retrospectivamente. Resultados: As taxas de sucesso do enxerto foram de 94,8% e 92,9% para o grupo endoscópico e microscópico, respectivamente (p > 0,05). Os valores de gap aéreo-ósseo no pós-operatório melhoraram significantemente em ambos os grupos (p < 0,001). A duração média da cirurgia foi significantemente menor no grupo endoscópico (média de 34,9 minutos) em relação ao grupo microscópico (média de 52,7 minutos) (p < 0,05). O tempo médio de internação foi de 5,2 horas (variação de 3-6 horas) no grupo operado por endoscopia e de 26,1 horas (variação de 18-36 horas) no operado por microscopia (p < 0,05). Conclusão: A timpanoplastia transcanal via endoscópica é uma opção razoável à timpanoplastia microscópica convencional no tratamento da otite média crônica, com taxas de sucesso de enxertos e resultados auditivos comparáveis à microscópica.

The effect of epidermal growth factor on the pseudo-healing of traumatic tympanic membrane perforations / Efeito do fator de crescimento epidérmico na pseudocicatrização de perfurações traumáticas da membrana timpânica

Abstract Introduction: Traumatic tympanic membrane perforations tend to heal spontaneously. However, in this study, several perforations exhibited abnormal healing, where the morphology of healing tympanic membranes differed from that of non-perforated tympanic membranes. Pseudo-healing of the tympanic membrane was characterized by the accumulation of thickened tissue in the perforated area. Objective: The purpose of this study was to evaluate the utility of epidermal growth factor in cases showing pseudo-healing of traumatic tympanic membrane perforations. Methods: A total of 26 traumatic tympanic membrane perforations showing pseudo-healing were included in this study. In all cases, tissue that accumulated in the perforated area was removed, which subsequently caused a new perforation to form. An epidermal growth factor solution was applied to the tympanic membrane once daily to keep the tympanic membrane moist. Closure rates and times were evaluated at 6 months. Results: During the 6 months follow-up period, two patients were lost. Of the remaining 24 patients, the closure rate was 100% (24/24) and the closure time was 6.1 ± 2.3 days (range: 3-12 days). The morphology of the healed tympanic membrane was not significantly different from that of the remnant tympanic membrane. Conclusions: Pseudo-healing of traumatic tympanic membrane perforations affects sound conduction. This can be associated with various symptoms, including tinnitus, aural fullness, and ear discomfort. The excision of excessive epithelial tissue and topical application of epidermal growth factor can correct the pseudo-healing of traumatic tympanic membrane perforations.

Resumo Introdução: As perfurações traumáticas da membrana timpânica tendem a cicatrizar espontaneamente. Entretanto, neste estudo, várias perfurações exibiram cicatrização anormal, na qual a morfologia da cicatrização das membranas timpânicas diferiu da de membranas timpânicas não perfuradas. A pseudocicatrização da membrana timpânica foi caracterizada pelo acúmulo de tecido espesso na área perfurada. Objetivo: Avaliar a utilidade do fator de crescimento epidérmico em casos que apresentaram pseudocicatrização de perfurações traumáticas da membrana timpânica. Método: Um total de 26 casos de perfurações traumáticas da membrana timpânica apresentando pseudocicatrização foram incluídos neste estudo.. Em todos os casos, o tecido que se acumulou na área perfurada foi removido, o que subsequentemente causou uma nova perfuração. Uma solução de fator de crescimento epidérmico foi aplicada à membrana timpânica uma vez ao dia para manter a membrana timpânica úmida. As taxas de fechamento e os tempos foram avaliados aos 6 meses. Resultados: Dois pacientes foram perdidos no período de 6 meses de acompanhamento. Dos 24 pacientes restantes, a taxa de fechamento foi de 100% (24/24) e o tempo de fechamento foi de 6,1 ± 2,3 dias (variação: 3 a 12 dias). A morfologia da membrana timpânica cicatrizada não foi significativamente diferente daquela da membrana timpânica remanescente. Conclusões: A pseudocicatrização de perfurações traumáticas da membrana timpânica afeta a condução do som. Isso pode estar associado a vários sintomas, inclusive zumbido, plenitude aural e desconforto auditivo. A excisão do tecido epitelial excessivo e a aplicação tópica de fator de crescimento epidérmico podem corrigir a pseudocicatrização de perfurações traumáticas da membrana timpânica.

Bilan anatomique et fonctionnel de la tympanoplastie en technique Underlay / Anatomical and functional overview of underlay tympanoplasty technique

Introduction : La tympanoplastie en technique underlay vise à mettre un greffon en dessous des reli quats tympaniques. Le but de l'étude était d'en évaluer les résultats anatomiques et fonctionnels au Bénin. Méthode : il s'est agi d'une étude rétrospective réalisée dans le service d'ORL-CCF de l'Hôpital d'Instruction des Armées de Cotonou de novembre 2016 à octobre 2018. Ont été inclus tous les patients ayant bénéficié d'une tympanoplastie en technique underlay pour une otite moyenne chronique simple à tympan ouvert. Les données anatomiques et fonctionnelles pré et post-opératoires ont été comparées à trois mois post-opératoire. Résultat : En deux ans, 10 patients ont bénéficié d'une tympanoplastie soit une incidence de 5 cas par an. L'âge moyen des patients était de 26 ans avec des extrêmes de 17 et 39 ans et une sex-ratio de 0,66. L'abord chirurgical retro-auriculaire et la technique underlay ont été utilisés pour tous les patients. Aucun patient n'a été opéré des deux oreilles. La fermeture de la perfo ration tympanique a été objectivée chez 8 patients sur 10 avec 2 cas de surinfection post-opératoire. Le gain audiométrique moyen a été de 25 dB. Le rinne audiométrique était supérieur à 20 dB chez tous les patients en pré-opératoire et chez 3 patients en post-opératoire. Conclusion : La tympanoplastie est une chirurgie rare au Bénin. Réalisée par la voie retro-auriculaire et la technique underlay, elle a permis d'obtenir d'excellents résultats en termes de fermeture anatomique du tympan mais aussi un gain auditif significatif. C'est une technique à recommander dans nos contextes au Bénin

Endoscopic type I tympanoplasty in 70 patients with chronic otitis media: A preliminary report

Objective@#To evaluate the preliminary surgical results of Endoscopic Type I Tympanoplasty among patients with inactive chronic otitis media without ossicular pathology. @*Methods@#Design: Prospective Series. Setting: Tertiary Government Hospital. @*Participants@#Seventy patients with inactive mucosal chronic otitis media (COM) with air bone gap (ABG) of ≤ 40 dB on the preoperative audiogram scheduled to undergo Type I Tympanoplasty between July 2018 and December 2020 were enrolled. @*Results@#Seventy-three (73) ears were evaluated. The overall rate of graft uptake was 95.9% at 12 weeks. There was a statistically significant (p<.001) improvement in hearing on comparison of pre-operative (25.74 ± 7.34 dB) and post-operative (14.82 ± 6.55 dB) air bone gap. The duration of surgery was less than one hour in 76.7% and 77.2 % patients experienced only mild post[1]operative pain. @*Conclusion@#Endoscopic tympanoplasty can provide good results with respect to graft uptake and hearing gain with short surgical duration and minimum postoperative morbidity. Longer follow up of at least 6 months (for graft uptake) and preferably not less than 12 months (for hearing results) may confirm our preliminary findings.

Factors Related to Tympanic Membrane Perforation in Children with Acute Suppurative Otitis Media / 中国医学科学院学报

Objective To explore the factors related to tympanic membrane perforation in children with acute suppurative otitis media,and to provide reference for clinical practice. Methods We reviewed the clinical data of 1274 children with acute suppurative otitis media from February 2017 to May 2020,and analyzed the factors related to tympanic membrane perforation. Results Tympanic membrane perforation occurred in 67 out of the 1274 children with acute suppurative otitis media,with the incidence of 5.27%.The univariate analysis showed that 11 factors including the duration of onset(

Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film / Perfurações traumáticas da membrana timpânica: recuperação clínica imediata com o uso de fragmento de celulose bacteriana

Abstract Introduction: Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists' offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients' symptoms and accelerate the healing process. Objective: To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic). Methods: We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation. Results: Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000 Hz, after film use. Conclusion: The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.

Resumo Introdução: A perfuração da membrana timpânica é uma condição clínica relativamente frequente em consultórios de otorrinolaringologistas. A conduta é quase sempre expectante, aguardando cicatrização espontânea, que costuma ocorrer na quase totalidade dos casos em algumas semanas. No entanto, enquanto não se completa, os pacientes mantêm sintomas desconfortáveis. Embora algumas pesquisas sugiram o uso de materiais diversos para auxiliar na recuperação da membrana timpânica, nenhuma apresentou evidência substancial de melhoria no processo cicatricial. Por outro lado, a oclusão da perfuração com alguns materiais de textura e resistência específicas poderia aliviar os sintomas dos pacientes durante o processo cicatricial. Objetivo: Avaliar a melhoria clínica (sintomática e funcional) após a colocação de película de celulose bacteriana (Bionext®) sobre a perfuração da membrana timpânica (traumática). Método: Foram avaliados pacientes com perfurações traumáticas da membrana timpânica que deram entrada no pronto-socorro de otorrinolaringologia. Eles foram avaliados em relação a suas queixas e exame audiométrico, antes e após a aplicação de película de celulose que oclui a perfuração da membrana timpânica. Resultados: Foram incluídos 24 pacientes, nos quais foram pesquisados o grau de incômodo global causado pela perfuração da membrana timpânica e a presença de sintomas de autofonia, plenitude auricular e tinnitus. A média da nota atribuída ao incômodo global causado pela perfuração foi de 7,79; caiu para valor médio de 2,25 após a aplicação da película. A avaliação dos sintomas também apresentou melhoria após uso da película, autofonia caiu de valor médio de 6,25 para 2,08; zumbido de 7 para 1,92 e plenitude auricular de 7,29 para 1,96. A análise auditiva apresentou um valor médio de limiares ainda dentro da normalidade em frequências baixas e médias, com perda de audição leve em frequências agudas, porém com melhoria significante em todas as frequências, com exceção de 8000 Hz, após a colocação da película. Conclusão: A aplicação de fragmento de película de celulose bacteriana sobre perfurações traumáticas da membrana timpânica promoveu recuperação funcional e sintomática imediata nos pacientes estudados.

Comparison of temporal muscle fascia and tragal cartilage perichondrium in endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap / Comparação entre fáscia do músculo temporal e pericôndrio de cartilagem tragal na timpanoplastia endoscópica tipo 1 com descolamento limitado do retalho timpanomeatal

Abstract Introduction Elevation of tympanomeatal flap is one of the basic steps of tympanoplasty. A satisfactory level of anatomic and functional success can be achieved by using different grafts with limited tympanomeatal flap elevation. Objectives We aimed to compare the anatomic and functional success of tragal cartilage perichondrium and temporal muscle fascia in cases of endoscopic type 1 tympanoplasty performed with limited tympanomeatal flap elevation. Methods In total, 81 cases (33 females, 48 males, mean age 22.1<±<10.1 years, interval 18-49 years) which underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap were included the present study. All cases were divided into two groups as tragal cartilage perichondrium (group A) and temporal muscle fascia (group B). The comparison of the groups were made considering the pre- and postoperative air-bone gap and the tympanic membrane status. Results There was no statistically significant difference between Group A and Group B in preoperative and in postoperative air-bone gap values (p<=<0.608 and 0.529, respectively). In Group A and B, postoperative air-bone gap values demonstrated significant decrease compared to the preoperative values (p<=<0.0001). Group A and group B did not demonstrate significant differences between postoperative improvements of air-bone gap values (p<=<0.687). Graft retention success was 92.6% in group A while it was 90.0% in group B. There was no statistically significant difference between the groups in terms of graft retention success (p<=<0.166). Conclusion In accordance with the results of this study, we believe that both tragal cartilage perichondrium and temporal muscle fascia, and also in limited tympanomeatal flap elevation in endoscopic tympanoplasty are all eligible for result in safe and successful surgery.

Resumo Introdução O descolamento do retalho timpanomeatal é uma das etapas básicas da timpanoplastia. Um nível satisfatório de sucesso na restauração anatômica e funcional pode ser alcançado com o uso de diferentes enxertos e descolamento limitado do retalho timpanomeatal. Objetivos Comparar os resultados anatômicos e funcionais entre o uso de pericôndrio de cartilagem tragal e de fáscia do músculo temporal em timpanoplastias endoscópicas tipo 1 feitas com descolamento limitado do retalho timpanomeatal. Método Foram incluídos no estudo 81 pacientes (33 mulheres, 48 homens, média de 22,1 ± 10,1 anos, variação de 18-49 anos), submetidos a timpanoplastia endoscópica transcanal tipo 1 com descolamento limitado do retalho timpanomeatal. Todos os casos foram divididos em dois grupos: pericôndrio da cartilagem tragal (grupo A) e fáscia do músculo temporal (grupo B). Na comparação dos grupos consideraram-se o gap aéreo-ósseo, pré e pós-operatório, e a condição da membrana timpânica. Resultados Não houve diferença estatisticamente significante entre os grupos A e B no pré e pós-operatório (p = 0,608 e 0,529, respectivamente). Nos grupos A e B, os valores do gap aéreo-ósseo no pós-operatório demonstraram redução significante em relação aos valores pré-operatórios (p = 0,0001). Os grupos A e B não demonstraram diferenças significantes entre as medidas pré e pós-operatórias dos valores dos gaps (p = 0,687). O sucesso da retenção do enxerto foi de 92,6% no grupo A, enquanto no grupo B foi de 90,0%, não ocorreu diferença estatisticamente significante entre os grupos (p = 0,166). Conclusão De acordo com os resultados deste estudo, acreditamos que tanto o pericôndrio da cartilagem tragal como a fáscia do músculo temporal, usados com descolamento limitado do retalho timpanomeatal na timpanoplastia endoscópica, são elegíveis para uma cirurgia segura e bem-sucedida.

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft / Timpanoplastia endoscópica com enxerto de cartilagem tragal de espessura parcial ou total

Abstract Introduction: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Resumo Introdução: A cartilagem é o material de enxerto de escolha no tratamento cirúrgico de certas condições clínicas da orelha média. Devido ao possível efeito prejudicial na audição pós-operatória, as indicações para seu uso rotineiro ainda são controversas. Objetivo: Relatar a experiência dos autores com a timpanoplastia tipo 1 endoscópica usando cartilagem tragal e comparar os resultados entre a cartilagem tragal com espessura parcial e espessura total, em termos de integração do enxerto e melhoria da audição. O estudo também buscou apresentar sugestões para cirurgia endoscópica de orelha média com uma única mão (single-handed endoscopic ear surgery). Método: Foram selecionados 50 pacientes com otite média crônica supurativa, atendidos neste ambulatório entre fevereiro de 2014 e setembro de 2015, alocados aleatoriamente em dois grupos: 25 pacientes foram incluídos no grupo A, no qual uma cartilagem tragal de espessura total foi usada e outros 25 pacientes foram incluídos no grupo B, no qual foi usada uma cartilagem tragal de espessura parcial. Em todos os casos, uma audiometria foi feita dois meses após a cirurgia; os pacientes foram acompanhados por um ano. Resultados: Dos 50 pacientes, o enxerto foi bem-sucedido em 39 (78%), entre os quais 22 pertenciam ao grupo A e 17 pertenciam ao grupo B. A melhoria da audição em ambos os grupos foi muito semelhante. Conclusão: O estudo indicou que a timpanoplastia endoscópica com cartilagem tragal é uma técnica confiável, com alto grau de integração do enxerto e bons resultados de audição, independentemente da espessura usada. Além disso, a cartilagem tragal é facilmente acessível, adaptável e resistente à reabsorção; a cirurgia endoscópica é minimamente invasiva, sem sutura e proporciona uma visão panorâmica da orelha média.

Results of endoscopic transcanal tympanoplasty performed by a young surgeon in a secondary hospital / Resultados da timpanoplastia transcanal endoscópica realizada por um jovem cirurgião em um hospital secundário

Abstract Introduction: Tympanoplasty is performed to close the tympanic membrane perforation and recover the hearing level of patients with non-suppurative chronic otitis media. Endoscopic tympanoplasty has recently been increasingly preferred by ear nose and throat surgeons to treat tympanic membrane perforations. Objective: The aim of this study is to discuss the outcomes of patients undergoing endoscopic tympanoplasty performed by a young surgeon in a secondary hospital in the context of the literature. Methods: Fifty patients undergoing endoscopic Type 1 tympanoplasty between February 1, 2017 and February 1, 2018, were included. The patients' age, gender, perforation side and size, preoperative and postoperative pure tone audiometry, graft failure, postoperative pain and complication status were evaluated. Results: The graft success rate was 94% at 6 months postoperatively. Audiometry thresholds were obtained at frequencies of 0.5, 1, 2 and 4 kHz. Preoperative pure tone audiometric thresholds were 41.6, 36.3, 34.1, and 39.1 dB, and postoperative, 6 months after surgery, 19.5, 17.8, 17.5, and 20.8 dB. Pure tone audiometry air-bone gaps at the same frequencies changed from 30.5, 24.6, 22.2, and 28.6 dB preoperatively, to 11.0, 9.3, 8.6, and 13.9 dB 6 month after the surgery. There was a statistically significant improvement between the preoperative and postoperative pure tone audiometry, and air bone gaps at all measured frequencies (p < 0.05). Conclusion: Endoscopic transcanal cartilage tympanoplasty has become more commonly performed by otolaryngologists due to the shortening of operation and hospitalization times as well as similar audiological results to those obtained with microscopic tympanoplasty. The surgical and audiological results of a young ear nose throat specialist can reach a similar level of success to those of experienced surgeons, due to a fast learning curve.

Resumo Introdução: A timpanoplastia é realizada para fechar a perfuração da membrana timpânica e restaurar a audição de pacientes com otite média crônica não-supurativa. Recentemente, a timpanoplastia endoscópica tem se tornado a técnica preferida por cirurgiões otorrinolaringologistas, com indicação crescente em casos de perfurações timpânicas. Objetivo: O objetivo deste estudo é discutir os resultados em pacientes submetidos a timpanoplastia endoscópica realizada por um jovem cirurgião em um hospital secundário, no contexto da literatura. Método: Cinquenta pacientes submetidos a timpanoplastia endoscópica Tipo 1 entre 1° de fevereiro de 2017 e 1° de fevereiro de 2018 foram incluídos. A idade dos pacientes, sexo, lado e tamanho da perfuração, limiares da audiometria tonal pré-operatória e pós-operatória, falha do enxerto, dor pós-operatória e ocorrência de complicações foram avaliados. Resultados: A taxa de sucesso do enxerto foi de 94% aos 6 meses de pós-operatório. Nas frequências de 0,5, 1, 2 e 4 kHz, a audiometria tonal pré-operatória mostrava limiares de 41,6; 36,3; 34,1 e 39,1 dB e a pós-operatória após 6 meses, revelou limiares de 19,5; 17,8; 17,5 e 20,8 dB. Nas mesmas frequências, os gaps aéreo-ósseos pré-operatório na audiometria tonal eram de 30,5; 24,6; 22,2 e 28,6 dB e com 6 meses de pós-operatório, de 11,0; 9,3; 8,6 e 13,9 dB. Houve melhora estatisticamente significante entre os limiares da audiometria tonal pré- e pós-operatória em todas as frequências (p < 0,05). Houve diferença estatisticamente significante entre os gaps aéreo-ósseo pré- e pós-operatório, ocorrendo diminuição dos mesmos em todas as frequências (p < 0,05). Conclusão: A timpanoplastia endoscópica com cartilagem por via transcanal tem sido mais comumente realizada pelo otorrinolaringologista devido ao menor tempo de cirurgia e hospitalização e resultados audiológicos semelhantes aos com o uso de microscópico. Os resultados cirúrgicos e audiológicos de um jovem especialista em otorrinolaringologia podem atingir um nível semelhante ao de cirurgiões experientes, com uma rápida curva de aprendizado.

Resultados quirúrgicos de la timpanoplastia tipo I durante los años 2014 al 2019, en el Hospital Universitario Clínica San Rafael de Bogotá / Surgical results of type I tympanoplasty during 2014 to 2019, at Hospital Universitario Clínica San Rafael, Bogotá

Introducción: Las perforaciones timpánicas son una patología otológica frecuente tanto en población adulta como pediátrica. El daño hacia la membrana timpánica puede ser ocasionada por diversos factores como explosiones, traumas penetrantes, barotraumas e infecciones. Los síntomas más comunes incluyen el tinnitus, plenitud aural e hipoacusia. En los casos en los que es necesario realizar un tratamiento quirúrgico se opta por las timpanoplastias. El objetivo de este estudio es determinar la efectividad del cierre anatómico a través de esta técnica. Adicionalmente, identificar las comorbilidades asociadas, las causas por la que se decide realizar el procedimiento quirúrgico y las características sociodemográficas de la población intervenida. Objetivo general: Determinar la frecuencia de las reperforaciones timpánicas postoperatorias a los tres y seis meses, que fueron sometidos a timpanoplastia tipo I en el Hospital Universitario Clínica San Rafael de Bogotá, Colombia., durante los años 2014 al 2019. Materiales y métodos: estudio de tipo retrospectivo, descriptivo y de corte transversal, donde se incluyeron pacientes adultos y pediátricos del servicio de otorrinolaringología del Hospital Universitario Clínica San Rafael de Bogotá, Colombia, con antecedente de perforaciones timpánicas durante los años 2014 al 2019 y que fueron intervenidos con timpanoplastia tipo I. Se evaluaron resultados postquirúrgicos, principalmente las perforaciones posteriores a la cirugía con técnica medial "over-under" utilizando injerto de cartílago de concha y fascia temporal. Resultados: Se intervinieron 47 pacientes. 62% fueron de sexo femenino y 38% de sexo masculino. Se evidenció reperforación posoperatoria en 8.5% del total de la muestra. Ninguno antes de tres meses, 1 paciente entre 3 y 6 meses y 3 pacientes después de 6 meses posoperatorios. La causa más frecuente de la timpanoplastia tipo I fue la infecciosa, (66%). La comorbilidad asociada más frecuentemente a las perforaciones fue la otitis media crónica (OMC), en el 51%. Las audiometrías mostraron una mejoría del 17% y del 20% entre el PTA preoperatorio y posoperatorio, en el oído derecho y en el oído izquierdo, respectivamente. Conclusiones: La timpanoplastia tipo I con técnica over under se considera exitosa para el cierre anatómico de las perforaciones timpánicas, evaluado a los tres y seis meses posoperatorios, con porcentajes que se igualan a los reportados en estudios similares en la literatura. Los resultados audiométricos no mostraron una mejoría estadísticamente significativa en ambos oídos por lo cual se deben continuar realizando estudios para evaluar otros factores asociados a las perforaciones como otitis media crónica y colesteatoma, entre otros.

Introduction Tympanic perforations are a frequent otological pathology in both adult and pediatric populations. Damage to the tympanic membrane can be caused by various factors such as explosions, penetrating trauma, barotraumas, and infections. The most common symptoms include tinnitus, aural fullness, and hearing loss. In cases where surgical treatment is necessary, tympanoplasties are chosen. The objective of this study is to determine the effectiveness of anatomical closure through this technique. Additionally, to identify the associated comorbidities, the causes for which the surgical procedure was decided to be performed, and the sociodemographic characteristics of the intervened population. Main objective: to determine the frequency of postoperative tympanic perforations early (three months) and late (six months), in patients who underwent type I tympanoplasty in the ENT department of the San Rafael Clinical University Hospital in Bogotá, Colombia, during the years 2014 to 2019. Materials and methods: a retrospective, descriptive and cross-sectional study, that included adult and pediatric patients of the otolaryngology service of the San Rafael Clinical University Hospital of Bogotá, Colombia, with a history of tympanic perforations during the years 2014 to 2019 and who were operated with type I tympanoplasty were evaluated. Post-surgical results were evaluated. mainly the post-surgery perforations with "over-under" medial technique using ear cartilage graft and temporal fascia. Results: 47 patients were included in the study, of which 62% were female and 91% were older than 7 years. The percentage of reperforation was 8.5%, that is, 4 of 47 patients, and at 12.8 months on average. The most frequent cause of tympanic perforation was infectious with 66% and medium size 55.3%. The most frequent otolaryngological comorbidity was chronic otitis media with 51%. The audiological results showed a gain of 17% in the right ear and 20% in the left ear. Conclusions: Type I tympanoplasty with over under technique is considered successful for the anatomical closure of the tympanic perforations, evaluated at 3 and 6 months postoperatively, with percentages that are equal to those reported in similar studies in the literature. The audiometric results did not show a statistically significant improvement in both ears, so studies should continue to evaluate other factors associated with perforations such as chronic otitis media and cholesteatoma, among others.

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations / Identificação e conduta nas perfurações traumáticas da membrana timpânica com bordas invertidas ou evertidas

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

Resumo Introdução: A maioria das perfurações de membrana timpânica traumáticas apresenta bordas invertidas ou evertidas; no entanto, os efeitos dessas configurações sobre a cicatrização espontânea do tímpano continuam a ser uma questão controversa. Objetivo: Investigar a influência de bordas invertidas ou evertidas sobre a cicatrização espontânea de perfurações traumáticas de membrana timpânica. Método: Os prontuários clínicos de pacientes com perfuração traumática de membrana timpânica que preencheram os critérios do estudo foram recuperados e categorizados em dois grupos, baseados na configuração invertida ou evertida das bordas da membrana timpânica. As características de configuração da borda de cada membrana foram descritas com o uso de endoscópios de 30º e 70º. Resultados: No total, 196 pacientes (196 orelhas) preencheram os critérios de inclusão; desses, 148 apresentavam bordas de membranas timpânicas invertidas ou evertidas, enquanto 48 não. Dos 148 pacientes, as bordas da perfuração estavam evertidas em 77 pacientes, invertidas em 44 pacientes, caídas em 17 pacientes e ambas invertidas e evertidas em 10 pacientes. O formato da perfuração era triangular em 18,9% dos pacientes, em forma de fatia de pizza em 11,5%, em forma de rim em 14,2%, ovoide em 20,3% e de forma irregular em 35,1% dos pacientes. A diferença não foi significante entre os grupos com e sem membrana timpânica invertida/evertida em termos de taxa ou tempo de fechamento. Da mesma forma, a diferença não foi significativa entre os grupos com e sem aproximação das bordas em termos de taxa de fechamento ou tempo de fechamento no fim do período de seguimento de 12 meses. Conclusões: Este estudo sugere que a avaliação com endoscópios de 30º e 70º pode identificar claramente as bordas invertidas/evertidas das perfurações de membranas timpânicas. A borda da perfuração timpânica em casos invertidos/evertidos é brilhante, enquanto a borda é áspera e irregular em casos não invertidos/evertidos. O rebordo timpânico invertido/evertido gradualmente torna-se necrótico, mas isso não afetou o processo de cicatrização. Além disso, a aproximação das bordas não melhorou o resultado da cicatrização.

Tiempo seguro para cambiar de altitud en post operatorio de Timpanoplastia / Safe time for altitude change after tympanoplasty

Introducción: La tasa de éxito reportada en timpanoplastia es de más del 90%. Una variable que se ha estudiado poco, pero que en nuestra población es frecuente, es el cambio temprano de altitud y presión, ya que muchos de nuestros pacientes suelen proceder de lugares diferentes a Bogotá. El objetivo de este estudio es evaluar si este factor influye en el éxito de la timpanoplastia en población pediátrica. Diseño: Estudio de cohorte descriptiva Metodología: Se revisaron historias clínicas de pa-cientes operados en el Hospital Universitario San Ignacio entre septiembre de 2014 y noviembre de 2016. Se incluyeron datos como la edad del paciente al momento de la cirugía, el tamaño de la perforación, abordaje quirúrgico, tipo de injerto, si hubo o no traslado fuera de Bogotá y cuántos días posterior a la cirugía y finalmente, el éxito de la cirugía definido por integración del injerto principalmente. Resultados: La tasa de éxito en nuestra cohorte fue del 90%. El 52% de los pacientes (n=13) se trasladaron fuera de Bogotá, todos por vía terrestre. El 38.4% (n=5) de estos, se tras-ladaron entre los 15 y 30 días del postoperatorio. Seguido de un 30% (n=4) durante los primeros 15 días. Durante la primera semana y posterior al mes postoperatorio, un 23% y 4%, respectivamente. De los dos pacientes en los cuales no hubo integra-ción del injerto, uno de ellos tenía una preforación prequirúrgica de la membrana timpánica del 40% y se trasladó por vía terrestre a los 15 días de realizada la cirugía. El segundo paciente, presentó otorrea días previos a la cirugía y se trasladó a los 8 días del postoperatorio fuera de la ciudad. Conclusiones: Observamos que el trasla-do temprano durante el postoperatorio de timpanoplastia no afecta negativamente la integración del injerto

Introduction: The reported rate of success for tympanoplasty is high, over 90%. A less studied variable, although of frequent presentation in our population, is the in-fluence of altitude and pressure changes during the early stage of the postoperative period, since many patients travel to Bogota from other regions. The objective of this study is to evaluate if this factor has an impact on the tympanoplasty rate of success in pediatric patients. Design: Descriptive cohort study. Methods: Clinical case-his-tory reports from patients operated at the San Ignacio University Hospital between September 2014 and November 2016 were analyzed. The variables considered in this study were the age of patients at the time of the surgical intervention, tympanic perforation size, surgical approach, types of tympanic graft, early travel to areas outside Bogota and, if it occurred, number of days after surgery, and the success rate of the surgery determined mainly by graft healing. Results: The success rate in our cohort was 90%. 52% of the patients (n=13) traveled out of Bogota on land. 38.4% (n=5) of these patients, traveled between the day 15th and 30th of the postoperative period, 30% of these patients (n=4) traveled within the first 15 days after the surgery, 23% during the first week of the postoperative period, and 4% traveled out of Bogota more than one month after the surgery. Regarding the tympanic surgery procedure, two patients did not show closure of the perforation; one of them showed 40% of pre-surgical tympanic membrane perforation and moved out of Bogota 15 days after the surgery. The other patient showed otorrhea some days before the surgery and traveled on land on the 8th day of the postoperative period. Conclusions: We obser-ved in our group of patients that early travel of patients to their places of origin after tympanoplasty, does not affect graft take rate negatively

Pattern and causes of tympanic membraneperforation at a private hospital in Dar es Salaam, Tanzania

Introduction: There is variation in the size, shape and position of tympanic membrane perforations; the degree of conductive hearing loss depends on the size and position of perforation.Objective: To determine the pattern and causes of tympanic membrane perforation at a private health facility in TanzaniaMethod: A hospital-based cross-sectional study in the ENT clinic at Ekenywa Specialised Hospital was conducted from January to May 2019. Ears were examined thoroughly by an Otorhinolaryngologist. Data were analysed using SPSS Version 21Results: Two hundred and fifty patients were examined and 50 (20%) were found to have tympanic membrane perforations. Thirty (60%) were new patients while twenty (40%) were under review. Most 35(70%) were males. Central perforation predominated in 30 (60%), followed by subtotal in 10 (20%), total in 8 (16%) and marginal perforations in 2 (4%). The left ear was more affected in (60%) than the right ear. Bilateral perforations accounted for 5 (10%) of cases. Chronic suppurative otitis media was found in 35 (70%); other causes were acute suppurative otitis media in 13 (26%) and trauma in 2 (4%) patientsConclusions: The clinical picture depicted in this study is similar to that found elsewhere. There is a need for prompt diagnosis of tympanic membrane perforation. Proper education on ear care in patients with perforated tympanic membrane is of paramount importance

Évolution des acouphènes après myringoplastie

BUT : Etudier l'évolution des acouphènes après myringoplastie chez l'adulte et rechercher les facteurs prédictifs de leur disparition après la chirurgie.METHODES : Etude rétrospective, portant sur 71 myringoplasties réalisées sur une période de quatre ans [2010-2013], tous les patients présentaient des acouphènes préopératoires et une surdité de transmission à l'audiométrie préopératoire.RESULTATS : L'âge moyen de nos patients était de 43,3 ±15 ans avec 44 femmes et 20 hommes. A l'audiométrie préopératoire, ils avaient tous une surdité de transmission. Les acouphènes ont régressé totalement en post opératoire dans 44,3% des cas et ont persisté dans 18,6% des cas. L'amélioration était partielle dans 37,1% des cas. en analyse univariée, nous avons trouvé une corréla¬tion significative, entre la disparition totale des acouphènes en post opératoire et le seuil moyen de la CA préopératoire inférieur à 39 dB (0.033) et un seuil moyen de la conduction osseuse (CO) pré opératoire inférieur à 15 dB sur les fréquences 2000 (0.028) ; 3000 (0.024) et 4000 Hz (0.022), un rinne préopératoire inférieur à 25 dB sur la fréquence de 1000 Hz (0.048), un seuil moyen de la CA post opératoire inférieur ou égal à 30 dB (p=0,001), un Rinne résiduel inférieur à 20 dB (p=0,014). La marginalité de la perforation par rapport au manche du marteau était significativement associée à la persistance des acouphènes (p=0,028). En analyse multivariée, seuls l'âge ≤ 56 ans; l'étiologie traumatique de la perforation et le seuil moyen de la CA post opératoire ≤26,89 dB étaient retenus par l'étude multivariée, comme des facteurs prédictifs de la disparition des acouphènes.CONCLUSION : Nous avons trouvé une corrélation entre la régression des acouphènes apres myringoplastie et des facteurs liée au terrain tel que l'âge, aux caractéristiques et à l'étiologie de la perforation et les résultats audiométriques post opératoires

Numerical analysis of the influence of otitis media on the hearing compensation performance of round-window stimulation / 生物医学工程学杂志

In order to study the influence of tympanic membrane lesion and ossicular erosion caused by otitis media on the hearing compensation performance of round-window stimulation, a human ear finite element model including cochlear asymmetric structure was established by computed tomography (CT) technique and reverse engineering technique. The reliability of the model was verified by comparing with the published experimental data. Based on this model, the tympanic membrane lesion and ossicular erosion caused by otitis media were simulated by changing the corresponding tissue structure. Besides, these simulated diseases' effects on the round-window stimulation were studied by comparing the corresponding basilar-membrane's displacement at the frequency-dependent characteristic position. The results show that the thickening and the hardening of the tympanic membrane mainly deteriorated the hearing compensation performance of round-window stimulation in the low frequency; tympanic membrane perforation and the minor erosion of ossicle with ossicular chain connected slightly effected the hearing compensation performance of round-window stimulation. Whereas, different from the influence of the aforementioned lesions, the ossicular erosion involving the ossicular chain detachment increased its influence on performance of round-window stimulation at the low frequency. Therefore, the effect of otitis media on the hearing compensation performance of round-window stimulation should be considered comprehensively when designing its actuator, especially the low-frequency deterioration caused by the thickening and the hardening of the tympanic membrane; the actuator's low-frequency output should be enhanced accordingly to ensure its postoperative hearing compensation performance.

Microscopic versus Endoscopic Inlay Butterfly Cartilage Tympanoplasty

BACKGROUND AND OBJECTIVES: Inlay butterfly cartilage tympanoplasty makes the graft easy, and reduces operating time. The present study aimed to investigate the outcomes of microscopic versus endoscopic inlay butterfly cartilage tympanoplasty. SUBJECTS AND METHODS: In this retrospective study, the outcomes of 63 patients who underwent inlay butterfly cartilage tympanoplasty with small to medium chronic tympanic membrane perforation were evaluated. Twenty-four patients underwent conventional microscopic tympanoplasty and 39 underwent endoscopic tympanoplasty. The outcomes were analyzed in terms of the hearing gain and graft success rate. RESULTS: The surgical success rate was 95.8% in the patients who underwent conventional microscopic tympanoplasty and 92.3% in those who underwent endoscopic tympanoplasty. In both groups of patients, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values in either group. CONCLUSIONS: Endoscopic inlay tympanoplasty using the butterfly cartilage technique appears to be an effective alternative to microscopic tympanoplasty and results in excellent hearing.