Advances in research on treatment of tympanosclerosis / 临床耳鼻咽喉头颈外科杂志

Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.

Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

Timpanoplastías en el Hospital San Vicente de Arauco: Revisión de 3 años / Tympanoplasties in San Vicente de Arauco Hospital: 3 years review

Resumen Introducción: La timpanoplastía es el tratamiento de elección en la otitis media crónica simple. En Chile se han realizado diversos estudios para evaluar el éxito de la timpanoplastía. En nuestro centro evaluamos el resultado anatómico y funcional, correlacionando los resultados con la demografía de nuestra población. Objetivo: Realizar una descripción epidemiológica de los pacientes con diagnóstico de otitis media crónica simple, sometidos a timpanoplastía en el Hospital San Vicente de Arauco entre los años 2017 y 2019. Material y Método: Estudio retrospectivo y descriptivo. Se revisaron las fichas clínicas de pacientes con cirugía realizada entre enero de 2017 y noviembre de 2019. Este estudio cuenta con la aprobación del comité de ética del servicio de salud Arauco. Resultados: Se realizaron 77 timpanoplastías. 56 oídos cumplieron los criterios de inclusión. 71,43% fueron de sexo femenino. El rango de edad es de 8 a 64 años. 92,86% corresponde a timpanoplastía tipo I. Se utilizó un abordaje endoauricular en el 58,93%. El injerto utilizado fue predominantemente compuesto (cartílago-pericondrio) en un 75%. Se usó una técnica medial en un 94,94%. Se obtuvo un éxito anatómico 85,71% de los pacientes. Se obtuvo una ganancia sobre 10 dB en un 60,71% de los pacientes. Conclusión: No se encontraron diferencias significativas importantes que relacionan las elecciones quirúrgicas con los resultados anatómicos y auditivos del procedimiento a mediano plazo.

Abstract Introduction: Tympanoplasty is the treatment of choice for chronic otitis media. In Chile, several studies have been carried out to evaluate the success of tympanoplasty. Here, we assesed the anatomical and functional outcomes, correlating the results with the demographics of our population. Aim: To carry out an epidemiological description of patients with a diagnosis of chronic otitis media who underwent tympanoplasty at our hospital between 2017 and 2019. Material and Method: Retrospective, descriptive study. We reviewed clinical records of patients who underwent surgery between January 2017 and November 2019. This study has been approved by the ethics committee of Arauco health service. Results: 77 tympanoplasties were performed, of which 56 ears met the inclusion criteria. 71.43% were female. The age range is 8 to 64 years. 41% had chronic pathologies. 51.79% were left ear surgeries. 92.86% were type I tympanoplasty. An endoauricular approach was performed in 58.93%. A cartilage - perichondrium composite graft was used in 75% of the surgeries. A medial technique was performed in 94.94%. Anatomical success was achieved in 85.71% of patients. An average gain over 10 dB was obtained in 60.71% of the patients. Conclusion: There were no significant differences regarding the surgical choices with the anatomical and auditory results.

Endoscopic tympanoplasty with inlay cartilage graft in an university hospital / Timpanoplastia endoscópica com enxerto de cartilagem inlay em hospital universitário

Abstract Introduction Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.

Resumo Introdução Timpanoplastia é o procedimento cirúrgico voltado para a reconstrução da membrana timpânica e restauração do mecanismo condutor do som. Pode ser executada através de diversos tipos de acesso e de enxertos e é considerada bem-sucedida quando obtém fechamento completo da perfuração timpânica e melhoria na condução sonora. Objetivo Descrever a prevalência de sucesso no fechamento completo das perfurações timpânicas e os resultados auditivos das timpanoplastias endoscópicas com enxerto de cartilagem de tragus inlay. Metodologia Estudo retrospectivo desenvolvido em hospital terciário de referência. Pacientes com perfurações timpânicas centrais e com cadeias ossiculares íntegras submetidos a timpanoplastias endoscópicas com enxerto de cartilagem de tragus inlay foram incluídos. Foram avaliados o índice de integridade do neotímpano e os parâmetros auditivos pré e pós-operatórios foram comparados com o teste t de Student pareado. Resultados Foram identificadas 83 timpanoplastias endoscópicas com cartilagem inlay, 63 (76%) obtiveram neotímpano íntegro e 20 (24%), perfurações residuais. O gap aéreo-ósseo pré-operatório foi, em média, 18 ± 8,9 dBNA e o pós-operatório 11 ± 10 dBNA (p = 0,0005), sofreu redução em 71% e recuperação completa em 27%. O SRT pré-operatório médio foi 35 ± 13,5 e o pós-operatório 27 ± 14,4 (p = 0,0002). A média tritonal pré-operatória foi 34 ± 14,3 e a pós-operatória 24 ± 15 (p = 0,0002). Conclusão Nesta casuística, as timpanoplastias endoscópicas com cartilagem de tragus inlay apresentaram fechamento completo da perfuração timpânica em 76% dos casos, com melhoria significativa dos parâmetros auditivos.

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.

Clinical manifestation and treatment of temporal bone tympanic plate fracture / 中华耳鼻咽喉头颈外科杂志

Objective: To elucidate the clinical manifestations of temporal bone tympanic plate fracture and the correlation between treatment time after injury and its prognosis, and to discuss the importance of early treatment of tympanic fracture. Methods: Retrospective analysis was carried out on the clinical data of 15 patients(17 ears)with temporal bone tympanic plate fracture from March 2006 to July 2019. The course of disease was less than 1 month (initial stage) in 7 cases (7 ears), 1 month to 6 months (middle stage) in 2 cases (3 ears), and 6 months or more (late stage) in 6 cases (7 ears). The symptoms, signs, CT findings, pure tone audiometry results, surgical methods and clinical efficacy of each group were summarized. Results: Most patients with temporal bone tympanic plate fracture were referred to otology department by maxillofacial surgery. Fracture occured indirectly with the chin or zygomatic region as the direct stress point. Thirteen of the 15 patients had mental region wounds or scars, and 14 patients had external acoustic canal bleeding immediately after injury. In the initial-stage group, hearing was mostly unchanged, while in the middle and late-stage groups, hearing loss was mainly caused by conduction factors. In the initial stage group, 6 cases/7 cases were cured by external acoustic canal packing; External acoustic canal stenosis or atresia occurred in 2 cases in the middle-stage group and were cured by external acoustic canal plasty. All the 6 patients in the late-stage group had external acoustic canal stenosis or atresia, among whom 5 patients with external acoustic canal cholesteatoma were cured by external acoustic canal plasty, and the other one patient with middle ear cholesteatoma was cured by modified radical mastoidectomy and tympanoplasty after external acoustic canal plasty for three times. Conclusions: Temporal bone tympanic plate fracture is a special type of temporal bone fracture. In the early stage of temporal bone tympanic fracture, bleeding of the external acoustic canal is the main symptom, and hearing is normal mostly. Advanced conductive deafness may result from external acoustic canal stenosis and/or cholesteatoma formation later. Bleeding of the external acoustic canal and irregular bulge of the anterior wall of the external acoustic canal with mental region wound are important signs for early diagnosis of temporal bone fracture. Temporal bone tympanic fracture should be paid attention to, early detection and timely treatment can avoid external acoustic canal stenosis and atresia.

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

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.

A Comparative Study of Endoscopic versus Microscopic Cartilage Type I Tympanoplasty

Abstract Introduction The use of endoscope is rapidly increasing in otological and neuro- otological surgery in the last 2 decades. Middle ear surgeries, including tympanoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Superior visualization and transcanal access to diseases normal- ly managed with a transmastoid approach are touted as advantages with the endoscope. Objectives The present study aimed to compare the outcomes of endoscopic and microscopic cartilage tympanoplasty (Type I) Methods This was a retrospective comparative study of 70 patients (25 males and 45 females) who underwent type I tympanoplasty between March 2015 and April 2016. The subjects were classified into 2 groups: endoscopic tympanoplasty (ET, n = 35), and microscopic tympanoplasty (MT, n = 35). Tragal cartilage was used as a graft and technique used was cartilage shield tympanoplasty in both groups. Demographic data, perforation size of the tympanic membrane at the preoperative state, operation time, hearing outcome, and graft success rate were evaluated. Results The epidemiological profiles, the preoperative hearing status, and the perforation size were similar in both groups. The mean operation time of the MT group (52.63 ± 8.68 minutes) was longer than that of the ET group (48.20 ± 10.37 minutes), but the difference was not statistically significant. The graft success rates 12 weeks postoperatively were 91.42% both in the ET and MT groups, that is, 32/35; and these values were not statistically significantly different. There was a statistically significant improvement in hearing within the groups, both pre- and postoperatively, but there was no difference between the groups. Conclusion Endoscopic tympanoplasty is a minimally invasive surgery with similar graft success rate, comparable hearing outcomes and shorter operative time period as compared to microscopic use.

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors / Reconstrução da cadeia ossicular na otite média crônica: resultados auditivos e análise de fatores prognósticos

Abstract Introduction The goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors. Objective Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery. Methods Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz. Results Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB. Conclusion We achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.

Resumo Introdução A ossiculoplastia tem como objetivo a melhoria da audição e o sucesso desse procedimento depende de diversos fatores. Objetivo Analisar os resultados auditivos em pacientes com otite média crônica submetidos a reconstrução da cadeia ossicular, bem como os fatores preditivos de sucesso cirúrgico. Método Prontuários de pacientes submetidos a ossiculoplastia entre 2006 e 2016 foram revistos. Sessenta e oito pacientes foram incluídos, total de 72 orelhas. Os seguintes dados foram analisados: sexo, idade, tabagismo, lateralidade, doença, exames audiométricos, tipo de cirurgia, cirurgia prévia, características da orelha média, otorreia e estado da cadeia ossicular. Os pacientes também foram classificados de acordo com dois índices: índice de risco da orelha média e estadiamento do parâmetro de desfecho da ossiculoplastia. Os resultados foram avaliados comparando o gap aéreo-ósseo antes e após a cirurgia. O sucesso da reconstrução foi definido como gap aéreo-ósseo ≤ 20 dB e a melhoria dos limiares de recepção de fala, calculados pelas frequências médias de 0,5, 1, 2 e 3 kHz. Resultados A taxa de sucesso da reconstrução foi de 61%. O gap aéreo-ósseo pré-operatório médio foi de 34,63 dB e diminuiu para 17,26 dB após a cirurgia. Houve correlação entre baixo risco no índice de risco para orelha média e os índices de estadiamento do parâmetro de desfecho da ossiculoplastia com sucesso pós-operatório. O ossículo com erosão mais frequente foi a bigorna e o tipo de prótese mais utilizada foi a cartilagem tragal. Nos pacientes sem bigorna o sucesso foi alcançado em 74,2% das cirurgias. Na ausência do estribo, a taxa de sucesso diminuiu para 63,3%. Na ausência do martelo, 85% dos pacientes apresentaram gap aéreo-ósseo ≤ 20 dB. Conclusão Melhora significativa da audição foi observada em pacientes submetidos à ossiculoplastia, os resultados foram comparáveis aos de outros centros. O "status" dos ossículos influenciou os resultados pós-operatórios, principalmente a presença do estribo. Também concluímos que os índices analisados podem ajudar a prever o sucesso da cirurgia.

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.

Effect of Incudostapedial Reconstruction Using Conchal Cartilage Interposition Graft on Hearing Outcome

Abstract Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient. Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type. Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed. Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB. Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.

Impacto de la mastoidectomía en la reparación de la perforación timpánica en pacientes con otitis media crónica no colesteatomatosa con hueso mastoideo esclerótico / Impact of mastoidectomy in the repair of tympanic perforation in patients with chronic non-cholesteatomatous otitis media with sclerotic mastoid bone

Objetivo: describir las características clínicas y resultados obtenidos en pacientes a los cuales se les realizó reparación de perforación timpánica secundaria a otitis media crónica no colesteatomatosa con hueso mastoideo esclerótico, con y sin mastoidectomía. Materiales y métodos: estudio de tipo trasversal comparativo, con un muestreo no probabilístico por serie consecutiva de casos. Se revisaron los expedientes de pacientes que cumplan con los criterios de inclusión en el periodo comprendido enero del 2015 a mayo 2016. Se tomarón datos como; edad, sexo, estado de procedencia,a la otoscopia, presencia de otorrea transoperatoria y postoperatoria, estado de la mucosa, presencia de timpanoesclerosis o miringoesclerosis, perforación o retracción del injerto. Resultados: un total de 48 pacientes fueron seleccionados; 31 del sexo femenino y 17 del sexo masculino, con edad promedio de 43,25 años, el seguimiento fue de 3 meses. Al comparar al grupo de paciente con mastoidectomía y sin esta, no se encontró diferencia estadísticamente significativa en cuanto a éxito de la cirugía (perforación de injerto RR 1,2, p 1, otorrea posoperatoria RR 2,26, p 0;68 y retracción del injerto RR 0;76, p 1). Se encontró que las características durante y previa a la cirugía no influyeron en el resultado final, presentando un promedio global del 94% de integración del injerto. Conclusión: la mastoidectomía no muestra beneficio adicional en la reparación de la membrana timpánica, las características durante y previa a la cirugía no influyeron en el resultado final..(AU)

Objective: to describe the clinical characteristics and results obtained in patients who underwent repair of tympanic perforation secondary to chronic non-cholesteatomatous otitis media with sclerotic mastoid bone, with and without mastoidectomy. Material and methods: comparative cross-sectional study, with a non-probabilistic sampling by consecutive series of cases. We reviewed the files of patients who meet the inclusion criteria in the period from January 2015 to May 2016. Data was collected such as; age, sex, state of origin, history of smoking, cause of perforation, duration of dry ear, data to otoscopy, presence of transoperative and postoperative otorrhea, state of the mucosa, presence of tympanosclerosis or miringoesclerosis, perforation or retraction of the graft. Results: a total of 48 patients were selected; 31 of the female sex and 17 of the male sex, with an average age of 43.25 years, the follow-up was 3 months. When comparing the group of patients with and without mastoidectomy, no statistically significant difference was found in the success of the surgery (graft perforation RR 1.2, p 1, postoperative otorrhea RR 2.26, p 0.68 and graft retraction RR 0.76, p 1). We found that the characteristics during and before surgery did not influence the final result, presenting an overall average of 94% of graft integration. Conclusions: the mastoidectomy shows no additional benefit in tympanic membrane repair, the characteristics during and prior to surgery did not influence the final result..(AU)

Change of Tympanogram after Chronic Otitis Media Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) is an important factor for the postoperative success after tympanoplasty, though much debates have been reported. In this study, we investigated the tympanogram changes after tympanoplasty, indirectly checking up ETF, to find out the relationship between tympanogram changes and associated factors of tympanoplasty. SUBJECTS AND METHOD: Included in this study were 238 cases of tympanoplasty (canal wall up mastoidectomy with tympanoplasty type I or tympanoplasty type I only) performed by one surgeon for chronic otitis media from January, 2012 to June, 2017. In all cases, tympanometric tests were undertaken at one month, three month, six month, and one year post-operatively, and pure tone audiometry tests were taken at 1 year, post operatively. RESULTS: The average hearing level and air-bone gap were 41.8±19.7 dB, and 17.1±9.3 dB, pre-operatively, and 29.9±21.1 dB, and 6.9±8.5 dB, 1 year post-operatively, respectively. Most of the cases showed improvement in hearing. The results of tympanometry showed that hearing improvement was greater for the A type than for the B or C type (p<0.001). The smaller the size of the tympanic membrane was, the higher, the type A tympanogram appeared to be (p=0.008). CONCLUSION: The estimation of pre-operative ETF using post-operative tympanogram changes can give insight to the degree and process of recovery of the normal middle ear after tympanoplasty.

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.

Can Endoscopic Tympanoplasty Be a Good Alternative to Microscopic Tympanoplasty? A Systematic Review and Meta-Analysis

Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, –3.84 to –0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.