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.

Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with plateletrich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which plateletrich fibrin was used. The postoperative infection rate was also lower in the same group. (AU)

Intraoperative findings during canal wall down mastoidectomy in chronic suppurative otitis media at a tertiary care hospital, Sukkur, Pakistan

To assess the intraoperative findings during canal wall down mastoidectomy in patients for unsafe type of chronic suppurative otitis media [CSOM]. This prospective interventional study was carried out at Department of ENT and Pediatrics of Ghulam Muhammad Mahar Medical College Hospital, Sukkur, Pakistan from June 2009 to June 2011. Eighty patients who were 5-55 years of age, of both genders, with CSOM who underwent canal wall down mastoidectomy were included in the study. The operative findings like extent of cholesteatoma, granulation tissue in different location in middle ear cleft and ossicular chain condition and otogenic complication were identified. Females were affected more than males [n=48; 60%]. Granulation tissue was found in 50 [62.5%] of cases, while cholesteatoma in 30 [37.5%] cases. The extent of disease was attic in 4 [5%], attic and middle ear 30 [37.5%], attic and antrum 16 [20%] and attic, antrum and middle ear 30 [37%] patients. In majority of the cases there were involvement of more than one ossicle; among the most affected single ossicle malleus was found necrosed in 50 [62.5%], and absent in 6 [7.5%] cases, incus was found necrosed in 42 [52.5%], and stapes was found necrosed in 20 [25%] of cases. The primary disease found in our patients undergoing canal wall down mastoidectomy was granulation. Less common were cholesteatoma and multi-ossicular

Evaluation of mastoid cavities after canal wall down mastoidectomy

To evaluate mastoid cavities after canal wall down procedures in terms of achieving a dry mastoid cavity, presence of residual or recurrent disease [Granulations and cholesteatoma]. Quasi-experimental study. The study was done in the ENT Department, CMH Rawalpindi Study was done in fourteen months from Nov 2006 to Jan 2008. Fifty patients undergoing canal wall down mastoidectomy were included. Their mastoid cavities were evaluated for persistence of discharge and recurrence of granulations and cholesteatoma after the surgery. After follow up period of 3 months, 8% patients had mild discharge, 12% had granulation and 2% patients had recurrence of cholesteatoma. Canal wall down mastoidectomies are very effective in controlling the recurrence of cholesteatoma, granulations formation and otorrhoea to a greater extent

Myringoplasty in children: predictive value of preoperative assessment of Eustachian tube function

Our aim was to determine the value of preoperative Eustachian tube [ET] function assessment in predicting the results of myringoplasties in children. One hundred children suffering from inactive chronic suppurative otitis media were enrolled in this study. All children had undergone preoperative evaluation of the ET function using pressure equalizing test. Children were classified into three groups according to the ET function. The patients were operated at ORL Departments, Mansoura and Banha University hospitals between 2003 and 2006. Tympanic membrane perforations were reconstructed by autogenous temporalis fascia graft using underlay technique. Success was defined as no evidence of tympanic membrane perforation via otoscopic examination at the end of 6th month and air bone gap less than 20 dB. A success rate of 91.6% in terms of graft uptake and hearing improvement of 95.4% was seen in good ET function, compared to 36.4% graft uptake and 62.5% hearing improvement in poor ET function. This study revealed that preoperative assessment of ET function is an important factor when considering myringoplasty in children

Myringoplasty for chronic otitis media.

METHODS: 25 children in the age group of 8-14 years suffering from chronic suppurative otitis media were taken up for myringoplasty using onlay technique under general anaesthesia. RESULTS: All selected cases had a central type of dry perforation, good cochlear reserve and healthy middle ear mucosa. Cases having enlarged adenoids, infection in nose or throat, any traumatic perforation or previous attempt at closure were excluded from the study. It was found that there was 76% take up of graft after two months who also had improvement in hearing. CONCLUSION: We conclude that myringoplasty stands a good chance in children.

Staged Tympanoplasty: syears experience

This study has reported data of 155 staged tympanoplasty cases. Staging has been done for 105 cholesteatoma cases and 50 cases with advanced mucosal disease. The results showed closure of air-bone gap to 20 dB or less in more than 60% of patients. These encouraging results, despite the small number of cases, are in favor of staging tympanoplasty for the management of patients with chronic supportive otitis media. Staging allows establishment of a good middle ear space and gives a chance to remove possible cholesteatoma remnants or recurrence. The preserved ossicles of the patient were used as an autograft for ossicular reconstruction. This is more economical and as effective as other expensive plastipore or more recently used gold prostheses

Otite média secretora: perfil terapêutico por uma amostra de especialistas / Otitis media with effusion: treatment modalities applied by a group of ent doctors

O tratamento da otite média secretora (OMS) apresenta grande dificuldade de padronizaçäo, devido à combinaçäo de importantes fatores etiológicos na patogênese da doença. Dessa forma, diferentes modalidades de tratamento podem ser empregadas. Para melhor conhecermos os atuais conceitos no tratamento da OMS, foi realizada uma pesquisa com 150 médicos otorrinolaringologistas de diferentes regiöes do País. Oitenta questionários foram respondidos; e os dados, computados. Os resultados mostraram que, na grande maioria, os especialistas prescrevem, como primeira opçäo terapêutica, antibióticos por 8 a 10 dias (Amoxacilina em 40 por cento dos casos), associados com corticosteróides por 11 a 15 dias. Nas consultas seguintes näo houve predomínio de qualquer grupo de medicaçöes. Em relaçäo ao tratamento cirúrgico, näo houve concordância do momento preciso de sua indicaçäo. Na maioria, os especialistas indicam tubo de ventilaçäo de curta duraçäo. Os autores analisam as terapêuticas propostas e comparam com a literatura e internacional

Atualizaçäo em otite média crônica supurada em crianças / Uptade in chronic suppurative otitis media in children

A otite média crônica supurada (OMCS) é uma doença bastante freqüente no nosso meio, necessitando muitas vezes intervençäo cirúrgica. Complicaçöes também podem ocorrer, às vezes fatais. Os autores apresentam Revisäo da Literatura dos últimos cinco anos da otite média crônica supurada, com enfoque para a doença na infância. Definem a otite média crônica supurada como otorréia persistente há mais de três meses, apresentando a incidência. Relatam os fatores de risco, a fisiopatologia para cronificaçäo do processo inflamatório, os agentes mais freqüentes, o diagnóstico clínico e a importância do estudo audiológico e de imagem, o tratamento clínico e cirúrgico, e as complicaçöes que podem decorrer da otite média crônica supurada, principalmente da colesteatomatosa.

Cirugía de oido crónico: experiencia en el Hospital San Juan de Dios / Chronic ear surgery: experience in the San Juan de Dios Hospital

Los resultados de 252 casos de Cirugia de Oído Crónico operados en el Hospital San Juan de Dios, son presentados en este trabajo. Los cirujanos involucrados en esta casuística son los adjuntos del Servicio de Otorrinolaringología del Hospital San Juan de Dios y los Residentes del último año del curso de Post-grado. Se presenta un análisis estadístico relacionando la edad, tiempo de evolución de la enfermedad, hallazgos quirúrgicos, técnicas quirúrgicas utilizadas y resultados obtenidos. Se discuten estos resultados y se hace énfasis en la falsa premisa que la Cirugía de Oido Crónico en niños no es una decisión prudente de tomar.

Myoglobinuria following the use of succinylcholine.

Eight hours following tympanoplasty performed under general anaesthesia (sodium pentothal and trichloroethylene), a 30 year old male complained of muscular weakness and dark coloured urine. Urinalysis revealed myoglobin pigment. A rise in BUN (47mg%), serum creatinine (5.7mg%), creatinine phosphokinase (15,500 U/L) and CPK-MB fraction (4690 U/L) was noticed 36 hrs later. The patient developed acute renal failure, and recovered after haemodialysis. From a history of use of succinylcholine as a muscle relaxant during operation, myoglobinuria appears to be secondary to muscle damage caused by succinylcholine.

Evolución clínica y audiométrica de las timpanoplastias: estudio de 5 años / Clinical and audiometric evolution of timpanoplasties: a five-year study

Se realizó un estudio de 30 pacientes operados de timpanoplastia en el año 1982 en el Servicio de Otorrinolaringología del Hospital Provincial Clinicoquirúrgico Docente "Dr. Gustavo Aldereguía Lima" de Cienfuegos. Se analizó la incidencia por edad, área de procedencia, características clínicas de la otorrea y perforación, estado de la caja y mastoides, afecciones asociadas y evolución clínica y audiométrica según el tipo de timpanoplastia empleada durante un período de 5 años, se plantea la necesidad de utilizar otro tipo de material de injerto como neotímpano y sustitutivos de la cadena osicualr para mejorar el pronóstico funcional

Otitis medias crónicas en el infancia: formas de presentación / Otitis media chronic in the infancy: presentation forms

Se analizaron historias clínicas de niños con otitis medias crónicas, observando que este tipo de proceso en nuestro medio, hace su debut al 1er. año de vida con picos de máxima frecuencia, variables según la forma de presentación. Las otitis medias crónicas tipo II y III con grave compromiso de la estructura y función y con mayor índice de complicaciones fueron los más frecuentes (64%) y de aparición más temprana. Las imágenes radiológicas oscilaron entre lesiones mínimas en las otitis medias crónicas tipo I a trastornos morfológicos severos en las tipo II y III