ABSTRACT
OBJECTIVE: To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. STUDY DESIGN: Prospective case series. SETTING: Tertiary care facility. PATIENTS: Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. INTERVENTION: In-office fat graft myringoplasty technique under local anesthesia. MAIN OUTCOME MEASURES: Complete perforation closure rate and audiometric outcomes. RESULTS: A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air-bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. CONCLUSION: In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.
Subject(s)
Adipose Tissue/transplantation , Ambulatory Surgical Procedures/methods , Myringoplasty/methods , Tympanic Membrane Perforation/surgery , Tympanic Membrane/transplantation , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neck/surgery , Prospective Studies , Treatment OutcomeABSTRACT
Drug-induced sleep endoscopy (DISE) is a complementary method for the diagnosis of obstruction sites in patients with snoring and obstructive sleep apnea (OSA) and allows the optimization of treatment. We present the first case of a patient having a seizure during DISE, after sedation with midazolam and propofol. We recommend that DISE should be performed in a safe environment, under monitoring, and with anesthesia equipment that can be used to counteract potential complications caused by seizures.
