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At least 343 records · Page 19Linked to original sources
PubMed1990

[Experimental study in dogs of a human reticulated placental IV collagen film for myringoplasty].

This experimental study involving dogs tested type IV human collagen as a biomaterial for use in the tympanic membrane reconstruction. A loss of substance was induced for the two tympanic membranes, and a type IV collagen graft made to one side. The kinetics of receiver fibroblast colonisation of the graft, as well as in the case of resorption, were studied. Anatomopathological examination revealed the process of reconstitution. This animal study prepares the way for studies on man.

Animals↗
PubMed2004

Training opportunities for specialist registrars post-calmanization: audit of trainees' exposure to repair of the tympanic membrane.

Specialist training at the registrar grade in the United Kingdom has undergone significant change in the recent past. One of the effects has been a reduction in the length of time spent in training. This and the application of the European working time directive have the potential to reduce trainees' surgical exposure. The proportion of tympanic membrane procedures performed by reconstructive otolaryngology registrars in the Grampian University hospitals was audited to monitor the impact of these changes. Case notes of all patients who underwent myringoplasty or tympanoplasty between July 1998 and June 1999 were analysed retrospectively. Details of the surgeons' grade were recorded. The proportion of myringoplasties performed by registrars as determined by the Royal College of Surgeons of England National Comparative Audit survey, carried out in 1995 before the widespread implementation of recommended changes in otolaryngology registrar training, was set as the gold standard. In the period July 1998-1999 registrars had performed fewer myringoplasties than the standard, 17 per cent versus 34.2 per cent respectively (p = 0.035). A strategy to increase registrar exposure to myringoplasty surgery was then adopted by the department and the proportion of myringoplasties performed by registrars re-audited prospectively. The proportion of myringoplasties undertaken by registrars increased in the period January 2001 to July 2001 compared to July 1998-1999, 53 per cent versus 17 per cent respectively (p < 0.0007). Changes in working practice can address shortfalls in registrars' exposure to surgical procedures.

Education, Medical, Graduate↗
PubMedDate not supplied

Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot treatment algorithm.

PURPOSE: The objective of this study was to examine the success of a pilot treatment algorithm for tympanic membrane perforations in children after tympanostomy tube placement. MATERIALS AND METHODS: A retrospective chart review of children with diagnosed tympanic membrane perforations after tympanostomy tube placement from 1998 to 2003 at a tertiary care children's hospital was performed. The patients had been treated according to an algorithm used by 2 pediatric otolaryngologists for management of tympanic membrane perforations: observation vs myringoplasty. Success rates were examined. RESULTS: Ninety-five children were identified, 27% of whom had nonhealing perforations after tube extrusion; 73% of the perforations were caused by a retained tube. The median duration of tube retention was 48 months, ranging from 13 to 120 months. After the treatment protocol, 76% of the patients underwent gelatin film or paper patch myringoplasty, 23% had adipose myringoplasty, and 1% were observed. Overall, 91% had healed perforations after the first intervention. Among those requiring a second intervention, the sizes of initial perforations were between 15% and 40%, with postrepair perforation sizes between 5% and 40%. In addition, 75% of those requiring a second intervention underwent tympanoplasty repair and 25% had fat patch myringoplasty. None required a third intervention. CONCLUSIONS: Our treatment algorithm for children with tympanic membrane perforations after tympanostomy tube placement appears to be successful and is an excellent model for other clinicians.

Algorithms↗
PubMed2001

Hearing results of ossiculoplasty in Austin-Kartush group A patients.

OBJECTIVE: To compare hearing results in patients who underwent ossiculoplasty for Austin-Kartush group A impairments (incus erosion, malleus handle present, stapes superstructure present) with the results in patients with an intact ossicular chain who required only myringoplasty. The literature on hearing results of ossiculoplasty with different types of prostheses and different techniques is reviewed. PATIENTS AND STUDY DESIGN: This study retrospectively reviews a series of 181 consecutive ossiculoplasties and 204 consecutive myringoplasties. SETTING: The study was carried out partly at a private practice and partly in an academic tertiary referral center. MAIN OUTCOME MEASURES: This study complies with levels 1 and 2 of the guidelines recommended by the American Academy of Otolaryngology--Head and Neck Surgery (1995). RESULTS: When success was defined as a postoperative air-bone gap within 10 dB, the success rate was higher for myringoplasty (81%) than for ossiculoplasty (55%). When success was defined as a postoperative air-bone gap within 20 dB, the success rate was 97% in myringoplasties and 85% in ossiculoplasties. There was no significant deterioration over time of the mean postoperative air-bone gap for any frequency. CONCLUSION: Cumulative data from several authors show that -50% of patients undergoing partial ossiculoplasty have a postoperative air-bone gap of 0 to 10 dB, and 80% have a postoperative air-bone gap of 0 to 20 dB. Equally good results may be achieved with autograft (no difference was found between interposition of the incus or the head of the malleus), homograft, or alloplastic partial prostheses. With alloplastic total prostheses, 36% of patients have a postoperative air-bone gap of 0 to 10 dB, and 74% have a postoperative air-bone gap of 0 to 20 dB.

Adult↗
PubMed1999

[The selection of tympanoplastic type in treating chronic suppurative otitis media].

OBJECTIVE: To investigate the effect of different type of tympanoplasty on chronic suppurative otitis media (CSOM). METHOD: Myringoplasty, focuses clearance and myringoplasty, focuses clearance and ossiculoplasty and myringoplasty were performed in 189 cases of CSOM. RESULT: The cure rate of perforation of tympanic membrane with myringoplasty was above 99% accompanied by the varying improvement in acoustic sensibility. CONCLUSION: Different types of tympanoplasty should be used according to the CSOM. The slighter the pathological changes of CSOM, the more the hearing improve. The better effects was in tympanoplasty of simple type. The tympanic exploration is necessary to be included in tympanoplasty.

Adolescent↗
PubMed2003

[Tympanoplasty with adipose tissue].

BACKGROUND: Among other materials it is also possible to use autologous fat tissue for closing tympanic membrane perforations. In this study we have evaluated 44 consecutive myringoplasties with adipose tissue performed between 1999 and 2001. MATERIAL AND METHOD: The indications were residual microperforations following tympanoplasty with temporalis fascia or tympanic membrane perforations due to trauma or chronic otitis media simplex. Myringoplasty with fat tissue was performed as an outpatient procedure and took about 15 minutes. The adipose tissue was harvested from the posterior side of the ear lobe in local anaesthesia. After refreshing the borders of the tympanic membrane perforation with a micro hook, the adipose tissue was positioned into the perforation by using a handheld or fixed ear speculum. The graft was covered with a silk strip soaked with Garamycine ointment. In bigger perforations a bed of gelfoam was put into the tympanic cavity in order to avoid adhesions between the graft and the promontorium. RESULTS: A permanent healing of the tympanic membrane was achieved in 40 (91 %) out of the 44 patients. In 21 patients hearing improved between 5 -10 dB. Surgical complications did not occur. CONCLUSIONS: Our results indicate that transcanal myringoplasty with adipose tissue is a simple and minimally invasive method for closing small to medium sized tympanic membrane perforations.

Adipose Tissue↗
PubMed2007

Chorda tympani nerve function after middle ear surgery.

OBJECTIVE: To assess chorda tympani nerve function before and after different types of middle ear surgery. The hypothesis was that in cases with cholesteatoma, iatrogenic injury to the nerve results in less postoperative taste disturbance than those undergoing myringoplasty or stapedectomy. STUDY DESIGN: Prospective questionnaire study. SETTING: ENT Department of a district general hospital in England. PATIENTS: Adult patients undergoing middle ear surgery in which there would be elevation of the anulus. MAIN OUTCOME MEASURE: Patients' change in taste sensation after surgery with follow-up to demonstrate subsequent recovery. RESULTS: A significantly higher incidence of taste disturbance follows myringoplasty and stapedectomy than for procedures in which the initial diagnosis was cholesteatoma, regardless of the extent of injury sustained by the nerve. The most common complaint after chorda tympani nerve injury is of a metallic taste sensation. CONCLUSION: Despite the small patient cohort, the results support the hypothesis that iatrogenic chorda tympani nerve injury in surgery for cholesteatoma results in less postoperative taste disturbance than that for otosclerosis. This may be because the disease process of cholesteatoma renders the nerve hypofunctional. The situation after myringoplasty is less clear. A larger study may help validate these findings.

Adolescent↗
PubMed1978

Tragal perichondrium and cartilage in reconstructive ear surgery.

Two hundred and fifty-five ear operations using tragal perichondrium and cartilage for reconstruction are presented. Of these, 108 were myringoplasties, 137 were tympanoplasties with ossicular reconstruction performed by nine different methods, and 10 were tympanoplasties with reconstruction of posterior canal wall defects left by radical mastoid surgery. The method presented in this study of using the tragal perichondrial graft is well suited for myringoplasty and can be used where the drum remnant is very small or the anulus is missing. The natural angle of the tragal perichondrium can take the place of the missing anulus anteriorly, inferiorly or posteriorly. Myringoplasty graft survival at one year follow-up was 92%, and 76% had hearing within 10 db of bone conduction. In tympanoplasty, the tragal perichondrium was used en bloc with its cartilage for reconstruction of the ossicular chain where suited. The malleus was used to reconstruct the ossicular chain in different variations. Other methods used are fully described. At one year follow-up the rate of grafting success for tympanoplasties was 91%, and 78% had hearing within 10 db of bone conduction. A method for reconstruction of the posterior canal wall and tympanoplasty after radical mastoidectomy is presented. It uses tragal cartilage and perichondrium en bloc. At one year follow-up, eight of ten cases operated on by this method had an intact drum and posterior canal wall, one had an intact drum but the posterior canal collapsed into the mastoid, and one had an intact canal wall but the eardrum re-perforated. Nine had postoperative hearing within 10 db of bone conduction. A randomly selected group of 100 tympanoplasties was examined for postoperative gain in hearing according to the speech reception threshold, a more practical criterion of surgical success than 10 db air-bone gap. Although the total number showing improvement was similar to the number gaining hearing within 10 db of pure tone bone conduction (76% vs. 78%), when changes of 5 db were discounted, only 56% were improved (and 33% had a significant gain in hearing).

Adult↗
PubMed1984

Role of the mastoid in tympanic membrane reconstruction.

Otologists have long debated the importance of the mastoid in determining the success or failure of tympanic membrane reconstruction. The pneumatic spaces within the mastoid represent an "air reservoir" which can be drawn upon during periods of eustachian tube dysfunction and buffer the middle ear against the development of detrimental negative pressures. Mastoid inflammatory disease, if untreated, may result in recurrent suppuration and graft failure. Small mastoid volume, aside from its well known association with chronic infectious middle ear disease, has been shown to effect adversely graft survival following myringoplasty. In 48 patients undergoing myringoplasty with simple mastoidectomy, neither small mastoid size nor inflammatory mastoid disease significantly decreased the rate of graft healing. This suggests that simple mastoidectomy is an effective means of repneumatizing the mastoid and eradicating mastoid sources of infection. The successful surgical creation of a pneumatized mastoid cavity in communication with the middle ear was confirmed by postoperative computerized tomographic (CT) scans. In failed cases, CT scanning predictably identified residual mastoid disease. Simple mastoidectomy is considered to be a safe and useful adjunct to myringoplasty in selected cases of chronic otitis media with perforation.

Hearing↗
PubMed1977

Eustachian tube function and size of the mastoid air cell system in middle ear surgery.

Myringoplasty results in patients with poor tubal function and small cell systems are often disappointing, to both patient and surgeon. Surgical procedures to improve tubal function have been introduced but they all have the disadvantage of being rather elaborate and difficult to perform. The mastoid air cell system on the other hand does not offer the same problems of access. With the concept of creating an air-filled cavity in connection with the middle ear, mastoidectomy was performed in myringoplasty cases with poor tubal function and small (less than 9 cm2 lateral area) cell systems. Preliminary results show a healing rate of 82% in patients managed according to these principles, against 50% in corresponding cases when myringoplasty alone was done.

Eustachian Tube↗
PubMed1998

[Fat tissue in the treatment of tympanic membrane perforations].

Adipose myringoplasty is presented as a simple and effective technique in managing tympanic membrane perforations. A review of 34 fat plug myringoplasties performed in 28 patients with drum perforations over a 4-year period was done. Twenty-two myringoplasties were postinflammatory, five--posttraumatic and three--postinflammatory in temporalis fascia. Criteria for selection, operative technique and results are discussed.

Adipose Tissue↗