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PubMedDate not supplied

Size of typmanic membrane perforation and hearing loss.

This prospective study was done to assess the level of preoperative hearing impairment in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. It was observed that greater hearing loss was reported in group D perforation (44 dB), where as in group A, it was 31 dBHL. The average hearing loss at 500 Hz was 46.40 dB, at 1000 Hz was 30.90 dB and at 2000 Hz it was 31.9 dB. This shows that the hearing loss is more at lower frequencies and less as the frequencies increase. This study shows that as the size of perforation is increased, the hearing loss also increases. The hearing loss is more marked at lower frequencies as compared to higher frequencies.

Adolescent↗
PubMed1985

[Unusual zones of osteitis detected during salvage tympanoplasty].

Three patients were noted to have unusual zones of osteitis during salvage myringoplasty. The first case involved the whole upper wall of the bony canal and was camouflaged by a weeping mucopolypoid carpet. In the second case there was a wide zone of osteitis of the posterosuperior angle of the canal and another smaller zone in the anteroinferior tympanic region. The osteitis in the third case had invaded the total mastoid cortex producing a vast plaque of superficial osteitis which could be removed without difficulty. Diffuse osteomatous reaction of the wall of the canal had resulted. In all three cases a salvage myringoplasty was possible after elimination of the osteitic lesions, although a glue ear persisted with a punctiform perforation in one patient, suggesting tubal dysfunction.

Adult↗
PubMed1985

[Involvement of the tympanic bone in chronic otitis (44 cases)].

44 cases of tympanic involvement in the context of chronic otitis are described. 34 occurred during active chronic otitis. This is a rare possibility (approximately 4% of our own cases of chronic otitis). The following may be mentioned amongst them: 21 cases of osteitis, for which the following concepts should be borne in mind: the extreme severity of the chronic otitis responsible, in most instances, ears which had undergone multiple surgery (17/21), lesions exclusively of osteitis, but very extensive in 2/3 of cases (14/21). 7 cases of osteolytic disease, occurring severe or atypical cholesteatomatous chronic otitis and quite often involving associated osteolysis affecting the main VII, the promontory, the bulb of the internal jugular vein, or even the carotid canal. 4 cases of diffuse sub-obstructive osteomatous disease of the walls of the E.A.M., "progressive" development of which over several months was noted in 3 cases. Finally, 2 cases of mixed disease: (osteitis--osteomatoma and osteitis--osteolysis). 8 cases occurred following myringoplasty: this is a rare eventuality (approximately 1%), 1 case only of osteolysis due to iatrogenic cholesteatoma, 7 cases of osteitis, either highly localized and not preventing further myringoplasty (4 cases), or very extensive, finally resulting in a vast evacuation cavity. In 2 cases, a malformation is the origin of involvement of the tympanic at the origin of chronic otitis was felt probable, without it being possible to reach any definite conclusion concerning auriculobranchial fistula or Huschke foramen.

Adolescent↗
PubMed1993

Manometric and endoscopic study of tubal function in drum perforation.

Since good ventilation of the middle ear is a prerequisite to successful myringoplasty, it was our policy to study the tubal function in dry central perforation of the drum and to correlate the manometric with the endoscopic findings. Normal manometric results with patency of the tube (as proved by fluorescein-endoscopy) indicated good tubal function, with good prognosis for myringoplasty. Abnormal manometric results with failure of fluorescein to pass into the nasopharynx indicated mechanical tubal obstruction that was, in most cases, correctable. Nasal endoscopy proved to be indispensable in diagnosing, localizing, and even treating "hidden" lesions in their key areas that may be responsible for the obstruction. Thus, the correction of the mechanical tubal obstruction must precede ear surgery. Whenever tubal obstruction is diagnosed as functional or idiopathic, the ventilation of the middle ear should be facilitated during ear surgery by addition of a tympanostomy tube to the graft or drum remnant, with guarded prognosis.

Adult↗
PubMed1993

[Cholesteatoma of the middle ear with closed tympanic membrane in children. Apropos of 8 cases].

Among 30 children with cholesteatoma undergoing surgery at the Bicetre Hospital between 1985 and 1990, 8 had intact tympanic membranes. Since this represents a larger portion of the patient population than would be expected from previously published data, we under-look a critical analysis of the clinical findings. Among these 8 cases, 2 corresponded to the criteria of congenital cholesteatoma with no history of otitis or trauma and 3 corresponded to acquired types with histories of ventilatory intubation, myringoplasty and accidental trauma. Finally, 3 cases were possibly of mixed origin with lesions typical of congenital epithelial rests and a history of commonplace era infections. Based on these observations, the authors review the clinical characteristics and pathogenesis of congenital cholesteatoma and evoke the etiologic impact of trauma, particularly iatrogenic events such as myringoplasty and ventilatory intubation.

Child↗
PubMed1998

[The use of the ox's vein for myringotomy of the ear].

The study presents a modification of the method developed by Zini et al. to prepare an ox's vein for a myringoplasty. The graft of the vein was pickled in a trypsin solution, fixed in formaldehyde and stored in a 70% ethanol solution. It was established that the incubation period of the vein in the trypsin solution required to produce the best histological specimens for this purpose was 5 hours. The preparation of the ox vein for a graft with the use of trypsin is relatively simple and inexpensive. Xenografts of ox veins for use in myringoplasties in humans are a good material and may be successfully used both in reconstructions of large defects in the tympanic membrane and in operations to correct congenital atresia of the ear.

Animals↗
PubMed1999

Meta-analysis of pediatric tympanoplasty.

OBJECTIVE: To determine which preoperative conditions or surgical techniques may influence the success of tympanoplasty in the pediatric population. DATA SOURCES: A MEDLINE search of the English-language literature from 1966 to May 1997 was conducted using the search terms pediatric or child and tympanoplasty or myringoplasty. STUDY SELECTION: Articles that provided age-specific data on tympanoplasty or myringoplasty were included. Of the original 651 studies retrieved, 30 were accepted for inclusion. The principal reason for exclusion was inability to separate adult and pediatric results in series that combined both patient populations. DATA EXTRACTION: Success was defined as an intact tympanic membrane for the purpose of this review. Data were tabulated by consensus of 2 reviewers. DATA SYNTHESIS: The effect of surgical technique, prior adenoidectomy, presence of active infection, size of perforation, status of the contralateral ear, age, and eustachian tube function on healing of the tympanic membrane after surgery was assessed. Only those studies providing data on a given parameter of interest could be included when comparing each variable. Weighted means were compared and subjected to sensitivity analysis. Simple linear regression analysis was used to assess the effect of age on outcome. CONCLUSIONS: Greater success in healing of the tympanic membrane following tympanoplasty in children is seen with advancing age. None of the other parameters studied was shown to be a significant predictor of success. Guidelines for reporting results of tympanoplasty are presented.

Child↗
PubMed2003

Intravenous sedation vs general anesthesia for pediatric otolaryngology procedures.

OBJECTIVE: To compare efficacy, safety, and hospital charges for common pediatric otolaryngology procedures with the use of intravenous sedation (IVS) vs general anesthesia (GA). DESIGN: Retrospective chart study. SETTING: Hospital-based pediatric otolaryngology practice. PATIENTS: Patients younger than 18 years who underwent tympanostomy tube removal and/or patch myringoplasty with absorbable gelatin sponge, nasal ciliary biopsy, fine-needle aspiration, or other minor procedures between September 1, 1998, and August 31, 2001. INTERVENTIONS: Procedures performed in 2 settings: outpatient clinic with IVS or operating room with GA. MAIN OUTCOME MEASURES: Procedure completion rate, tympanic membrane perforation rate after ear procedures, complications, and hospital charges. RESULTS: Of 103 procedures, 54 were performed with IVS and 49 with GA. Within the GA group, 32 of 49 patients had additional operations performed and were excluded from analysis of safety and hospital charges. Procedure completion rate was 100% in both groups. The most common procedure was tympanostomy tube removal with patch myringoplasty (IVS, 52 ears; GA, 42 ears). The rate of persistent tympanic membrane perforation was similar between these groups (IVS, 7 [16%] of 45 ears; GA, 5 [15%] of 33; P =.96). All complications were minor and occurred at similar rates (IVS, 10 [19%] of 54 ears; GA, 3 [18%] of 17; P =.94). These events included hypoxia, airway obstruction, and bradycardia, all of which resolved spontaneously or responded to noninvasive interventions such as oxygen or repositioning. Average hospital charges were significantly higher for the GA group (IVS, $356.22; GA, $1516.55; P<.001). CONCLUSION: Various procedures can be performed safely, effectively, and with decreased hospital charges with the use of IVS administered by a pediatric sedation service.

Adolescent↗
PubMed2003

Paper patching for chronic tympanic membrane perforations.

OBJECTIVE: This study was designed to evaluate the results of paper-patch myringoplasty in patients with chronic perforations of the tympanic membrane of different sizes. STUDY DESIGN AND SETTING: A retrospective survey of paper-patch myringoplasties performed in a tertiary referral academic medical center on 77 patients with chronic perforations of the eardrum was carried out. Data consisted of the causes of the perforations, time the perforations had been present, their size, number of patch applications, duration of application, and number of successfully closed perforations. RESULTS: Closure rate was 63.2%, 43.5%, and 12.5% for small, medium, and large perforations, respectively. Small perforations needed the least number of repeated applications and the least time for closure. CONCLUSIONS AND SIGNIFICANCE: Paper patching is technically simple, time saving, safe to perform, cost effective, and suitable as an outpatient procedure and has a good success rate, It should be tried in perforations smaller than 5 mm before a patient is referred for surgery.

Adolescent↗
PubMed2006

Water precautions and ear surgery: evidence and practice in the UK.

BACKGROUND: Patients are traditionally advised to refrain from exposing their ears to water after most otological procedures. However, recent evidence suggests that water does not adversely affect the outcome for children with tympanostomy tubes. The evidence behind the potential harmful effects of water on the outcome of other otological procedures is scarce. OBJECTIVE: The study was done to determine the current practice of otolaryngology consultants in the UK on the advice given to patients regarding swimming, diving and bathing in soapy water after myringotomy and tympanostomy tube insertion, mastoidectomy and myringoplasty. METHOD: Questionnaire based survey mailed to 382 members (consultants only) of the British Association of Otolaryngologists--Head & Neck Surgeons in the UK. RESULTS: A total of 195 responses were received (reply rate 51 per cent). In all, 95.6 per cent of the respondents allowed their patients to swim after insertion of tympanostomy tubes, with 32.9 per cent insisting on the use of earplugs until extrusion of the tympanostomy tubes. However, 61.6 per cent of the respondents restricted diving in these patients. In comparison, the respondents were more conservative with water precautions following myringoplasty and mastoidectomy. More than half the respondents recommended earplugs for bathing after all three operations. CONCLUSION: This study reveals current national practice among UK otolaryngologists. There is no general consensus in post-operative advice following otolaryngological procedures, indicating a need for national guidelines.

Baths↗
PubMed2005

Curtailment of higher surgical training in the UK: likely effects in otology.

Higher surgical training in the UK faces a cut of two years. We conducted a questionnaire survey to assess the operative experience of current higher surgical trainees in otological surgery and the likely effect of the proposed reduction from six to four years. 91 (65%) of the 142 higher surgical trainees responded with details of major otological procedures performed (independently or assisting) over one year. In the present six-year scheme a typical trainee performs 72 myringoplasties, 79 mastoidectomies, 7 skull base procedures and 28 other procedures. In the first four years, however, his or her experience is only 39 myringoplasties, 44 mastoidectomies, 4 skull base procedures and 7 others. The large shortfall in experience that might result from shortening of the training programme would need to be met by intensification of the training or institution of accredited otology fellowships. Very similar dilemmas are faced by other surgical specialties.

Clinical Competence↗
PubMed2001

Outcome of 22 cases of perforated tympanic membrane caused by otomycosis.

Twenty-two cases of perforated tympanic membrane due to fungal otitis externa were observed over a five-year period. The diagnosis of fungal otitis externa was made on clinical grounds due to the obvious presence of fungal bloom in the external ear canal. Some perforations were noted at the first treatment after the fungal debris had been removed from the external ear canal using a microscope. Other perforations were observed to develop over a few days. Initially, a discrete area of the tympanic membrane appeared white and opaque. As time progressed the white area disintegrated, forming a perforation. Once the otitis externa had resolved most perforations healed spontaneously. Two that were observed to develop during treatment required a myringoplasty. Another one closed significantly but a tiny persistent perforation required cauterization with trichloracetic acid to encourage it to close over completely. The only residual hearing loss was in a case with almost total disintegration of the tympanic membrane requiring a myringoplasty. Treatment of fungal otitis externa for the patients in this series was aural toilet using suction under a microscope and insertion of a gauze wick saturated in a combination of hydrocortisone, clotrimazole, framycetin and gramicidin.

Administration, Topical↗
PubMedDate not supplied

[Surgical treatment of secretory otitis media: persistent perforation as a rare complication].

INTRODUCTION: The persistent perforation of the ear drum may appear as a complication after spontaneous or instrumental elimination of ventilatory tubes during surgical management of secretory otitis media. According to recent literature data its incidence can vary in an average interval from 0.5 to 3.4% for the short term ventilatory tubes and more than 8.5% for long term ventilatory tubes. This study showed the results of analysis of the incidence and therapy of persistent perforation of the ear drum after elimination of the short term ventilatory tubes during the treatment of secretory otitis media in 1554 children, treated over the period from 1988 to 1997 at the Ward of ORL, Zvezdara Clinical and Hospital Centre in Belgrade. MATERIAL AND METHODS: The retrospective analysis of medical documentation showed that 1554 children were surgically treated by short term ventilatory tubes between 1988 and 1997. Bilateral insertion of the ventilatory tubes was performed in 1353 children (Sheppard short term tubes) and unilateral insertion was performed in 201 children. The age of the patients ranged from 9 months to 12 years. RESULTS AND DISCUSSION: After 2907 inserted short term ventilatory tubes 25 (0.86%) persistent perforations of the ear drum were diagnosed. The average time of elimination was 6-8 months after tubes insertion. In 3 cases, refreshment of the edges of perforation and silastic sheet placement led to complete closure of ear drum defect. In 16 patients myringoplasty was performed. According to literature data and our clinical experience, the main cause of this complication is the state of the ear drum which is a part of pathophysiological mechanisms in secretory otitis media. The histopathological studies of the ear drum in secretory otitis media confirmed various morphological changes: thickening of the ear drum, subepithelialo oedema, infiltration of submucous space by lymphocytes, macrophages and plasmocytes. Fibrous layer showed irregularly oriented fibroblasts and a high production of fibrous fibres. The interaction among extracellular tissue, cells of the submucous and subepithelial layer and cytokines causes the process of reparation of the ear drum. CONCLUSION: Persistent perforation of the ear drum is a rare complication during surgical treatment of secretory otitis media, but it has its great clinical importance if spontaneous repair does not appear. Depending on the mucosal status, ear discharge, Eustachian tubes function and immunological status or upper respiratory mucosa, myringoplasty is the method of therapeutical choice.

Child↗
PubMed1993

Otolaryngological indicator operations: one year's experience.

One year's experience of otolaryngological indicator operations is presented. Of 59 myringoplasties, 47 (79%) were successful; trainees performed 44 (74%) of the procedures. Seventy patients undergoing septal surgery reported significant improvements in nasal obstruction (P < 0.001), catarrh and facial pain (P < 0.005). Seventeen laryngectomies were performed for stage III and IV disease. The median operative time of 3.1 h rose to 5.1 h with a concomitant neck dissection. Eleven complications ensued, and the median stay for an uncomplicated laryngectomy was 16 days and 30 days following complications. Forty-one parotidectomies, 19 submandibular gland excisions and 10 ductal procedures were performed with 5 wound complications and 5 minor temporary facial nerve weaknesses. We have established a baseline for comparison of our practice with others and concluded that septal surgery gives good symptomatic relief, trainees perform reasonable numbers of myringoplasties, and improvements remain to be made in our outpatient septal surgery data collection.

Adolescent↗
PubMedDate not supplied

[Therapeutic approach in blast injuries of the ear].

UNLABELLED: Otic blast injury is caused by arrhythmic air blast wave. The perforation of the tympanic membrane is the commonet finding associated with lacerations of mucosa in the middle ear. Makki [6] published 34 cases of myringoplasty after war blast injuries. However, healing of such perforations is common; Kerr [7] noted a healing rate of 83% after the blast injury. The aim of the study was to evaluate different therapic procedures of otic blast injuries. There were 74 patients with bilateral otic blast injuries, who underwent otomycroscopic examination. The following parameters were noted: Integrity of tympanic membrane and size of perforation, presence of haemorrhagic exudate in the middle ear and median value of conductive deafness (Table 2). Main symptoms, presented in Table 1 were: pain, deafness and otohaematorrhoea. The first group of 19 patients received antibiotics by parenteral way during 7 days according to the bacterial finding in ear exudate. Healing rate was dependent on the size of tympanic membrane perforation, and rated from 71% in perforation of one third of tympanic membrane to 25% in total perforation of tympanic membrane. Data are presented in Table 3. The second group of 24 patients received the same therapy as the first treatment, plus otomycroscopic removal of haemorrhagic exudate, lacerated middle ear mucosa, and repair of tympanic membrane lacerations. Healing rate was significantly better than the one obtained in the first group (Table 4). Persistent tympanic perforation, as indicator of failed therapy, was present in 5 (35%) of all examined ears with two thirds of tympanic membrane perforation in the first group, while in the second group the rate was 3 (12%). The third group received the same therapy as the second treatment, including administration of amicacyn into the external auditory canal. The results were statistically compared by chi 2 test, and we found that the second therapy protocol was significantly better. There was no significant difference between the second and the third therapy protocols. We found blast ruptures of tympanic membrane and auditory ossicles chain discontinuity in 88% of examined ears. In our material the high incidence of total tympanic membrane ruptures and subtotal ruptures (48%) is quite different in comparison to other authors [5-7]. We consider it as the effect of high power blast wave. Loss of conductive hearing was present in 91% of blast injured patients, while 7.4% of patients had mixed, predominantly senzoneural deafness. Consequently, in addition to mechanic blast injuries acoustic trauma could profoundly damage the inner ear. Spontaneous healing of tympanic membrane occurred in 71% of injured persons and this was a better result than the results obtained by other authors [3, 4, 6]. The spontaneous healing of tympanic membrane failed if infection of the middle ear occurred or blast caused the total tympanic membrane perforation. In the second and third therapy protocols significantly higher healing of tympanic membrane ruptures was evident; it rated from 88% to 91%. Better results could be explained by the effect of optimal healing conditions, based on removal of exudate from the middle ear and necrotic parts of tympanic membrane, completed by fitting of lacerated parts of tympanic membrane and antibiotic prophylaxis. Healing of tympanic membrane without scars and adhesions was more frequent than in patients treated only with antibiotics. Incidence of undesired outcome of persistent perforation of tympanic membrane was reduced. To prevent posttraumatic complications in the middle ear, we recommend early cleaning of margins, reposition of lacerated fragments of tympanic membrane, and removal of haemorrhagic exudate. Myringoplasty should be performed if spontaneous healing of tympanic membrane did not occur after 6 months. CONCLUSION: Otic blast injury was frequently found in war induced trauma. (ABSTRACT TRUNCATED)

Blast Injuries↗
PubMed1994

Ear drum perforations in children after ventilation tube treatment.

About 1% of ears treated with straight Teflon tubes get permanent drum perforations after extrusion of the tubes, according to the literature. This paper reports the results of treatment of 20 ears in 17 children who underwent myringoplasty to repair such perforations at a mean age of 9.6 years and with a mean follow-up of 2.4 years. The following history was found: 60% (12/20) perforated after 1 insertion, 47% (9/19) perforated within 12 months after insertion. Seventy percent (14/20) had recurrent infectious problems during tube-treatment and after the perforation was diagnosed. The mean preoperative air-bone gap was 17.9 dB. In 85% (17/20) there was a pure perforation at the site of the previous tube while 3 children had perforations combined with retractions. All drums healed after surgery without serious ventilation problems except in one child. There was no serious infectious problems. The mean postoperative air-bone gap was 10.6 dB. Active removal of long-lasting tubes (> 12 months) is not motivated considering the positive effects of tube treatment in many children and the few perforations that occur. A Teflon tube is a good choice as a standard tube with few perforations that can be successfully surgically treated if self-ventilation and good ear-hygiene is instituted.

Adolescent↗
PubMed1994

Tympanoplasty with reconstruction of soft posterior meatal wall in ears with cholesteatoma.

A surgical technique for the reconstruction of a posterior meatal wall using a soft material (fascia) was developed for ears with cholesteatoma. Both myringoplasty and reconstruction of the posterior meatal wall were simultaneously performed using a large sheet of fascia, after the removal of the posterior meatal bony wall and the lesion. Even if postoperative middle ear aeration is disturbed, a retraction pocket may be expected to occur easily in ears with a soft posterior meatal wall, because of its flexibility compared to ears with a usual hard posterior meatal wall. This method is simple and can be useful in ears in which the posterior bony wall is removed.

Adolescent↗