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PubMed2001

Perforation of the tympanic membrane and its effect on the real-ear-to-coupler difference acoustic transform function.

It is not always possible to undertake extensive real-ear measurements, especially in infants and young children. An alternative approach is to estimate the real-ear SPL by use of an acoustic transform function such as the real-ear-to-coupler difference (RECD). This may be used to estimate the real-ear sound pressure level (SPL) obtained from an insert transducer or a hearing instrument. The aim of the present study was to investigate the effects of tympanic membrane perforation on the RECD transform function. Subjects in the study comprised two groups of 12 individuals aged between nine and 65 years. One group of subjects had a tympanic membrane perforation and was recruited to the study before admission for myringoplasty. There was no evidence of middle ear pathology in the remaining subjects who comprised the control group. An RECD transform function for an insert transducer was measured on each subject using the standard clinical protocol on the Audioscan RM500 real-ear measurement system. There was a statistically significant difference between the two groups; mean RECD transform value of the perforation group was 9-12 dB lower than the corresponding value in the control group at audiometric frequencies below 1.5 kHz. This difference is probably due to the perforation acting as a vent and allowing low-frequency acoustic energy to escape into the middle ear cavity. Use of an average RECD transform function to estimate real-ear SPL in subjects with a perforation will overestimate the SPL reaching the tympanic membrane. As a result, the derived real-ear SPL obtained by use of either an insert transducer or a hearing instrument will be overestimated. This has implications for the selection and verification of a hearing instrument. The difference in the mean RECD transform function between the control group and subjects with a tympanic membrane perforation supports the use of individually measured RECD values wherever possible.

Acoustic Impedance Tests↗

PubMed1991

Tympanic membrane injury in welders: is prevention neglected?

Injury to the ear in welders is a recognized but poorly documented entity. Five cases are described to demonstrate a spectrum of severity of injury, ranging from minor burns to tympanic membrane perforation requiring myringoplasty. Welders are most at risk when working overhead, in cramped conditions or adjacent to other welders. Conventional safety helmets offer inadequate protection to the ears and it is recommended that insert ear plugs should be offered to all workers at risk, in addition to safer working practices. An increased awareness of these risks among occupational physicians, welders and employers is required before these recommendations can realistically be implemented.

Adult↗

PubMed2002

Preoperative topical ofloxacin solution for tympanoplasty: a randomized, controlled study.

OBJECTIVE: To establish the efficacy of immediate preoperative ototopical ofloxacin eardrops in eradicating middle ear pathogens and improving operative outcome. STUDY DESIGN: Single-blind, randomized control study. SETTING: Tertiary referral center, ambulatory clinic, and hospital setting. PATIENTS: Consecutive patients with chronic suppurative otitis media for Type I tympanoplasty (myringoplasty). INTERVENTIONS: The patients were randomly assigned to 3 groups: Group A underwent 10-minute daily treatments with eardrops for 2 weeks before surgery, Group B underwent 3-minute daily treatments for 2 weeks before surgery, and Group C underwent no treatment. MAIN OUTCOME MEASURES: Preoperative and perioperative bacteriology and success of the surgery as defined by an intact tympanic membrane in the eighth week postsurgery. RESULTS: There were 101 patients entered in the study. The preoperative, perioperative, and postoperative observation of discharge and quantity of the discharge were compared, and no differences were found among the groups (Kruskal-Wallis test). The perioperative culture results were analyzed and 18/21 (86%) became culture negative in Group A, 23/27 (85%) became culture negative in Group B, and 3/21 (14%) became culture negative in the control group (Group C versus Group A or Group B, chi(2) tests p < 0.001). The success rates of surgery as defined by an intact tympanic membrane showed no difference: 28/33 (85%), 27/33 (82%), and 31/35 (89%) in Groups A, B, and C, respectively. The preoperative positive bacteriology rate in the surgical failures was 10/15 (67%), compared with 16/76 (21%) for the successful procedures (p < 0.001). CONCLUSION: Our study has shown that ofloxacin successfully eradicates most bacterial flora preoperatively. We cannot, however, confirm the benefits of its preoperative usage in improving the graft success rate.

Adult↗

PubMed2002

Use of homograft dehydrated temporal fascia in tympanoplasty.

OBJECTIVE: To investigate the results of myringoplasty operations using homograft dehydrated fascia temporalis (Tutoplast) and compare these with those performed with autograft fascia temporalis. STUDY DESIGN: Prospective cohort. SETTING: University hospital. PATIENTS: Forty-three adult patients (> or =18 years of age) with central, dry perforations of pars tensa with intact ossicular chains. INTERVENTION: Tympanoplasty with an endaural approach and underlay technique was performed. Homograft dehydrated temporal fascia was used in 22 patients, and autograft was used in the remaining 21 patients. MAIN OUTCOME MEASURES: Preoperative and postoperative air-bone gap and speech reception threshold levels and postoperative compliance values of the homograft and autograft groups were compared. RESULTS: Postoperative perforations were encountered in two patients (9.1%) from the homograft group and three patients (14.2%) from the allograft group. Significant postoperative improvements in air-bone gap and speech reception threshold values were detected for both groups (p < 0.05). Although the mean compliance of the tympanic membranes was significantly lower in the homograft group, no statistically significant difference was observed between groups when the postoperative air-bone gap and speech reception threshold values were compared. CONCLUSION: Homograft temporal fascia can be used in tympanoplasty with the same success rate of autograft temporal fascia without impeding hearing. Its main advantages are the reduction in the duration of surgery and the length of preauricular and postauricular incisions. However, the advantages of the dehydrated homograft temporal fascia should be weighed against its cost and risk of transmission of viral and prion-mediated diseases.

Adult↗

PubMed2005

Inlay butterfly cartilage tympanoplasty in children.

OBJECTIVE: To assess the results of inlay butterfly cartilage tympanoplasty in children. STUDY DESIGN: Before-and-after trial; follow-up duration, 26.6 +/- 19.9 months (mean +/- standard deviation). SETTING: Tertiary referral center. PATIENTS: Fifty-nine pediatric cases of tympanic membrane perforation. INTERVENTION: Inlay butterfly cartilage tympanoplasty was performed under general anesthesia according to the technique originally described by Eavey and modified by Lubianca-Neto (i.e., without any associated split-thickness skin graft). MAIN OUTCOME MEASURES: Percentage of perforation closures, surgical complications, preoperative and postoperative puretone hearing thresholds; the results of inlay butterfly cartilage tympanoplasty were compared with those obtained in a retrospective series of 29 underlay fascia temporalis myringoplasties. RESULTS: The 71% "take rate" of inlay butterfly cartilage tympanoplasty was not significantly different from the 83% take rate obtained with underlay fascia temporalis tympanoplasty (p = 0.23, chi test). The anatomic results were improved when the graft diameter was at least 2 mm larger than the size of the perforation (81% take rate) (p = 0.009, chi test). No iatrogenic cholesteatoma was observed. Pure-tone hearing thresholds were improved at 0.5, 1, and 2 kHz, and stable at 4 kHz. Hearing levels were not different from those obtained with underlay fascia temporalis tympanoplasty. CONCLUSION: Inlay butterfly cartilage tympanoplasty is a safe, efficient, time-saving, and easy technique of tympanoplasty in children. Anatomic results may be improved by associating a split-thickness skin graft and/or by trimming a tragal graft much larger than the size of the perforation.

Adolescent↗

PubMed2006

Epithelial migration of the postmyringoplasty tympanic membrane.

OBJECTIVE: To determine whether the postmyringoplasty tympanic membrane (TM) behaves in a similar way compared with a healthy nonoperated eardrum by calculating and comparing the epithelial migration rate and pattern. STUDY DESIGN: Prospective, nonrandomized case-control study. Each subject who has undergone a myringoplasty and with healthy contralateral TM as control is included in this study. SETTING: Otolaryngology outpatient clinic. PATIENTS: A total of 23 subjects with 46 ears have been selected from otolaryngology outpatient clinic of the University Malaya Medical Center after excluding two subjects from this study. The study was conducted from June 2003 to September 2004. INTERVENTION: All the selected subjects' ears were examined under a microscope. Methylene blue ink dot was applied to the epithelium of the TM at the immediate vicinity of the umbo; then, weekly follow-up was performed until the migratory pattern and the rate of epithelial migration was noted. MAIN OUTCOME MEASURE: Direction and rate of epithelial migration in both study and control group were measured and compared. RESULTS: Epithelial migration did occur in postgrafted TM, from the umbo region toward the ear canal wall in a lateral radiating manner. Most of the patients (19 of 23 patients [82.6%]) showed nearly similar migratory pattern (same direction) in both the control and the study ear. None of the 46 ears showed any evidence of epithelial migration in the anteroinferior direction of TM. The rate of migration was slower in the beginning, especially near the umbo region (almost no movement at the first 1 or 2 weeks after ink dot application). For both groups, the rate of migration increased when approaching the periphery or annulus region. There was not much difference in the mean daily migratory rate between the control and the study ear (93.4 microm/d and 91.7 microm/d, respectively). The mean migratory rate was highest in subtotal perforation (97.2 microm/d) and lowest in small perforations (< 20%; 83.6 microm/d). CONCLUSION: There was no difference in epithelial migration rate and pattern between the postmyringoplasty TM and the healthy TM.

Adolescent↗

PubMed1987

Systemic antibiotic prophylaxis and reconstructive ear surgery.

This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively. The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period. The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms.

Ampicillin↗

PubMed1992

Underlay tympanoplasty with the graft lateral to the malleus handle.

In conventional underlay tympanoplasty the graft is placed medial to the malleus handle. The present study evaluates the results of a modification of this technique, in which the graft is placed lateral to the malleus handle, which has been dissected from the drum remnants. 39 ears with predominantly large or anterior pars tensa perforations were operated upon in this manner. After a median observation time of 20 months one ear was found to have a small reperforation. All ears had normal tympanomeatal angles, but 12 ears showed a small degree of laterofixation of the graft from the malleus handle. Analysis of the hearing showed good hearing improvement and no adverse effects attributable to the dissection of the ossicular chain. It is concluded that the technique is a good alternative to conventional underlay myringoplasty in ears with perforations involving the area anterior to the malleus handle.

Adolescent↗

PubMed1991

Repair of chronic tympanic membrane perforations using applications of hyaluronan or rice paper prostheses.

A controlled randomized study was performed in 60 patients with 64 chronic, dry tympanic membrane (TM) perforations. The perforations were randomly allocated to either resection of the perforation rim and instillation of 1% hyaluronan (Healon; HYA) in the perforation gap once daily for 7 days (33 ears) or resection of the perforation margin and application of a sterile rice paper prosthesis (31 ears). The treatment effect was documented by TM photography and morphometric measurements of the perforation area. The hearing was assessed with puretone and high-frequency audiometry. After 2 months, 5 of the HYA-treated perforations (15%) and 4 of the rice-paper-treated TMs (13%) were healed. After 1 year, 18 perforations (9 in each treatment group) were healed. In neither group were there any persistent adverse effects on hearing. It is noteworthy that 28% (18/64) of the chronic, long-standing TM perforations could be repaired by these technically simple and time-saving methods. Both procedures should be considered as easy first-choice alternatives to myringoplasty in selected cases.

Adolescent↗

PubMedDate not supplied

Osteoma of the promontory: a case report.

Osteomas of the middle ear are rare lesions. We report the case of a 20-year-old male with osteoma originating from the promontory coincident with tympanic membrane perforation. Histopathological diagnosis was performed by means of a superficial curettage during surgery, to avoid a cochlear fenestration. Postoperative closure of the air-bone gap after myringoplasty confirmed the presumed asymptomatic nature of these lesions.

Adult↗

PubMedDate not supplied

Tissue adhesion with highly concentrated human fibrinogen in otolaryngology.

This paper summarizes a tissue adhesive system consisting of highly concentrated human fibrinogen and thrombin. The addition of blood-clotting factor XIII stabilizes the adhesive system against fibrinolysis. Although the adhesion system cannot and should not replace surgical suture, it provides valuable assistance in tissue synthesis and in local hemostasis, particularly in cases where conventional suture methods are especially difficult to apply. In addition to good adhesion, an elastic consistency, and good tissue compatibility, the adhesive is completely absorbed and, therefore, preferable to conventional tissue adhesives based on cyanoacrylate. The system has been used successfully in split thickness skin graft application, myringoplasty, repair of dural defects, hemostasis after tonsillectomy, and achieving an airtight seal in tracheoplasty.

Animals↗

PubMed1986

The effect of butyl 2-cyanoacrylate on the middle and inner ear of the chinchilla.

Butyl 2-cyanoacrylate was placed on the oval and round window of the ear of the chinchilla and was also used as an adhesive for myringoplasty with autogenous muscle fascia. Butyl 2-cyanoacrylate was found to be difficult to manipulate and moderately toxic to the middle ear; there were occasional significant reactions in the inner ear.

Animals↗

PubMed2002

Major ear surgery in a paediatric day care unit.

Abstract Traditionally major ear surgery in children has been regarded as an in-patient procedure. Evidence from the USA for adults, however, concludes that it is both safe and effective to perform many major ear procedures as day cases. We have been carrying out major ear operations on children as day cases routinely for six years in a dedicated children's day unit and examined our data to find out whether it was both safe and feasible to perform major ear surgery in children on a day-case basis. As our main outcome measure we used the rate of unplanned admissions. We found that the unplanned admission rate for surgery, excluding mastoid surgery, was 6.7 per cent and that procedures such as myringoplasty, ossiculoplasty, bilateral pinnaplasty, meatoplasty and tympanotomy with excision of cholesteatoma, were eminently suitable for day surgery.

Adolescent↗

PubMed1982

The use of sclera in tympanic membrane reconstruction.

Sclera appears to be an appropriate grafting material because of its high density, high tensile strength, and low antigenicity. Preserved donor sclera has been used for myringoplasty in 125 cases over a 4 year period with an overall success rate for complete closure of the perforation of 96%. Several simple techniques for creating flanges to hold the graft in place were used. The size of the perforations ranged from several millimeters to 80% of the eardrum surface. Most of the cases have been done as outpatients, the adults with local anesthesia and the children with general anesthesia. The advantages of the procedure are: A. readily available graft material; B. high tensile strength of sclera maintains scaffolding effect for long periods of time; C. the flange technique holds the graft at the perforation site and prevents graft lateralization or medialization; D. the procedure can be performed as an outpatient health care costs.

Adult↗

PubMedDate not supplied

The prognostic value of Eustachian tube function measurements in tympanoplastic surgery.

The Eustachian tube function was tested preoperatively by sonotubometry and by the negative pressure equalization test in 87 ears subjected to simple myringoplasty, tympanoplasty alone, or tympanoplasty combined with mastoid surgery. The relations between tubal function test results and healing were analysed on average 10 months after the operation. The results indicating absent or partial pressure equalization ability were poorly correlated with the successful outcome of surgery, while sonotubometry showed a good correlation. Pressure equalization may produce such an unphysiological underpressure that many test results are erroneously negative. Sonotubometry is an entirely physiological method and has in this Department replaced the pressure equalization test for routine evaluation of the Eustachian tube function.

Adolescent↗

PubMed1999

[The role of areolar tissue on otologic surgery].

Areolar tissue is a loose conjunctive tissue, located between the fascia temporalis superficialis and the temporal aponeurosis. It can be used in several circumstances during otologic surgery. First, in stapes surgery, it can be used as an interposition between the piston and the platinotomy. Its thickness has no equivalent in comparison with other temporal tissues, explaining in part its usefulness in this indication. In perilymphatic fistula surgery, the areolar tissue is especially recommended for round window and oval window grafting because of its spontaneous adhesive capacity. It can be useful in myringoplasty, to reenforce an atrophic tympanic membrane or to close a small perforation. Also areolar tissue can be used as a flap or as a free graft to reconstruction of the external acoustic meatus. It's a good conjunctive support, which can be covered by skin graft. Finally areolar tissue is an interesting and useful material for otologic surgery. Its qualities are complementary to those of the temporal aponeurosis.

Connective Tissue↗

PubMed1975

Follow-up studies of aboriginal children with ear disease and hearing loss at Cherbourg (Queensland).

A random sample of 100 Aboriginal primary school children originally examined in February, 1970, was followed up in February, 1971, and February, 1972. Over this period, the incidence of hearing loss dropped from 41% to 23%. Most of the improvement occurred in the younger children, and, while this could be attributed to treatment in a few cases, the majority of children appeared to improve spontaneously. A complete school grade of 37 children aged six years in 1970 was retested six times over a period of three years. Again, there was a general improvement, from 60% incidence of hearing loss in 1970 to 22% in 1972. Most of this improvement was spontaneous. During the three years of observation (1970, 1971, 1972), 30 Aboriginal children from Cherbourg underwent surgery including myringotomy, myringoplasty and mastoidectomy. Operative successes and failures in these children are discussed.

Adolescent↗

PubMed2001

[One stage otoplasty treatment for congenital malformations of the auricle and middle ear].

OBJECTIVE: To investigate the application of one stage otoplasty for congenital atresia of the external acoustic canal and malformations of the middle ear and the auricle. METHOD: Patients with the ear malformations were given surgical reconstruction of one stage otoplasty. The auricle was reconstructed with the rib which was encapsulated with the superthin temporal flap. According to the malformations of the middle ear in patients, I style tympanoplasty and III style tympanoplasty were carried out respectively. All patients were performed myringoplasty with temporal fascia and reconstructed the external acoustic canal with full thickness skin-grafting. RESULT: A long term follow-up (4-6 years) demonstrated that 11 ears were survival of which 8 ears figuration were ideal. The hearing improvement was observed in all patients. CONCLUSION: One stage otoplasty is effective for treatment of the congenital malformations of the external and middle ear.

Adult↗