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PubMed2002

Paediatric day-stay myringoplasty: a review of 74 consecutive cases.

Day-case surgery is particularly attractive for children, allowing post-operative recovery in the safe environment of the family home. Myringoplasty using the traditional method of underlay temporalis fasia is usually performed as an in-patient. From 1995 to 2000, 74 myringoplasties were performed in a dedicated paediatric day surgery unit at the Mayday University Hospital. We have retrospectively reviewed the outcome results of these procedures and reported them here. Only three patients required admission overnight (four per cent) and six grafts failed (8.5 per cent) complying with accepted standards. This series suggests that day-case surgery is a safe and desirable practice for children undergoing myringoplasty. However, there should be the facility for admission if required.

Adolescent↗

PubMed2003

Day-case myringoplasty: five years' experience.

A retrospective study of patients who underwent myringoplasty as a day-case procedure in two freestanding day-surgery units during a five-year period was carried out. Their case notes were identified and details including age, site and size of perforation, grade of surgeon, surgical approach, graft material, post-operative dressings, overnight stay, complications, and outcome were noted and analysed. The total number of patients including both children and adults who had myringoplasty as a day case was 144. Of these, 125 patients with 143 procedures were included in this study. Their ages ranged from four to 74 years (mean = 31 years). The perforation size was small in 40 cases, medium in 61 cases, and large/subtotal in 42 cases. The overnight stay rate was 2.7 per cent and this was for immediate post-operative problems such as nausea and bleeding from the wound. The readmission rate for post-operative complications was 2.1 per cent. The follow-up ranged from six months to five years (mean = 19 months). The success rate was 83.3 per cent and thresholds on pure tone audiometry improved in 69.2 per cent of cases. The age of the patient, grade of the surgeon, and graft material did not influence the surgical outcome. There was no case of dead ear as a result of surgery. Myringoplasty can be safely performed in both adults and children as a day-case procedure with low overnight stay and readmission rates. Success rates are comparable to when the procedure is performed on an in-patient basis.

Adolescent↗

PubMed1991

Fat myringoplasty in the guinea pig.

Fat myringoplasty is a simple office technique for repairing tympanic membrane perforations. It involves wedging a piece of fat from the ear lobule into the perforation. A search of the literature failed to reveal any controlled studies on the efficacy of this method, which may allow patients to avoid more invasive procedures. Controlled perforations in guinea pig tympanic membranes were treated with fat myringoplasties, paper patches, or no intervention. Four weeks following the procedures, ears were examined and photographed under the microscope and studied histologically. The fat myringoplasty healing rate exceeded the rates of both the control and paper-patch groups. Results were stratified with respect to location and size of perforations. The results and histological studies suggest that controlled studies in humans are warranted.

Adipose Tissue↗

PubMedDate not supplied

Surgical treatment of chronic middle ear disease. 1. Myringoplasty and tympanoplasty.

Results of myringoplasty or tympanoplasty were evaluated in 225 ears followed for at least one year after surgery. Repair of the tympanic membrane with an underlay connective tissue graft (fascia in 90%) was successful in 97% of the ears. One late perforation developed 3 years postoperatively. The average postoperative air-bone gap was 4.8 dB in 88 cases of myringoplasty, the series including three ears with a rigid footplate. Rigid incus and malleus should not be mobilized but subjected to resection and reconstruction. Poor tubal function caused adhesive changes in one ear (1%). In tympanoplasty the average postoperative air-bone gap was 11.3 dB in 100 ears with stapes present and 20.6 dB in 36 ears with only the footplate remaining. Of the 137 tympanoplasty ears, 10 (7%) showed prominent adhesive changes. In 36 ears with cholesteatoma there was one recurrence 3 years later (3%). An air-bone gap of less than 20 dB was postoperatively noted in 94% of the ears undergoing myringoplasty and in 69% of the ears undergoing tympanoplasty.

Ear Diseases↗

PubMed1996

Effectiveness of fibronectin in myringoplasty using temporal fascia.

A study of myringoplasty with temporal fascia homograft employing fibronectin was conducted in 14 ears in which the same myringoplasty procedure without fibronectin (1-5 times) had failed to afford closure of tympanic membrane perforation. Closure was obtained in eight ears. These results suggest that fibronectin is effective in myringoplasty using treated temporal fascia homograft.

Adult↗

PubMed2005

Over-under myringoplasty.

OBJECTIVE: To determine the success rate of over-under technique of myringoplasty regarding rate of graft take, complications and hearing improvement. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Otorhinolaryngology and Head and Neck Surgery, Fauji Foundation Hospital, Rawalpindi from March 2003 to January 2005. PATIENTS AND METHODS: A total of 68 patients having dry central tympanic membrane perforations of various sizes secondary to chronic tubotympanic suppurative otitis media were included in the study. Over-under technique of myringoplasty was used to repair the tympanic membrane perforation. Outcome measures were graft success i.e., full or partial take, no perforation, atelactasis or lateralization within 6 months of operation and improvement in hearing. RESULTS: Sixtysix patients (97%) out of 68 had full graft take at six months of follow-up. Only one (1.5%) met with graft failure and another one (1.5%) had partial graft take. Delayed perforation was noted in two patients (3%), both of these were 10 months after surgery. Atelactasis was seen in only one patient (1.5%) eight months after operation. Lateralization did not occur in any patient. Hearing improvement was noticed in 67 (98.5%) patients. Average air bone gap decreased by 12.65 dB. CONCLUSION: Over-under myringoplasty is an effective technique of repairing the tympanic membrane perforation due to high rate of graft take, few complications and marked hearing improvement.

Adolescent↗

PubMed2000

Does indermil glue improve success rates in myringoplasty? Interim analysis of a prospective trial.

The success rates of myringoplasty vary in the literature from 65 to 97.5 percent. Various reasons for failure are cited, one being failure of the graft to act as an adequate scaffold due to its falling away from the edge of the perforation. The potential role of adhesives in myringoplasty has been described but not objectively assessed. A group of 15 patients with a perforation of the tympanic membrane present for at least 6 months was prospectively recruited. All patients underwent myringoplasty using underlayed temporalis fascia. In each case the graft was spot welded to the edge of the perforation using Indermil (n-butyl cyanoacrylate) glue. At mean 7.7 months post operatively 14 grafts are intact (93%) and all patients have audiometric improvement (p < 0.01). These results are better then those from national audit statistics in the UK using conventional methods suggesting this technique is very promising. The technique and results are described.

Adult↗

PubMedDate not supplied

[Risk factors for myringoplasty failure].

OBJECTIVE: Identify risk factors associated with failures in myringoplasty. MATERIAL AND METHODS: 290 cases were reviewed in the period of july 1997 to march 1999. An analysis of cases and controls was performed. RESULTS: The 290 myringoplasties were analyzed. The minimum period of follow-up was: 6 months. The estimated surgical success was 82.1%, and 17.9% of the cases were considered as a failure. There were no risk factors found statistically significant to the variables: age, sex, schooling or occupation of the patient, tobacco usage, alcoholism and associated illnesses; prior nasal or otological surgery or cause of the perforation nor evolution time whether or not it was a resident doctor who performed the surgery. These results are not definitive since the intervals of confidence were ample in the majority of these variables, which can be attributed to the size of the sample group. The significant risk variables found were: size of perforation greater than 40%, marginal localization of the perforation; tympanosclerosis, scar tissue and cholesteatoma. CONCLUSIONS: The risk factors in the myringoplasty failure are similar to those reported in diverse studies. The variables highly significant for failure are details that should be watched in the technique.

Adolescent↗

PubMed1989

[Transmyringeal myringoplasty--8 years' experience].

The authors present their eight-year experience with transmyringeal fixation of the transplant during myringoplasty. They compare two groups of operations. In the groups of classical myringoplasties (134) anatomical cure was achieved in 75.4%, while in the group of 132 myringoplasties with transmyringeal fixation in as many as 91.7%. The authors emphasize the necessity of perfect fixation of the transplant during the period of healing.

Humans↗

PubMed1986

[Polyglactin 910 (Vicryl) net in myringoplasty. An animal experiment and clinical study].

According to studies by Dociu (1978), the resorption of Vicryl sutures causes only a slight foreign-body reaction in the back musculature of rats. Similarly, in experimental studies by Bowald et al. (1978) Vicryl mesh is reported to be an excellent material for use in the reconstruction of arteries; the chief virtue attributed to it is that it promotes cell proliferation during the healing process, and so promotes the growth of new arterial walls. Stimulated by Dociu's and Bowald's favourable results, we decided to study the influence of an impregnated, and hence stiffer, Vicryl mesh on the outcome of myringoplasties. Myringoplasties were performed on both ears of 15 cats. One ear drum of each cat was reconstructed with fascia and Vicryl mesh, the other (= control) ear drum with fascia only. In addition, myringoplasties with autologous fascia and Vicryl mesh were performed on 18 patients. The absorption of Vicryl mesh results in a temporary but pronounced foreign-body reaction. In consequence, the tympanic membrane temporarily thickens and is thoroughly vasculated. According to our findings Vicryl mesh does not promote the growth of a new tympanic membrane. In our patients we noticed pulpy swelling of the fascia after myringoplastic surgery with fascia and Vicryl mesh. From the above we conclude that Vicryl mesh is not suitable for splintage in myringoplastic surgery.

Animals↗

PubMed1995

Tympanosclerosis in the tympanic membrane: influence on outcome of myringoplasty.

The effect of the presence of tympanosclerotic plaques in tympanic membrane on the outcome of a myringoplasty procedure was evaluated in this retrospective study. Long-term results of 714 myringoplasties were analyzed, and of these, 555 were eligible for further study. Three groups were studied separately: ears without tympanosclerosis, ears with a plaque not exceeding one third of the tympanic membrane surface area, and ears with a plaque involving more than one third of the surface area extending to the border of the perforation. The latter group was subdivided into one in which during the operation the plaque was removed and one in which it was left in place. Take rate percentages as well as postoperative hearing results were calculated for each separate group of ears. Concerning graft take rate, it is concluded that the presence of tympanosclerosis in the tympanic membrane played no substantial part in the long-term outcome. With regard to postoperative hearing results, however, this study shows an average hearing gain of 6 dB when plaques exceeding one third of the tympanic membrane surface area were removed as part of the myringoplasty procedure.

Adolescent↗

PubMed1995

Myringoplasty: long-term results in adults and children.

This report presents the long-term results 3 years after primary myringoplasties performed with formolized fascia temporalis autografts. The overall closure rate was 87.7% of cases, with improvement in hearing in 67.2% of cases. The best results were achieved with total perforations, and not with partial posterior perforations, contrary to popular opinion. The anterior perforations were the most difficult to close. Anterior angle blunting was avoided by careful technique. Although the results of myringoplasty are clearly better in adults than in children, there is not a determined "frontier age" before which a child may not undergo operation. The state of the middle ear at the time of operation influences surgical outcome: wet ears have a higher rate of perforation, myringitis, and retraction pocket. Medical treatment is recommended prior to surgery in every discharging ear, as a diagnostic method rather than a therapeutic one. If the ear remains wet, chronic otitis media should be considered rather than simple perforation of the eardrum, and a mastoidectomy should be combined with the myringoplasty.

Adolescent↗

PubMed1996

Bilateral fat graft myringoplasty in children.

The results after simultaneous bilateral fat graft myringoplasties in children have not been previously reported in the literature. We report on 28 children who underwent bilateral fat graft myringoplasties as outpatient procedures under general anesthesia. The success rate was 91% at final follow-up, with only 16% of children requiring insertion of pressure-equalizing (PE) tubes following surgery. No complications were documented. We concluded that bilateral fat graft myringoplasties are safe to perform, with an excellent success rate, and are suitable as outpatient procedures.

Adipose Tissue↗

PubMed2002

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.

Adolescent↗

PubMed2004

Short-term evaluation of over-under myringoplasty technique.

Over-under tympanoplasty is a technique aimed at eliminating the disadvantages of the two classical techniques of overlay and underlay myringoplasty, which are employed in repairing the tympanic membrane. In this retrospective study, a total of 104 patients underwent myringoplasty, which was performed by means of the underlay technique in 46 patients and over-under technique in 58 patients. The mean follow-up period was 11 months. In the first group of patients, the underlay technique was performed; the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the second group, the over-under technique was performed; the grafted membrane was placed under the remaining drum and over the malleus. The rate of success in the first group of 46 patients was 91.5%, and that of atelectasis was 19.5%. The rate of success in the second group of 58 patients was 94.9% and 12%, respectively. Lateralization of the graft was not observed in either of the groups. In the patients operated on by means of the underlay technique, the air-bone gap decreased by 16.55 dB this rate was 16.96 dB in those operated on by the over-under technique. The authors consider over-under tympanoplasty to be superior to the other two classical methods not only because of its effectiveness, but also because of the results achieved by this technique.

Adolescent↗

PubMed1995

An analysis of the results of myringoplasty in children.

An analysis of the results of 100 temporalis fascia underlay myringoplasties in children between the ages of 2-17 years is presented. The follow-up period in this retrospective review was from 6 to 24 months. There was no statistically significant correlation between the age of patient, a history of previous ear surgery, previous general anaesthesia, previous adenotonsillar surgery, preoperative otorrhoea, impaired eustachian tubal function, individual surgeon performing the surgery, size of perforation or operative technique and the outcome of the surgery with respect to graft take rate. The overall graft take rate was 75.3% of the 93 patients that returned for follow-up. The seniority of the surgeon and by implication the degree of operative experience of the surgeon is found to be significantly correlated with the graft take rate (P < 0.05). On audiometric testing, the mean pre-operative air conduction threshold improved significantly (P < 0.0001) from 32.0 dBHL (S.D. 11.22) to 20.18 dBHL (S.D. 15.54) while the speech reception threshold improved from a mean of 25.34 dBHL (S.D. 12.88) to 18.79 (S.D. 15.5) (P < 0.0005). Although not statistically significant, patients under the age of 8 years were found to have a low graft take rate (56%) when compared to the mean. The audiometric results in this age group were comparable to the rest of the group. The findings in this study suggest that myringoplasty is a beneficial procedure in the pediatric population in the hands of a skilled and experienced surgeon. The learning curve seen in the surgeons in this study suggests that suitable cases for junior surgeons should be carefully selected.

Adolescent↗

PubMedDate not supplied

[Myringoplasty: our results].

Tympanoplasty is the surgical technique used to restore the anatomy and function of the middle ear. The tympanoplasty type I or myringoplasty is performed when the ear only has a perforation of the tympanic membrane without any ossicular damage. We present a retrospective study started in 1997 and finished in 2000 with a total of 118 cases who had undergone a myringoplasty along this period of time. The percentage of closure was 85.59% (n = 101). The techniques used were underlay in a 60.16% of the patients (n = 71), overlay in 34.74% (n = 41) and sandwich in 5.08% (n = 6). In the paediatric patients (under 14 years of age) the percentage of a successful graft following surgery was 88% and in the adults 83.87%. More than fifty years have passed. Since Zöllner and Wullstein described for the first time this type of surgery important because of its good results.

Adolescent↗

PubMed2002

[Prognostic factors influencing anatomic and functional outcome in myringoplasty].

The objectives of myringoplasty are essentially two: restore the eardrum integrity and improve hearing level. We have carried out a retrospective study of myringoplasties performed in our Department, between 1996 to 2000, corresponding to 197 surgical interventions, in 162 patients. The characteristics more frequently seen for operating ears were central localization of tympanic membrane perforation, dry ear, good eustaquian tube function and underlay technique placing fascia graft. Endaural or retroauricular approach were similar in number. We obtained 73.6% of anatomic success, though in some cases we needed to reoperate the patient. When we analysed risk factors of anatomic success, we noticed than only the tympanic perforation site had influence, with better rate in posterior perforations and lower rate in subtotal perforations. We analysed functional results in ears with anatomic success, finding 75.6% of hearing level improvement with a gap of less than 20 dB. Factors influencing hearing improvement were surgeon experience and the presence of middle ear alterations.

Adolescent↗