Clinical and audiological short-term and long-term outcomes of fat graft myringoplasty

Introduction: Results of fat graft myringoplasty are often reported with only short-term follow-up. Audiological results are less commonly reported, as well as long-term follow-up results.

Materials and methods: One hundred consecutive patients scheduled for fat graft myringoplasty were included in a prospective cohort study. Clinical and audiological outcomes were assessed at six weeks and one year postoperatively.

Results: Perforation sizes ranged from 0.5 to 4?mm. The six-week follow-up showed a total perforation closure rate of 72.9% with a statistically significant (p?=?.03) higher rate for the pediatric age group (83.0%). 64.4% of all patients were healed at one-year follow-up. Statistical analyses for background factors did not reveal any significant difference in healing rates with regard to patient sex or location or cause of the perforation. The mean preoperative air-conduction (AC) threshold was 25?dB with an air-bone gap of 12?dB. At the one-year follow-up the mean air conduction threshold for healed ears was improved to 16.6?dB, still 54.2% of them had a type B tympanogram.

Conclusions: Children had a higher perforation closure rate at six-week follow-up than adult patients. Recurrent tympanic membrane perforations were common after initially successful fat graft myringoplasties. Long-term hearing was improved after successful fat graft myringoplasty, resulting in a mean AC threshold of 16.6?dB.     

Dimensional stability of the free fascia grafts: a human study

OBJECTIVES/HYPOTHESIS: In animals it has been shown that autologous free fascia grafts (fascia lata and temporal fascia) change dimensions during the vital first 5 days of healing. Poor dimensional stability of these grafts can be an important reason for failure of complete closure of tympanic membrane perforations in tympanoplasty operations, particularly in large perforations. Dimensional stability of these fascias has been studied in humans. STUDY DESIGN: Prospectively, 11 patients were studied. METHODS: Patients who were subjected to open mastoid cavity surgery were included in the study. The mastoid cavity was exteriorized, and the fascia graft was used to seal the perforation and cover a part of the bare mastoid bone in the routine way. At this stage, equally cut pieces of temporal fascia and fascia lata were laid on the remaining part of the bare mastoid bone. The mastoid cavity was then packed with Gelfoam and wound sutured. The pieces of graft material under study were removed after 5 days, leaving the graft used to seal the tympanic membrane perforation undisturbed. The harvested grafts were measured for their dimensional variations, if any. RESULTS: It was observed that free autologous temporal fascia grafts exhibited poor dimensional stability as compared with free autologous fascia lata grafts. CONCLUSION: Poor dimensional stability of free temporal fascia grafts as seen in animals was confirmed in the present human study. This poor dimensional stability of temporal fascia grafts might be contributing to failure of closure of tympanic membrane perforations in tympanoplasty.     

407耳夹层法鼓膜成形术的疗效分析

目的 :探讨选择何种方法修补穿孔的鼓膜以进一步提高手术疗效。方法 :自 1990年 1月～ 2 0 0 0年 12月 ,采用夹层法鼓膜成形术对 318例 (4 0 7耳 )慢性单纯型化脓性中耳炎患者行鼓膜成形术 ,随访 0 .5a～ 10a ,尤其强调术后3个月必须定期到医院复查。结果 :鼓膜穿孔愈合 395耳 ,再穿孔 12耳 ,愈合率为 97% ,修补鼓膜的外形具有良好的锥形和前下锐角结构 ,观察发现干耳与否对手术疗效的影响不大 ,而手术 3个月内的定期复查对预防感染、提高穿孔愈合率至关重要。术后纯音听阈降低 10dB～ 2 0dB者 14 7耳 ,听阈降低 2 0dB～ 30dB者 2 0 5耳 ,听阈降低 30dB以上者 37耳 ,降低不足 10dB者 18耳。结论 :夹层法鼓膜修补术是修补鼓膜穿孔从而成为治疗慢性单纯型化脓性中耳炎的理想方法     

Fat graft myringoplasty after unsuccessful tympanic membrane repair

The objective of the present study was to evaluate the efficacy of fat graft myringoplasty in repairing residual or recurrent tympanic membrane perforation. A retrospective analysis was performed on 31 patients, aged 25–57 years (mean 43.3), submitted to myringoplasty revision using fat graft. Fourteen were males and 17 females. Perforation size ranged from 1 to 5 mm. Follow-up time ranged from 4 to 62 months (mean 26 months). Fat graft myringoplasty was performed under local anesthesia, using ear lobe fat in 26 patients and abdominal fat in five patients closure of tympanic membrane perforation was achieved in 87.1% of ears. No modification of the hearing level was evidenced at the statistical analysis. Fat graft myringoplasty is a safe, effective and minimally invasive procedure, suitable to repair small residual/recurrent perforations of the tympanic membrane. The angiogenic properties of the fat are ideal to overcome the poor vascular supply in the vicinity of the tympanic membrane perforation.     

Tests of Eustachian tube function and ear surgery

Few objective measures exist to predict the outcome of ear surgery. Clinical and experimental experience has shown the key role of the Eustachian tube in this respect, but clinical testing is seldom performed. The present study confirms that Eustachian tube testing may be of clinical significance by comparing preoperative test results before myringoplasty with the late results of this operation. In 157 patients the ability to equilibrate a static air pressure of plus or minus 200 mm of water passively or actively was tested. It turned out that in those 15% who could equilibrate minus 200 mm passively a 7 times higher rate of succssful myringoplasty was found. Ears with cholesteatoma showed less ability to equilibrate actively. Despite these findings it is concluded that the present tests are insufficient for clinical use.     

Dimensional stability of free fascia grafts: clinical application

OBJECTIVES/HYPOTHESIS: Animal experiments and human studies show that autologous fascia lata and temporal fascia change their dimensions during first 5 days of healing. Poor dimensional stability of the temporal fascia grafts may be responsible for the residual perforation sometimes seen in clinical practice. STUDY DESIGN: Retrospective. METHODS: Tympanoplasties performed for large perforations or granular myringitis using either fascia lata or temporal fascia as graft material are included. The ears are divided into two groups. Group I includes ears with fascia lata, and group II includes ears with temporal fascia as graft material. Ears with minimum 1-year follow-up are included in the study. RESULTS: The results are studied in terms of 1) rate of primary closure of perforation, 2) rate of recurrent perforation, and 3) hearing improvement. It is noted that the ears with very large or subtotal perforations fared better (alpha = 0.05) in group I than similar ears in group II with respect to rate of primary closure of perforations. Similarly, ears in group I also have a lesser rate of recurrent perforation on long-term follow-up than ears in group II. No significant difference is noted in hearing improvement between the two groups. CONCLUSION: Shrinkage of graft during healing phase appears to have significant relevance in the clinical situation. Ears having large perforations have high chances of residual perforations caused by limited margin of remnant tympanic membrane overlapping the graft. It seems logical to use fascia lata as graft material for large perforations because it has better dimensional stability.     

鼓室成形术61耳疗效分析

本文61耳施鼓室形成术按Wullstein的分型,Ⅰ型31耳;Ⅱ型12耳;Ⅲ型13耳;Ⅳ型1耳;镫骨撼动2耳;人工鼓室2耳。在61耳中的绝大多数采用颞筋膜内植法修补鼓膜。一期愈合者32耳;遗有裂隙小穿孔者22耳;6耳失败;1耳不详。介绍了笔者改进之鼓膜刮刀,在修补鼓膜手术中造成新移植床的使用疗法。据初步观察61耳施鼓室成形术,术后听力平均提高73.8％;骨气导间距缩小者平均73.8％;两者完全一致。     

耳内镜与显微镜下鼓膜成形术的术中术后效果对比

目的 比较耳内镜下鼓膜成形术及显微镜下鼓膜成形术治疗因中耳炎引起鼓膜穿孔患者的术中术后各项指标变化及安全性.方法 选取2016年1月-2018年6月该院收治的鼓膜穿孔患者74例,分为耳内镜组(n=37)和显微镜组(n=37),耳内镜组行耳内镜下鼓膜成形术治疗,显微镜组行显微镜下鼓膜成形术治疗.观察两组患者手术相关指标、...     

Comparison of bilateral same-day and sequential endoscopic cartilage myringoplasty for bilateral chronic tympanic membrane perforation

Abstract

Background: There is debate over the applicability of bilateral same-day myringoplasty in patients with bilateral chronic tympanic membrane perforations (TMPs) requiring ear surgery on both sides.

Objectives: To evaluate the healing and hearing outcomes of bilateral endoscopic ‘push-through’ cartilage myringoplasty in patients with bilateral chronic TMPs with mucosal chronic otitis media (COM) on the same day.

Material and methods: The medical records of 60 patients (120 ears) with bilateral chronic TMPs who underwent bilateral same-day or sequential endoscopic push-through cartilage myringoplasty between January 2014 and March 2019 were evaluated.

Results: Of the 60 patients with 120 ears, 26 patients with 52 ears were in the bilateral same-day group and 34 patients with 68 ears in the sequential group. The overall graft success rate at 3?months was 92.3% (48/52) in the same-day group and 94.1% (64/68) in the sequential group. None of the sensorineural HL and retraction pockets occurred in two groups.

Conclusions and significance: Bilateral push-through cartilage myringoplasty can be performed safely for the patients with bilateral chronic TMPs in the same day, it significantly reduced the medical costs and shortened the operation time and length of stay compared to sequential myringoplasty.     

耳内镜下自体软骨膜烧伤性鼓膜大穿孔修补术

目的：探讨经耳道耳内镜下鼓膜修补术治疗烧伤性鼓膜穿孔的方法和技巧。方法回顾性分析耳内镜下鼓膜修补术治疗24例烧伤性鼓膜穿孔患者的临床资料。在耳内镜下采用自体耳屏软骨及软骨膜先内植,再制备鼓耳道皮瓣,最后“夹层”的鼓膜修补方法。对术后的愈合率及听力提高情况等方面进行了分析。结果全部患者术后经1—2年随访,一次性手术治愈率为96％（23／24）,总治愈率为100％。术后6个月复查听力,患者听力均提高,言语频率气导听阚为9.6±4.7dBHL,较术前听力提高14.5±6.8dBHL。语言频率气骨导差〈10dB占83.3％（20／24）。术后鼓膜愈合时间2周至1个月不等。结论 耳内镜下自体耳屏软骨及软骨膜先内植、再制备鼓耳道皮瓣、最后“夹层”的鼓膜修补方法可以使烧伤性鼓膜穿孔的鼓膜修补术操作更简便、更精确、视野更清晰、更微创。