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.     

Royal College of Surgeons comparative ENT audit 1990

The Royal College of Surgeons Comparative Audit Service was set up in 1990 so that surgeons could pool their audit data, to provide ‘standards’ with which to compare their own figures. A total of 405 consultant otolaryngologists were circularized in December 1991 inviting them to return data about their resources, workload, case-mix and complications, and about two specific audit topics—Myringoplasty and Carcinoma of the Larynx—for the calendar year 1990. A total of 65 consultants returned proformas with data on 52208 admissions and 31240 surgical procedures. The ‘average’ respondent admitted 829 patients in the year (19% of these day cases and 14% emergencies) and performed 744 surgical procedures with a mean complication rate of 1.39% using three theatre sessions per week. Cancelled theatre sessions per annum per consultant ranged from 0 to 71. The mean known success rate after myringoplasty was 65%, with hearing improvement in 53%. The ‘average’ ENT surgeon saw 3.5 new cases of invasive carcinoma of the larynx and treated 69% of these with radiotherapy alone, compared with 14% surgery alone. As well as allowing a profile to be drawn up of the ‘average’ ENT surgeon saw 3.5 new cases of invasive carcinoma of the larynx and treated 69% of these with radiotherapy alone, compared with 14% surgery alone. As well as allowing a profile to be drawn up of the ‘average’ respondent, this audit allowed individual consultants returning data to compare their own figures in detail with the pooled data, which were presented graphically at a meeting in April 1992.     

Posterior tragal perichondrium harvesting for myringoplasty

We present a modified harvesting approach for tragal perichondrium, used in tympanic membrane reconstruction. The technique described avoids amputation of the tragus thereby facilitating dissection of the perichondrium from the cartilage as compared to the traditional method. The approach described is technically easier, and removes any potential for cosmetic deformity associated with tragal cartilage amputation and reimplantation. Furthermore, both the anterior tragal perichondrium and the temporalis fascia remain intact if further surgery is required. We recommend this approach for permeatal, tragal perichondrial grafting of small to medium sized tympanic membrane perforations.     

Prophylactic antibiotics has no benefit for outcome in clean myringoplasty—A register-based cohort study from SwedEar

Objectives

To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6–24 months after surgery.

Design

A retrospective cohort study of prospectively collected data.

Setting

Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013–2019.

Participants

All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit.

Main Outcome Measures

The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery.

Results

In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs.

Conclusion

PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.