That condition where the tympanic membrane is displaced toward the promontory is termed atelectasis. Thirty-seven patients (61 ears) showing various degrees of atelectasis graded from stage 1 to stage 4 were studied. Atelectatic drums are an inflammatory phenomenon occurring in underventilated ears. This conclusion is reached by considering the reversibility of the atelectasis upon ventilation; while the inflammatory factor can be deduced from the history and histopathology of the atelectatic drum, as well as the histology of the necrosed incus, the latter occurs in over a third of our cases. Also pneumatization of the mastoid is almost never present. Twelve (21%) of the ears treated did indeed develop a perforation at one time or another (two had cholesteatomas). Chronic granulating external otitis with specific features occurred in 15% of cases. The characteristics of these ears and their case histories lead us to view atelectatic ears as part of the otitis media syndrome, where their place is somehow transitional between secretory otitis media on the one hand and chronic otitis media on the other.

No abstract

Objective: To evaluate the long-term results of fat graft myringoplasty in adult and pediatric populations. Design: Prospective case series study. Main Outcome Measures: Patients witb chronic tympanic membrane perforations were considered candidates for fat graft myringoplasty. Excluded were patients witb purulent discharge, suspected ossicular disease, suspected cholesteatoma, or a perforation diameter greater than 6.5 mm. Fat was harvested from the ear lobule or subcutaneous tissue just posteriorinferior to tbe lobule. Results: Tbe study population comprised 27 adults and 11 children. Twenty-eight perforations were small (73.7%) and 10 were large (26.3%). Altogether, 31 of 38 perforations were successfully repaired (81.6%), including 22 of 28 small perforations (78.6%) and 9 of 10 large perforations (90%). Assessment by age showed that 23 of 27 perforations of the adults (85.2%) and 8 of 11 perforations of the children (72.7%) successfully closed (p = .648). Follow-up ranged from 25 to 53 months (mean 40.6 ± 8.3 months). No recurrence of the perforation during tbe follow-up period was recorded if the initial results were successful. The speech reception threshold improved significandy (18.5 ± 7.7 dB vs 23.5 ± 8 dB; p = .043). No significant sensorineural hearing loss occurred.Conclusions: Fat graft myringoplasty is a reliable technique for the closure of small-and medium-sized perforations. The grafting results showed excellent long-term durability. Given the simplicity of the technique, its short duration, and the favourable hearing results, fat graft myringoplasty should be considered tbe procedure of choice in patients with suitable perforations and when not otherwise contraindicated. SommaireObjectif: Evaluer les resultats a long terme de la myringoplastie avec greffe adipeuse dans des populations adulte et pediatrique. Devis: Serie de cas prospective. Methodes: Nous avons considere les patients avec une perforation tympanique chronique en excluant ceux avec une otorrhee purulente, une suspicion de pathologie ossiculaire ou d'un cholesteatome. Etaient aussi exclus les perforations de plus de 6.5 mm de diametre. Nous avons preleve le gras directement du lobule ou du tissu sous-cutane juste sous-jacent. Resultats: Nous avons etudie 27 adultes et 11 enfants. Vingt-buit perforations etaient petites et 10 grandes. Trente-et-une des 38 perforations ont ete reparees (81.6%), incluant 22 des 28 petites (78.6%) et 9 des 10 grandes. Pour ce qui est de I'age, 23 des 27 perforations chez les adultes (85.2%) et 8 des 11 chez les enfants ont ete fermees avec succes (p=.648). Nous n'avons note aucune recidive de perforation si la prise initiate etait un succes. Le seuil vocal s'est ameliore de iaqon significative (18.5±7.7 dB vs 23.5±8 dB ; p=.O43). Aucune perte de perception n'est a deplorer dans cette serie.Conclusion: La myringoplastie avec greffe adipeuse est une technique fiable pour la fermeture de petites et moyennes perforations. Les resultats montrent de plus une excellente performance a long terme. Etant donnes ...

No abstract

No abstract