Developing a novel meatal areolar tissue autograft for minimally invasive tympanoplasty

Abstract

Background: We developed an easy and minimally invasive method of transmeatal tympanoplasty using meatal areolar tissue (MAT) grafts to achieve less postoperative morbidity or surgical scarring. We compared the functional and anatomical results of the developed method with conventional endaural tympanoplasty with a temporalis fascia (TF) graft. Methods: In this retrospective cohort study, 58 patients (59 ears) with simple chronic otitis media who underwent type I tympanoplasty between January 2016 and August 2018 were included. All surgeries were performed in a tertiary referral hospital and by the same senior surgeon. The tympanic membrane (TM) was repaired with either a TF or an MAT graft. Results: Healing of the perforated TM and improvement in a hearing test by air-bone gap (ABG) closure were identified. Postoperative wound conditions were also evaluated. Twenty-eight ears were grafted with MAT, and 31 ears were grafted with TF. Graft success was observed in 26 patients (92.9%) in the MAT group and 28 patients (90.3%) in the TF group. Both groups showed functional improvement compared with the preoperative measurements. The postoperative pure tone audiogram ( p = 0.737), ABG closure ( p = 0.547), and graft success rate ( p = 0.726) were not significantly different between the two groups. Neither wound dehiscence nor keloid formation was observed in our patients. Conclusion: Both MAT and TF grafts revealed satisfactory surgical and functional results. Compared with the conventional endaural approach with TF grafts, the new transmeatal approach method with an MAT graft causes relatively minimal trauma and results in better wound cosmetics. This method represents an easy, minimally invasive surgery and shows comparatively good results.

Outstanding research paper awards of the Journal of the Chinese Medical Association in 2020

“…We are happy to learn that the authors developed a relatively novel and modified method as transmeatal approach with meatal areolar tissue (MAT) reconstruction, modified from the canonical endaural tympanoplasty and attempted to overcome the limitations of conventional tympanoplasty for the treatment of COM patients. 6 As predicted, the authors found this transmeatal approach method with a MAT graft could not only significantly reduce the severity of trauma (to avoid external skin wounds) as well as surgery-related morbidity but also had a better cosmetic result; additionally, this modified technique is easy and minimally invasive and of the most importance, the therapeutic effects are similar or not inferior to those done by other types which need more invasive procedures. 6 Based on impressive findings of the current study, it was worthy of further discussion.…”

“…6 As predicted, the authors found this transmeatal approach method with a MAT graft could not only significantly reduce the severity of trauma (to avoid external skin wounds) as well as surgery-related morbidity but also had a better cosmetic result; additionally, this modified technique is easy and minimally invasive and of the most importance, the therapeutic effects are similar or not inferior to those done by other types which need more invasive procedures. 6 Based on impressive findings of the current study, it was worthy of further discussion.…”

“…As shown by authors, only patients with COM accompanied with small perforations were elected into the study group to be treated with this novel transmeatal approach with MAT reconstruction. 6 It is not surprising to have an excellent outcome in their study.…”

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The honor was given to Dr. Yen-Chi Chen for his excellent work, which was selected from all original articles published in the 2020 print issues of the Journal of the Chinese Medical Association (JCMA). [1][2][3][4][5][6] This article was entitled "Developing a novel meatal areolar tissue autograft for minimally invasive tympanoplasty." 6 Dr. Chen won this credit at the Annual Meeting of the Chinese Medical Association on August 7, 2021, held at Taipei, Taiwan.

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“…The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019, COVID-19) pandemic in Taiwan affect all of us and significantly impact healthcare, medical science as well as face-to-face connection 7-10 ; therefore, the annual meeting was held by virtual meeting.The authors tried to use the new technology in the management of patients with chronic otitis media (COM), which is a bothersome disease characterized as an enduring inflammation of the middle ear and mastoid cavity with the presence of a tympanic membrane perforation, and possibly leading to progressive degradation of the middle ear cavity and its components, causing conductive and mixed hearing losses. 6,11 Although tympanoplasty with temporalis fascia (TF), areolar tissue, perichondrium, or cartilage has been widely performed in patients with COM, with the aim of reducing infection recurrence and refining hearing, and in turn improving social development and quality of life, there is no doubt that several postoperative morbidities or complications, such as keloid formation, perichrondritis, recurrence of disease, continuous conductive hearing loss, the need of intraoperative and postoperative ventilation tube insertion, and occurrence of severe infection or pain to the patients occur in certain percentage of the patients, which was reported to be ranged from 0% to 47.1%. 11,12 Based on absence of 100% satisfactory therapeutic effects of tympanoplasty, it suggests the…”