Lateral Tympanoplasty for Total or Near‐Total Perforation: Prognostic Factors

Angeli, Simón I.; Kulak, Jessica L.; Guzmán, José Eduardo

doi:10.1097/01.mlg.0000232495.77308.46

Cited by 53 publications

(67 citation statements)

References 13 publications

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“…Success rates with these techniques range from 77% to 96% . Higher success rates are found using the lateral graft approach for large and anterior perforations, which have a reduced rate of closure overall …”

Section: Discussionmentioning

confidence: 99%

“…Exposure of the anterior middle ear is limited, and the success rate is lower for larger perforations . In the overlay (lateral) approach, the squamous layer of the TM is removed, and the graft is placed lateral to the tympanic annulus . This technique has higher success for large and anterior perforations, but is associated with prolonged surgery and risk of blunting of the anterior angle and graft lateralization.…”

Section: Introductionmentioning

confidence: 99%

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Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

2018

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Objectives/Hypothesis A hybrid variation of a tympanoplasty technique, termed over–under tympanoplasty (OUT), was evaluated to demonstrate the long‐term outcomes and complications compared to medial tympanoplasty. Study Design Retrospective review. Methods Patients who underwent a tympanoplasty between 2010 and 2015 were included. Primary outcome measures included graft healing at 18 months, change in air‐bone gap (ABG), and change in high‐frequency hearing at 8 kHz. The Shapiro‐Wilk test, Student t test, and nonparametric Mann‐Whitney test were used to compare results. Univariate logistic regression analysis was used to identify potential predictors of surgical success. Results One hundred eleven patients were included; 84 underwent the over–under technique and 27 underwent medial tympanoplasty. At the 18‐month follow‐up, 100% of patients in the medial tympanoplasty group had closure of the TM perforation compared to 84% (71/84) in the over–under group. In the over–under group, 12% of patients developed small or pinpoint perforations, and 4% developed larger, recurrent perforations. Mean improvement in ABG was similar between the two groups (11.6 dB for the medial group vs. 11.9 dB for the over–under group, P < .001). No hearing loss was noted in either group. No lateralization of the graft or anterior blunting was noted. Conclusions In this series, the OUT technique had a high success rate with TM perforations, including anterior, near total, and total perforations. Hearing loss from dissection on the malleus was not found. This approach blends the advantages and minimizes the disadvantages of the classic techniques and is well suited for all types of tympanic membrane perforations. Level of Evidence 3b Laryngoscope, 129:1206–1210, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

2018

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“…However, some retrospective studies show that there is no difference in outcomes of graft success rate or post-operative hearing with regard to whether mastoidectomy is performed in addition to tympanoplasty (Balyan et al, 1997;Mishiro et al, 2001). Mastoidectomy may be indicated to reduce the burden of disease in cases with abscess formation in the mastoid, tympanoplasty or recalcitrant disease (Collins et al, 2003;Angeli et al, 2006).…”

Section: Surgerymentioning

confidence: 99%

Current concepts in the pathogenesis and treatment of chronic suppurative otitis media

Mittal

Lisi

Gerring

et al. 2015

Journal of Medical Microbiology

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200

161

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Otitis media (OM) is an inflammation of the middle ear associated with infection. Despite appropriate therapy, acute OM (AOM) can progress to chronic suppurative OM (CSOM) associated with ear drum perforation and purulent discharge. The effusion prevents the middle ear ossicles from properly relaying sound vibrations from the ear drum to the oval window of the inner ear, causing conductive hearing loss. In addition, the inflammatory mediators generated during CSOM can penetrate into the inner ear through the round window. This can cause the loss of hair cells in the cochlea, leading to sensorineural hearing loss. Pseudomonas aeruginosa and Staphylococcus aureus are the most predominant pathogens that cause CSOM. Although the pathogenesis of AOM is well studied, very limited research is available in relation to CSOM. With the emergence of antibiotic resistance as well as the ototoxicity of antibiotics and the potential risks of surgery, there is an urgent need to develop effective therapeutic strategies against CSOM. This warrants understanding the role of host immunity in CSOM and how the bacteria evade these potent immune responses. Understanding the molecular mechanisms leading to CSOM will help in designing novel treatment modalities against the disease and hence preventing the hearing loss. IntroductionOtitis media (OM) refers to a group of complex infectious and inflammatory diseases affecting the middle ear (Dickson, 2014). OM in general is very common, as studies show that around 80 % of children should have experienced at least one episode by their third birthday (Teele et al., 1989). OM has been broadly classified into two main types, acute and chronic. Acute OM (AOM) is characterized by the rapid onset of signs of inflammation, specifically bulging and possible perforation of the tympanic membrane, fullness and erythema, as well as symptoms associated with inflammation such as otalgia, irritability and fever (Pukander, 1983;Harkness & Topham, 1998). Despite appropriate antibiotic therapy, AOM may progress to chronic suppurative OM (CSOM) characterized by persistent drainage from the middle ear associated with a perforated ear drum (Wintermeyer & Nahata, 1994;Harkness & Topham, 1998). When examined by otoscope, the middle ear looks red and inflamed with purulent discharge in CSOM patients (Figs 1 and 2). It is one of the most common chronic infectious diseases worldwide especially affecting children (Roland, 2002; Verhoeff et al., 2006). Hearing impairment is one of the most common sequelae of CSOM (Aarhus et al., 2015). The resultant hearing loss can have a negative impact on a child's speech development, education and behaviour (Olatoke et al., 2008; Khairi Md Daud et al., 2010). Mortality due to complications of CSOM is typically higher than other types of OM (Yorgancilar et al., 2013a;Qureishi et al., 2014). Intracranial complications like brain abscess and meningitis are the most common causes of death in CSOM patients (Dubey et al., 2010;Chew et al., 2012;Sun & Sun, 2014).In this article, the rec...

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“…Regardless of what techniques used, in cases which the malleus handle is in close relationship with perforation, the squamous epithelium covering the malleus handle should be desepithelised. According to several authors the malleus handle has a key role in the success of the tympanoplasty and it is worthwhile to preserve it (2, 3, 5). In contrast some other authors reported that the presence of the malleus handle was not an important prognostic factor (8, 9).…”

Section: Discussionmentioning

confidence: 99%

Shall We Resect the Tip of Manubrium Mallei in Tympanoplasty?

Kutluhan

Yalçıner

Güler

et al. 2011

Clin Exp Otorhinolaryngol

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ObjectivesIn tympanoplasty operations if perforation is related with malleus handle, malleus handle is desepithelised. We planned this research to investigate whether the epithelial remnants remain as a result of this desepithelisation or not.MethodsThe 35 patients who were performed tympanoplasty operation were divided into two groups. In the first group which included 13 patients the tip portion of manubrium mallei were cut off without desepithelisation. In the second group which included 22 patients the tip portions of manubrium mallei were cut off after the meticulous desepithelisation. The presence of squamous epithelium was examined histopathologically on the specimens.ResultsSquamous epithelium was observed in 9 of the 13 non-desepithelised specimens and in 6 of 22 desepithelised specimens.ConclusionIn tympanoplasty operations despite careful desepithelisation, squamous epithelial remnants may remain on the malleus handle. So the tip of manubrium mallei could be resected to prevent the future development of cholesteatoma.

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Lateral Tympanoplasty for Total or Near‐Total Perforation: Prognostic Factors

Cited by 53 publications

References 13 publications

Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

Current concepts in the pathogenesis and treatment of chronic suppurative otitis media

Shall We Resect the Tip of Manubrium Mallei in Tympanoplasty?

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