Tympanoplasty in Subtotal Perforation with Graft Supported by a Slice of Cartilage: A Study with Near 100 % Results

Mundra, R. K.; Sinha, Richi; Agrawal, Richa

doi:10.1007/s12070-013-0673-3

Cited by 22 publications

(17 citation statements)

References 12 publications

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“…It is an important prognostic factor for the success in tympanoplasty. 8 ET dysfunction secondary to infection and inflammation can be treated with medications, but the bony narrowing of pretympanic segment demands the surgical modification in middle ear keeping in mind the post operative hypoventilation of middle ear. Surgical modification can be done by using cartilage graft, for better stability and thus preventing medialisation of the graft.…”

Section: Discussionmentioning

confidence: 99%

“…This offers extremely reliable method for reconstruction of tympanic membrane in cases of ET dysfunction. 8 In cases of severe ET dysfunction due to pretympanic segment narrowing, balloon tuboplasty of the pretympanic segment can be combined with tympanoplasty, resulting in significantly high graft take up rate and restoration of middle ear integrity. 9 , 10 In our study, we found that decrease in pretympanic diameter and Reid plane-ET angle coexist with ET dysfunction, thus demanding intraoperative surgical modifications.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Nemade

Shinde

Rangankar

et al. 2018

World j. otorhinolaryngol.-head neck surg.

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ObjectiveTo evaluate the significance of Eustachian tube (ET) angles and ET pretympanic diameter on high resolution computed tomography (HRCT) Temporal bone in patients with chronic otitis media (COM).MethodsA retrospective study was carried out at Tertiary care centre. Group A included 92 ears with COM (38 patients with bilateral COM and 16 with unilateral COM); and Group B included 108 normal ears (54 patients with bilateral normal ears). Reid plane-ET angle, Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone, and compared in the two groups. Patients with chronic otitis media (Group A) were subdivided into Group A1 (Blocked ET) and Group A2 (Patent ET). The parameters were evaluated and compared in the subgroups too.ResultsThe mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41 ± 2.57 and 148.12 ± 3.43 respectively; whereas in Group B it was 27.56 ± 3.62 and 145.14 ± 4.34 respectively. Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients. ET pretympanic diameter was (5.37 ± 2.10) mm in Group A and (6.47 ± 2.40) mm in Group B. It was significantly less in patients with COM. A significant correlation was found between the ET patency and the two ET parameters (Reid plane-ET angle and pretympanic diameter).ConclusionsEustachian tube angles in adults may play a significant role in the etiology of chronic otitis media. Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Nemade

Shinde

Rangankar

et al. 2018

World j. otorhinolaryngol.-head neck surg.

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“…21 Mundra et al, achieved 98.94% of success in terms of graft uptake by using a slice of cartilage support in subtotal perforations, by underlay technique. 22…”

Section: Resultsmentioning

confidence: 99%

Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

Gangadar

Priyadarshini

2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

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“…Mundra et al . found residual perforations in only 1.06% using perichondrium/temporalis fascia supported by cartilage . Although TM closure rates seem to be higher in grafting techniques using a combination of perichondrium or temporalis muscle fascia and cartilage, this procedure is time‐consuming and would not be necessary in the majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Healing of the tympanic membrane after surgical intervention for atelectasis of the middle ear in sixty‐two adults

Noij

Borgstein

2016

Clinical Otolaryngology

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In treating atelectasis of the middle ear multiple techniques have been described, including grafting of the eardrum defect, for example with perichondrium or cartilage. 1 Several studies suggested that excision of the retraction pocket in paediatric ears does not require grafting. The spontaneous healing capacity of the paediatric tympanic membrane (TM) ranged from 87.2% to 96.8%. 2-5 These results are comparable to spontaneous healing after traumatic perforations of the tympanic membrane, which is generally treated conservatively, and to results of myringoplasty operations for perforated membranes. 6,7 As it appears that excision of the atrophic segment of the tympanic membrane in paediatric ears does not require grafting, and traumatic perforations in adults generally heal as well as in children, this might be an appropriate treatment for adults as well. Methods Ethical considerationsThis study was approved by the Institutional Ethics Committee. Patient selection and characteristicsCase files of all adult patients (≥18 years of age) who have undergone excision of the atrophic segment of the tympanic membrane in the Tergooi hospital in the Netherlands between 2010 and 2013 were examined to determine the spontaneous healing rate of the tympanic membrane and hearing thresholds. Exclusion criteria were tympanoplasty in the past or need for an atticoantrostomy in cholesteatoma. Every patient was classified according to the Erasmus atelectasis classification, a classification for retraction pockets of the pars tensa, previously described for paediatric patients (Table 1). 8 Sixty-two patients were included in this study. Median age at time of surgery was 43.0 years (range 18-71 years). The male-to-female ratio was 1 : 1. Thirteen patients received surgery on both ears. Two patients received a second surgery on one ear because atelectasis recurred, which were also included in our analysis. Therefore, seventy-seven ears were included. Surgical techniqueSurgery was performed by, or under supervision of, the last author.The majority of middle ear operations were performed transmeatally, and two retraction pockets required a combined mastoidectomy approach for a cholesteatoma was present that could not be resected completely via the transmeatal approach. These cases were only included if an atticotomy was not performed. If the tympanic membrane was not fixed to middle ear structures, simple excision was carried out, and the atrophic section of the tympanic membrane was removed up to the normal margins. A fixed tympanic membrane was approached via a tympanomeatal incision, the atrophic drum being very carefully separated from middle ear structures to prevent tearing, and everted completely before subsequent excision; the atrophic section of the tympanic membrane being removed entirely up to the normal margins.After resection, a margin of normal membrane remains from which the new drum regenerates. In fifty-three cases, a T-tube was inserted through the perforation that remains after excision to facilitate middle ear venti...

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Tympanoplasty in Subtotal Perforation with Graft Supported by a Slice of Cartilage: A Study with Near 100 % Results

Cited by 22 publications

References 12 publications

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

Healing of the tympanic membrane after surgical intervention for atelectasis of the middle ear in sixty‐two adults

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