Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Gutiérrez, Jorge; Cabrera, Claudia I.; Stout, Amber; Mowry, Sarah E.

doi:10.1177/00034894231159000

Cited by 3 publications

(2 citation statements)

References 83 publications

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“…Tympanoplasty is the standard procedure for treating these patients (Fisch, 1994;Bayram et al, 2020;Lubianca Neto et al, 2022;Gutierrez et al, 2023;Zhao and Chen, 2023). It involves removing lesions and reconstructing the middle ear structure to improve hearing.…”

Section: Introductionmentioning

confidence: 99%

Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis

Qin,

Yin,

Sun

et al. 2023

Front. Bioeng. Biotechnol.

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Background: For patients with severe tympanic adhesion, reconstructing the tympanic air cavity is often challenging, resulting in poor hearing reconstruction outcomes. Therefore, establishing a sound conduction pathway independent of the tympanic air cavity may be a viable method for reconstructing hearing in these patients.Purpose: The objective of this study was to evaluate the feasibility of sound conduction independent of the tympanic air cavity (i.e., replacing the original cavity with a tympanic vibrating material) using finite element analysis.Methods: We established a sound-structure coupling finite element model of the tympanum vibration conduction system, which included the tympanic membrane (TM), ossicular prosthesis, and tympanic vibrating material. This model was used to simulate middle ear vibrations under sound pressure, and we extracted the frequency response curve of the ossicular prosthesis’ vibration displacement amplitude to evaluate the sound conduction effect of the middle ear. Next, we adjusted the structural and mechanical parameters of the tympanic vibrating material to analyze its impact on the sound conduction effect of the middle ear. Finally, we compared the frequency response curve of the stapes footplate in normal subjects to evaluate the feasibility of sound conduction independent of the tympanic air cavity.Results: The Shell tympanic vibrating material had a better vibration conduction effect compared to solid or porous tympanic vibrating material. The vibration amplitude decreases with the increasing elastic modulus of the tympanic vibrating material. Implantation of 40 kPa-shell tympanic vibrating material had the lowest hearing loss less than 5 dB, and the hearing loss with 1 MPa-porous tympanic vibrating material was largest and less than 25 dB.Conclusion: Our study suggests that replacing the tympanic air cavity with a tympanic vibrating material is feasible. The establishment of a sound conduction pathway independent of the tympanic air cavity could potentially provide a method for hearing reconstruction in patients with severe tympanic adhesion.

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Section: Introductionmentioning

confidence: 99%

Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis

Qin,

Yin,

Sun

et al. 2023

Front. Bioeng. Biotechnol.

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show abstract

“…The structure of the TM is important for normal hearing. Many diseases cause hearing loss by altering the TM, such as perforations [3][4][5][6][7], retraction pockets [8][9][10][11], and cholesteatoma [11][12][13]. Other ear diseases cause hearing loss by affecting the middle ear space, which lies directly behind the TM, such as ear infections, middle ear fluid, or tumors of the middle ear.…”

Section: Introductionmentioning

confidence: 99%

Automated Segmentation of Optical Coherence Tomography Images of the Human Tympanic Membrane Using Deep Learning

Oghalai,

Long,

Kim

et al. 2023

Algorithms

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Optical Coherence Tomography (OCT) is a light-based imaging modality that is used widely in the diagnosis and management of eye disease, and it is starting to become used to evaluate for ear disease. However, manual image analysis to interpret the anatomical and pathological findings in the images it provides is complicated and time-consuming. To streamline data analysis and image processing, we applied a machine learning algorithm to identify and segment the key anatomical structure of interest for medical diagnostics, the tympanic membrane. Using 3D volumes of the human tympanic membrane, we used thresholding and contour finding to locate a series of objects. We then applied TensorFlow deep learning algorithms to identify the tympanic membrane within the objects using a convolutional neural network. Finally, we reconstructed the 3D volume to selectively display the tympanic membrane. The algorithm was able to correctly identify the tympanic membrane properly with an accuracy of ~98% while removing most of the artifacts within the images, caused by reflections and signal saturations. Thus, the algorithm significantly improved visualization of the tympanic membrane, which was our primary objective. Machine learning approaches, such as this one, will be critical to allowing OCT medical imaging to become a convenient and viable diagnostic tool within the field of otolaryngology.

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Comparison of Hearing Outcomes in Tympanoplasty With and Without Ossiculoplasty: A Retrospective Cohort Study

Alosaimi,

Abulfateh,

Bedawi

et al. 2024

Cureus

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Objectives To examine the ability of the Middle Ear Risk Index (MERI) score components in order to predict postoperative air-bone gap (ABG) and success rate in patients who underwent tympanoplasty. Methods A retrospective cohort study was conducted at King Hamad University Hospital between May 2017 and February 2021. A total of 79 patients were divided into two groups: 42 patients (53.2%) underwent tympanoplasty without ossiculoplasty, and 37 patients (46.8%) underwent tympanoplasty with ossiculoplasty. Data collected included demographic information, four-frequency ABG pre- and post-surgery, and total MERI scores. Statistical analyses included paired sample t-tests to assess changes in ABG and chi-square tests to evaluate associations between categorical variables. A p-value of <0.05 was considered significant. Results Seventy-nine patients were evaluated. Over half (53.2%) underwent myringoplasty only, and 46.8% (n = 37) underwent tympanoplasty with ossiculoplasty. Post-operative ABG was highly correlated with the presence of cholesteatoma, ossicular chain score, and the presence of previous surgery. The MERI score was correlated with the postoperative ABG gap, but with a relatively poor correlation coefficient, making it nonpractical for clinical use. Ossicular chain score alone was a better indicator of postoperative ABG. Successful closure of ABG was high in both groups, reaching 83.6% (n = 31) in the ossiculoplasty group and 92.8% (n = 39) in the myringoplasty group. Some components of the MERI score were found to be significantly interrelated, making the MERI score not a reliable prognostic indicator. Patients who underwent tympanoplasty with ossiculoplasty had high pre- and postoperative ABG values (27.47 ± 14.22 and 15.02 ± 8.58, respectively). The mean total MERI score (5.56 ± 2.24) was also significantly higher in patients who underwent ossiculoplasty. Conclusions Our findings indicate that both cholesteatoma and ossicular pathology significantly influence hearing outcomes, with a high degree of interrelation. While the MERI provides some insight, its limited predictive value, due to the interdependence of its components, suggests that it may not be a reliable tool for clinical decision-making in tympanoplasty and ossiculoplasty.

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Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Cited by 3 publications

References 83 publications

Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis

Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis

Automated Segmentation of Optical Coherence Tomography Images of the Human Tympanic Membrane Using Deep Learning

Comparison of Hearing Outcomes in Tympanoplasty With and Without Ossiculoplasty: A Retrospective Cohort Study

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