Results of inlay cartilage myringoplasty in terms of closure of central tympanic membrane perforations.
ABSTRACT There is a current effort to perform myringoplasty for tympanic membrane perforations as a day-stay procedure. In 1998, an inlay myringoplasty using tragal cartilage/perichondrium was described. A retrospective study was performed by the author to analyse the results of inlay cartilage myringoplasty, in terms of closure of simple perforations of the tympanic membrane. The results of a control group of previous cases of underlay temporalis fascia myringoplasty were retrieved from the hospital records. All the operations in both groups were performed by the same author at the same institution. The operation of inlay cartilage butterfly myringoplasty has been performed in 28 ears with simple central tympanic membrane perforations. Inconsistent results have been obtained, in that only 43 per cent showed closure of the perforation at the most recent follow-up. A control group of standard underlay temporalis fascia myringoplasty has been performed by the same author in 23 ears. Eighty-three per cent of the perforations were closed at the last follow-up. The difference is statistically highly significant (p < 0.01).
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ABSTRACT: The objective of this study is to understand the outcome of minimally invasive topical anesthetized transcanal inlay and underlay tympanoplasty, and to compare these 2 procedures in hearing result, take rate, perioperative pain, and operation time. This is a retrospective study conducted from September 2003 to December 2006. Forty-eight tympanoplasty in 46 patients, 28 inlay and 20 underlay procedures, with small- to medium-sized tympanic membrane perforations without middle ear lesion, were studied in a tertiary referral center. Interventions included otologic examination, perioperative hearing evaluation, local anesthetized transcanal inlay, or underlay tympanoplasty. The outcome measurements were the following: the take rate and audiometric result at the last follow-up visit, perioperative pain, and duration of surgery. The statistical methods used were t test, Mann-Whitney U test, chi(2) test, and Fisher exact test. The take rate were 82.1% in the inlay group and 85% in the underlay group, without significant difference (P = .79) at the last follow-up visit. Air-bone gap closure was 6.3 +/- 2.5 dB in the inlay group and 9.3 +/- 3.2 dB in the underlay (P = .07). Linear analogue scale of perioperative pain was lower in the inlay group with significance (1.7 +/- 1.2 in the inlay and 4.6 +/- 1.9 in the underlay group, P < .001). The duration of the surgery was significantly shorter in the inlay group (31.8 +/- 13.9 minutes for the inlay group and 75.9 +/- 14.6 minutes for the underlay group, P < .001). Minimally invasive topically anesthetized transcanal tympanoplasty provides satisfactory surgical and audiometric outcome both in inlay and underlay procedures. The take rate and extent of hearing recovery are similar in both groups. However, inlay tympanoplasty is superior to transcanal tympanoplasty because of less discomfort and shorter operation time.American journal of otolaryngology 11/2008; 29(6):363-6. DOI:10.1016/j.amjoto.2007.11.002 · 1.08 Impact Factor
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ABSTRACT: Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.Expert Review of Medical Devices 11/2009; 6(6):653-64. DOI:10.1586/erd.09.47 · 1.78 Impact Factor