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Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations.

Celik H, Samim E, Oztuna D - Clin Exp Otorhinolaryngol (2015)

Bottom Line: Graft success rate was 87.5% in this study.Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period.The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences.

View Article: PubMed Central - PubMed

Affiliation: Otorhinolaryngology Clinic, Ministry of Health Ankara Education and Research Hospital, Ankara, Turkey.

ABSTRACT

Objectives: To evaluate endoscopic push-through technique cartilage myringoplasty results.

Methods: This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies.

Results: Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences.

Conclusion: Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.

No MeSH data available.


Related in: MedlinePlus

Desepitelizaiton of the perforation edges.
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Figure 1: Desepitelizaiton of the perforation edges.

Mentions: First, perforation edges and anterior annulus were visualized with a 0°, 4-mm×18-cm rigid endoscope. The edges of the perforation were desepitelized with an angled pick (Fig. 1). Later, a 4- to 5-mm incision was performed 2- to 3-mm medial to the tragal cartilage's free border, incising the skin and the cartilage. The cartilage was freed of the perichondrium, and elevated at the EAC aspect of the cartilage. On the opposite side, the perichondrium left attached to the cartilage, and a 3- to 4-mm-sized cartilage was removed with its perichondrium attached on one side, the other side of it being uncovered by perichondrium. The incision was sutured with an absorbable material. The ear canal-side of the cartilage is concave, therefore this side was preferably placed towards the middle ear. Under endoscopic vision, the middle ear was tightly packed with gelfoam through the perforation, until the level of the perforation. The tubal orifice was supported more tightly in order to prevent medialization due to negative pressure produced by sniffing. Later, the size and the diameter of the perforation were measured using a sterile piece of aluminum foil. The foil was placed on the cartilage, and the graft was prepared 1-2 mm larger it. The tragal cartilage was not thinned out, and used as a graft at its natural thickness. The cartilage graft was pushed through the perforation, and placed in an underlay fashion, its concave and perichondrium - free surface looking towards the middle ear (Figs. 2, 3). It was covered with gelfoam until the level of the isthmus.


Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations.

Celik H, Samim E, Oztuna D - Clin Exp Otorhinolaryngol (2015)

Desepitelizaiton of the perforation edges.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553352&req=5

Figure 1: Desepitelizaiton of the perforation edges.
Mentions: First, perforation edges and anterior annulus were visualized with a 0°, 4-mm×18-cm rigid endoscope. The edges of the perforation were desepitelized with an angled pick (Fig. 1). Later, a 4- to 5-mm incision was performed 2- to 3-mm medial to the tragal cartilage's free border, incising the skin and the cartilage. The cartilage was freed of the perichondrium, and elevated at the EAC aspect of the cartilage. On the opposite side, the perichondrium left attached to the cartilage, and a 3- to 4-mm-sized cartilage was removed with its perichondrium attached on one side, the other side of it being uncovered by perichondrium. The incision was sutured with an absorbable material. The ear canal-side of the cartilage is concave, therefore this side was preferably placed towards the middle ear. Under endoscopic vision, the middle ear was tightly packed with gelfoam through the perforation, until the level of the perforation. The tubal orifice was supported more tightly in order to prevent medialization due to negative pressure produced by sniffing. Later, the size and the diameter of the perforation were measured using a sterile piece of aluminum foil. The foil was placed on the cartilage, and the graft was prepared 1-2 mm larger it. The tragal cartilage was not thinned out, and used as a graft at its natural thickness. The cartilage graft was pushed through the perforation, and placed in an underlay fashion, its concave and perichondrium - free surface looking towards the middle ear (Figs. 2, 3). It was covered with gelfoam until the level of the isthmus.

Bottom Line: Graft success rate was 87.5% in this study.Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period.The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences.

View Article: PubMed Central - PubMed

Affiliation: Otorhinolaryngology Clinic, Ministry of Health Ankara Education and Research Hospital, Ankara, Turkey.

ABSTRACT

Objectives: To evaluate endoscopic push-through technique cartilage myringoplasty results.

Methods: This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies.

Results: Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences.

Conclusion: Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.

No MeSH data available.


Related in: MedlinePlus