[The state of the regenerative activity of the tympanic membrane tissues and the results of myringoplasty at different time points of remission of experimental otitis media].

The objective of the present study was to estimate the regenerative potential of the tympanic membrane tissues in the early period of remission after experimental otitis media and evaluate the results of myringoplasty. The experiments were carried out using 23 outbred dogs exhibiting no signs of "spontaneous otitis". Experimental otitis media was induced in 20 animals using a Staphylococcus aureus strain as the pathogenic organism. The treatment of the experimental animals was started two weeks after the development of otitis and continued up to obtaining the "dry ear" condition. The animals were allocated to 4 groups depending on the time of myringoplasty. In the animals of group 1 myringoplasty was performed one week after remission, those of groups 2, 3, and 4 underwent myringoplasty two, three, and four weeks after the onset of remission respectively. The results of the study indicate that the first two weeks after the inflammatory process in the middle ear subsided are the optimal time for myringoplasty because the proliferative activity during this period amounts to its maximum which promotes the survival of the transplant and the closure of tympanic defects.

Benchmarks for the durations of ambulatory surgical procedures in otolaryngology.

OBJECTIVES: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. METHODS: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. RESULTS: An estimated 1.68 +/- 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (+/- SE) surgical times were 8.0 +/- 0.5, 23.9 +/- 1.8, and 20.3 +/- 0.8 minutes, respectively. The total operating room times were 17.6 +/- 0.9, 48.2 +/- 2.0, and 40.7 +/- 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 +/- 4.78 and 79.8 +/- 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). CONCLUSIONS: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

Paediatric myringoplasty in India.

In comparison to chronic non-suppurative otitis media, the incidence of chronic suppurative otitis media is no less in developing countries. This is due to lack of consciousness, low socioeconomic condition, and increased susceptibility to upper respiratory tract infection. Thirty-two ears of 20 patients between the ages of 5 and 12 years are included in this study who underwent myringoplasty, and were followed up for 3 months to 1 year postoperatively. Successful take of the graft was 60% in patients of 5 to 8 year age group, and 72.7% in 9 to 12 year age group. Postoperative air conduction was elevated up to 10 dB level in all the successful ears. In paediatric patients, the tympanic membrane perforation should be repaired to reduce the enormous degree of morbidity, and economic and social disability which afflict so many hundred thousands of people.

Myringoplasty in children.

Our 11 years of experience of myringoplasty in 87 children aged 3 to 14 years were retrospectively studied. The children were followed up over a period of 3 years. Children in the 3-to-12-year-old age group had a success rate of 57.7%. Graft-take rate was 100% in children operated on at the age of 13 and 14 years. Revision surgery was needed in 33 ears, and ultimate success was achieved in 88.9%. Within the same period, 38 ears were conservatively treated and 20 perforations of them were spontaneously closed. The state of the opposite ear and the perforation size were not a decisive factor in the results of myringoplasty. Children between 7 and 10 years old with small mastoid pneumatization had a statistically lower graft-take rate. We concluded that myringoplasty is warranted for children 13 years of age and older or children aged 7 to 12 years with large mastoid pneumatization.

Myringoplasty in children: anatomical and functional results.

To assess the results of myringoplasty in children and determine the factors influencing post-operative results a retrospective study of the anatomical and functional results of 41 myringoplasties in children was performed, considering only the cases of uncomplicated perforation that did not require ossiculoplasty or mastoidectomy. The overall success rate was 80.5 per cent after a mean follow-up of 39 months. The mean post-operative air conduction threshold significantly improved in the successful cases with a mean audiological improvement of 11 dB (p<0.05). No post-operative sensorineural hearing loss was observed. There was a significant statistical association between the presence of a dry ear at the time of surgery and good surgical results (p<0.01). Surgical outcome was not affected by the patient's age, the site and size of the perforation, previous adenoidectomy, surgical technique (overlay vs underlay), or the status of the contralateral ear. Our findings suggest that myringoplasty is a valid procedure in the paediatric population that gives good anatomical and functional results. The status of the middle ear (i.e. the presence of a dry ear), significantly improves surgical outcome; and so careful inflammatory changes in the middle-ear mucosa should be evaluated and medical treatment considered before surgery.

Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas.

OBJECTIVES: We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas. MATERIALS AND METHODS: The study was longitudinal and prospective, with a two-year follow up. Seventeen East Greenlandic patients with bilateral chronic suppurative otitis media or chronic otitis media were selected. Their median age was 16 years; 53 per cent were female and 47 per cent male. Hearing was assessed using median air conduction pure tone average gain, and the 'take rate' (i.e. the percentage of total ears with a closed perforation) was evaluated. RESULTS: All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of < or =25 dB in at least one ear. In total, 71 per cent of the patients were satisfied. There were no hearing hazards. CONCLUSIONS: The results of mobile, one stage, bilateral ear surgery conducted in Greenland for long-lasting chronic suppurative otitis media and chronic otitis media were acceptable and safe, and more ears underwent surgery at reduced cost compared with unilateral ear surgery.

Cartilage tympanoplasty: literature review.

There has been renewed interest in the use of cartilage for middle-ear reconstructions. The aim of the present review is to examine the indications, techniques and surgical outcomes of cartilage tympanoplasties reported in the literature. There have been concerns regarding weakening of cartilage struts, from histological studies involving explants; as a result, cartilage struts for ossiculoplasty have not gained popularity. On the other hand, cartilage tympanoplasty is now an established procedure for tympanic membrane and attic reconstruction. The commonest techniques involve cartilage palisades and composite cartilage-perichondrial island grafts. There are many variations on the shape, size and thickness of the cartilage grafts. The perceived benefit of cartilage tympanoplasty is to prevent retraction pockets at the grafted site, even though many otologists accept that this technique may not deal with the causal factors involved in the retraction process. Concerns that the stiffness and mass of cartilage grafts may adversely affect hearing have not been substantiated in clinical reports thus far.

[Healing rates, cholesteatoma occurrence and functional results in overlay and underlay techniques for myringoplasty (author's transl)]. / Heilungsrate, Cholesteatombildung und funktionelles Ergebnis nach Auflegen oder Unterlegen des Transplantates bei der Myringoplastik.

From a total of 91 myringoplasties, 42% of the grafts used were placed medial to the tympanic membrane while 58% were placed laterally. Successful closures of the perforation were achieved in 68% of the first group and in 62% of the second group. Grafting with canal skin during the procedure or the size of the mastoid air cell system (as demonstrated by x-ray) failed to influence graft success. Cholesteatomas were found in 13% of the patients undergoing overlay techniques but in only 3% of the underlay grafts. Air-bone gaps at 500, 1,000 and 2,000 Hz averaged 12.9 dB preoperatively, and were 4.8 dB postoperatively in patients with medially-placed grafts and 7.4 dB in those patients with the lateral grafts.

Myringoplasty using a subcutaneous soft tissue graft.

A retrospective study was performed on patients who underwent myringoplasty using an autologous subcutaneous soft tissue graft over a 5-year period. Details including age, site and size of perforation, grade of surgeon, surgical approach, postoperative dressings, overnight stay, complications and outcome were recorded and analysed. Fifty-two patients underwent myringoplasty using a subcutaneous soft tissue graft. Their ages ranged from 4 to 78 years (median = 36 years). The mean follow-up period was 19 months. Successful closure to give an intact tympanic membrane was obtained in 82.7% of patients. Thresholds improved on pure tone audiometry in 57.1% and deteriorated in only one patient. There was no case of dead ear as a result of surgery. Subcutaneous tissue graft has comparable outcomes with temporalis fascia graft with additional advantages of a smaller incision, minimum dissection and a lower risk of bleeding.

Myringoplasty--effects on hearing and contributing factors.

Indications for myringoplasty are chronic otorrhoea and hearing impairment. Some authors have described poor postoperative hearing results and sensorineural hearing loss associated with the surgery, and question the indication for myringoplasty on an ear with normal hearing (< 25 dB). This study of 211 consecutive myringoplasties performed over 1 year details the 'take rate,' hearing gains and losses, and factors found to influence the above. The take rate of 78% is comparable with figures in the literature. The most significant factors influencing this are the grade of the surgeon and the size of the perforation. The average pre-operative air-bone gap was closed from 23.7 dB to 13.9 dB with a 4.5% incidence of postoperative sensorineural hearing loss. Postoperatively 77.9% of patients had an air-bone gap of less than 20 dB. We conclude that myringoplasty is a beneficial procedure, closing the tympanic membrane and improving the hearing.