Application of Enhanced Recovery After Surgery in Perioperative Period of Tympanoplasty and Mastoidectomy.

INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols are a series of perioperative care to optimize preoperative preparation, prevent postoperative complications, minimize stress, and speedup recovery. Tympanoplasty and mastoidectomy are common surgical procedures for chronic suppurative otitis media. OBJECTIVE: To compare the efficacy and safety between ERAS and conventional recovery after surgery in the perioperative period of chronic suppurative otitis media. METHODS: From April 2018 to February 2019, a total of 84 patients scheduled for tympanoplasty and/or mastoidectomy due to chronic suppurative otitis media were involved and randomly divided into the ERAS group and the control group. The patients' preoperative anxiety, postoperative pain, and comfort level were determined by comparing the results of Self-Rating Anxiety Scale (SAS), Visual Analog Scale (VAS) and General Comfort Questionnaire (GCQ). The postoperative complications, postoperative hospital stay, and hospitalization cost were calculated. RESULTS: The ERAS group showed a lower SAS score (30 [28-31.5] vs 35 [30-43], P < .05], a higher GCQ score (88 [84-100] vs 83 [78.25-92.25], P < .05), and a lower VAS score (0 [0-0] vs 1 [0-2], P < .05] after surgery. No significant difference (P > .05) was observed between the ERAS group and the control group in postoperative complications, postoperative hospitalization time, and hospitalization cost, respectively. CONCLUSION: Enhanced recovery after surgery can reduce pain and improve comfort in the perioperative period of chronic suppurative otitis media.

[The state of microcirculation in the middle ear structures at different stages of the treatment of the patients presenting with chronic otitis media].

The present work was designed to study dynamics of blood circulation in the tympanic membrane and tympanic cavity mucosa of 92 patients (105 ears) presenting with otosclerosis, adhesive non-perforative otitis media, and different stages of chronic suppurative otitis media. Normal characteristics of tympanic microcirculation were determined in 22 otologically healthy volunteers (30 ears). Laser Doppler flowmetry with the use of a specially designed probe (the outer diameter: 1.9 mm) was applied. The results of Doppler flowmetry varied in ontologically healthy subjects. The same circulation parameters in the vessels of the microcirculatory bed of the postero-superior quadrant of the tympanic membrane in the patients presenting with chronic suppurative otitis media at the stage of remission, otosclerosis, and adhesive non-perforative otitis media did not significantly differ from those of otologically healthy subjects. The blood flow was shown to increase in the tympanic membrane of the majority of the patients during the postoperative period (within 2nd to 4th weeks after types I-III tympanoplasty); thereafter, it either decreased or returned to the baseline level by weeks 6-8. Four months after the improvement of perfusion parameters of tympanic cavity mucosa and the arrest of exacerbation of mesotympanitis, characteristics of microcirculation in tympanic cavity mucosa were not significantly different from those of the patients with adhesive perforative otitis media. It is concluded that laser Doppler flowmetry may be used as an objective non-invasive technique for the study of microcirculation in the tympanic membrane and tympanic cavity mucosa.

Early healing and hearing improvement following type one tympanoplasty using the 'drum sandwich' technique.

BACKGROUND: The results of a number of tympanic membrane perforation closure techniques have been reported. However, relatively little has been published on the 'drum sandwich' technique. METHOD: Retrospective chart review of 123 patients undergoing type one tympanoplasty, performed by one surgeon using the drum sandwich technique. RESULTS: Ninety-two per cent of perforations were successfully closed, and 87 per cent of patients had healed ears and were free from aural discharge 6 weeks following surgery. Post-operative hearing data were only available for 81 ears. Of these, 58 per cent had closure of the air-bone gap to within 10 dB. The mean hearing gain for the group was 10.6 dB. CONCLUSION: The drum sandwich technique produces rapid healing of the ear with acceptable hearing outcomes. Drum closure rates are comparable with those reported for other techniques.

[Modified butterfly cartilage tympanoplasty: retrospective study on 26 patients]. / Tympanoplastie transcanalaire type "butterfly" modifiée: etude rétrospective sur 26 patients.

OBJECTIVE: To assess the results of inlay butterfly tympanoplasty on dry perforation. STUDY DESIGN: Retrospective case study. PATIENTS: 26 patient (14 male, 12 female), mean age 38 years, ranged from 9 to 73. Mean follow up: 20 months. SURGERY: Inlay cartilage butterfly tympanoplasty performed under general or local anesthesia according to the technique originally described by Eavey, with our specific modifications (use of a dermatological punch). RESULTS: 92.3% of perforation closure was obtained; 2 residual perforations and 1 non-epithelialisation were observed. No iatrogenic cholesteatoma was observed. The mean preoperative to post operative four-tone air bone gap improved from 27.67 to 20.1 (mean gain 7.5). CONCLUSION: Inlay butterfly cartilage tympanoplasty is a safe, efficient and easy technique. This technique need more prospective evaluation, and its place among other techniques of tympanoplasty needs to be precised.

Timpanoplastia secundaria contejido aerolar laxo y nutriciónsubdérmica / Secondary tympanoplasty with areolar tissue and subdermal nutrition

La timpanoplastia secundaria es un reto quirúrgico debido a que varios factores intervienen para obtener un resultado satisfactorio. Múltiples materiales han sido descritos para el cierre de las perforaciones timpánicas secundarias con tasas de éxito que oscilan en promedio del 93 por ciento. Los autores de este estudio describen una técnica quirúrgica que ha sido de gran utilidad en el Hospital Universitario del Valle, Cali, Colombia, para el cierre de perforaciones timpánicas secundarias con tejido areolar laxo. Este injerto posee una citoarquitectura ideal para integrarse al oído. Se reporta en esta serie una tasa de cierre de la perforación del 97 por ciento y una mejoría audiológica promedio de 21dB. Se considera que el mayor aporte vascular que se logra a través de la disección del ánulus posterior, colgajos meatales y timpánicos contribuyen de manera significativa a la viabilidad del injerto.

Secondary timpanoplasty is a surgical challenge since various factors contribute to obtain a satisfactory result. Multiples materials have been described for perforation closure in secondary timpanoplasty with a mean success rate around 93 percent. The authors describe a surgical technique that has proved to be of great help at the Hospital Universitario del Valle in Cali, Colombia with areolar tissue. The histological properties of areolar tissue makes it ideal for tympanic membrane repair. We report a closure rate of the 97 percent and a fair audiological results with a PTA less than 21 dB for the described series. The authors believe that a bigger blood supply that is achieved by posterior annulus dissection, meatal and timpanal flaps contribute significantly to the survival of the graft.

Timpanoplastia: evolução nas técnicas de reconstrução da cadeia ossicular / Tympanoplasty: Evolution of the Ossicular Reconstruction Techniques

A técnicas cirúrgicas da recuperação da audição na otite média crônica continuam em discussão. Os otologistas estão divididos quanto ao uso de material orgânico ou sintético na reconstrução da cadeia ossicular. Técnicas de interposição com material orgânico (ossículos, osso cortical ou cartilagem) e materiais combinados (osso e teflon) são apresentadas aqui. Os bancos de implantes otológicos desempenham a importante função de distribuição desses materiais.

The surgical techniques of hearing restoration in chronic otitis media are still in discussion. The otologists are divided conceming the use of organic or synthetic material. Interposition techniques with organic materials (ossicles, cortical bone or cartilage) and combined materials (bone and teflon) are presented here. An otological implant bank plays an important role in processing and distributing the materials.

[Simultaneous total ear reconstruction and hearing rehabilitation].

One hundred and fifty-eight patients with congenital microtia and atresia were treated with simultaneous total ear reconstruction and hearing rehabilitation including meatoplasty, tympanoplasty as well as fenestration. Using this operation, the authors have reconstructed 160 auricles and simultaneously restored their auditory function. After the operation, the hearing gain reached 20-45 dB in 132 cases (82.5%). The success rate of the reconstructed ear was 158/160 (98.2%). Most of the reconstructed ears were of excellent appearance.

Timpanoplastía con fascia temporal homóloga / Timpanoplasty with homologous temporal fascia

Se presenta 216 casos operados en un lapso de 10 años, considerándose edad preponderante, tamaño de la perforación taimpánica y ubicación de la misma, tipo de injerto utilizado durante el procedimiento quirúrgico para realizar comparaciones entre el auto y homoinjerto en relación a eliminación: mostrándosnos un comportamiento igual en ambos tipos 98.7 y 96.6 respectivamente. Los resultados anatómicos y funcionales comparativos utilizando estos dos tipos de injerto, tampoco muestran variaciones apreciables valoradas al mes, a los tres meses y a los cinco años, mereciendo nuestra confiabilidad, permitiéndonos no realizar discriminación para su utilización para las timpanoplastías. Nuestros resultados anatómicos y funcionales están muy cerca de los resultados que obtienen la mayoría de los cirujanos de oído, hecho que nos anima a seguir adelante con este método

[Prostheses of the PORP and TORP type constructed by our method]. / Protezki typu PORP i TORP wykonywane we wlasnym zakresie.

Authors have described their own method to prepare for prosthesis to reconstruction of transmissive system in tympanoplasty. Prosthesis PORP and TORP were prepared to use of simple apparatus from a polyethylene drain.

[Regenerative capacity of the tympanic mucosa following tympanoplasty (author's transl)]. / Reaktionsformen der Paukenschleimhaut am Beispiel ihrer chronischen Entzündung und Heilung nach Tympanoplastik.

From adult temporal bones with clinically normal ears mucous lining specimens were taken and investigated microscopically. Comparing these specimens with biopsies from the tympanon of patients following tympanoplasty, we could detect an over-all correspondence of epithelial and subepithelial cell structures of normal tympanic mucosa and of ears operated upon because of chronic inflammation. These findings suggest that the middle ear epithelium is an only partial developed mucociliar - and not an pluripotential - epithelium, arising by ingrowth of respiratory mucosa of the nasopharynx. It reacts upon every exogenic or endogenic irritation always in direction to complete differentiation. This differentiation is caused by stimulation of the O2-metabolism following such various proceedings as traumatisation, inflammation, otospongiosis activity, experimental tympanoplasty or explanation into tissue culture. The generally reversible process should not be defined as metaplasia.