Butterfly myringoplasty for total, subtotal, and annular perforations.

OBJECTIVES/HYPOTHESIS: The inlay "butterfly" cartilage tympanoplasty was first described as a treatment for small, central ear drum perforations. This technique can also be applied in large, marginal perforations, whereas the cartilage graft is anchored on the bony annulus. The aim of this study was to present the technique, to evaluate the results of butterfly tympanoplasty in marginal perforations, and to compare with the results of butterfly tympanoplasty in patients with nonmarginal perforations. STUDY DESIGN: Retrospective case series. METHODS: The files of patients who underwent inlay butterfly cartilage tympanoplasty for subtotal and total perforations from May 2011 to May 2013 were reviewed. Patients were followed with otoscopy and audiometry, and their results were compared with those of patients who underwent butterfly tympanoplasty for nonmarginal perforations. RESULTS: Forty-eight patients underwent butterfly tympanoplasty for subtotal and total perforations during the study period. Exclusion criteria included: active inflammation during the 3 months prior to surgery, cholesteatoma, lack of follow-up, incomplete data, ossicular chain anomaly/discontinuity, and significant sensorineural hearing loss (average bone-conduction threshold at 500,1000 and 2,000 Hz poorer than 20 dB). Thirty-three patients were included. The mean age at surgery was 34 years (range, 19-76 years); 17 patients (51%) were male. Four patients were treated previously by tympanoplasty (revision surgery), whereas the other 29 had primary surgery. None of the patients had intraoperative or immediate postoperative complications such as sensorineural hearing loss on the operated ear or facial nerve palsy. One month after surgery, two patients had a residual perforation (94% success rate), and the mean speech recognition threshold (SRT) improved from 38 dB to 24 dB. The pure tone audiogram improved from 37.7 dB to 10.6 dB, and the word recognition score improved from 97.7 to 99.75. These results are comparable with our results in nonmarginal perforations, whereas a 92% success rate and a postoperative SRT of 26 dB were achieved in a cohort of 42 patients. CONCLUSIONS: Inlay butterfly cartilage tympanoplasty is safe and effective in patients with total or subtotal perforations, and the results are comparable to those seen in nonmarginal perforations. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2565-2568, 2016.

Transarterial embolization for acute head and neck bleeding: eight-year experience with emphasis on rebleeding risk in cancer patients.

OBJECTIVES/HYPOTHESIS: To present our 8-year experience with transarterial embolization for head and neck bleeding, with an emphasis on the need for repeated procedures in patients treated for head and neck cancer. STUDY DESIGN: Retrospective case series. METHODS: Tertiary university-affiliated medical center. The cohort included 49 patients who underwent transarterial embolization for acute head and neck bleeding in 2004 to 2012. Outcome measures included procedural success, recurrence, complications, and outcome. RESULTS: Mean patient age was 60.3 years. Indications for transarterial embolization were bleeding from a tumor (42%), nasal bleeding (36%), bleeding related to neck trauma (8%), tracheal stomal bleeding (8%), and other (4%). Twelve of 21 patients with tumors had been treated by chemoradiation. At least one repeated procedure was required in 11 patients, of whom nine had a history of chemoradiation and surgery for cancer; four of them required a stent for exclusion of pseudoaneurysm, and in six the recurrence presented late after the initial procedure (1 month to 5 years). Major complications included cerebrovascular accident in one patient and death due to major bleeding in two cases. Twenty-one patients died during follow-up, including nine patients with cancer. Eleven deaths occurred up to 4 years after embolization. CONCLUSIONS: Transarterial embolization is an important tool for the control of head and neck bleeding. Special attention should be given to patients after chemoradiation for cancer. Every effort should be made to control the bleeding because some patients may gain a reasonable lifespan and improved quality of life. LEVEL OF EVIDENCE: 4.