Evaluation of inner ear damage by mastoid drilling with measurement of serum prestin (SLC26A5) levels.

OBJECTIVE: The objective of this study is to demonstrate any inner ear injury caused by drilling in mastoid surgery with prestin, outer hair cell motor protein specific to the cochlea. METHODS: The patients with chronic otitis media requiring mastoidectomy (n = 21) and myringoplasty (n = 21) were included. Serum prestin level obtained from blood samples was measured before surgery and on postoperative days 0, 3, and 7 using Human Prestin (SLC26A5) ELISA Kit. All patients underwent the Pure Tone Audiometry (PTA) test before surgery and on the postoperative 7th day. The drilling time was also recorded for all patients who underwent mastoidectomy. RESULTS: In both mastoidectomy and myringoplasty groups, the postoperative serum prestin levels increased on days 0 and 7 (pday-0 = 0.002, pday-7 = 0.001 and pday-0 = 0.005, pday-7 = 0.001, respectively). There was no significant difference in the serum prestin levels between the two groups, postoperatively. The PTA thresholds at day 7 did not change in either group. A significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. There was no correlation between the drilling time and the increase of prestin levels in the postoperative day 0, 3, and 7. CONCLUSION: Our results showed that mastoid drilling is not related to a significant inner ear injury. Although the myringoplasty group was not exposed to drill trauma, there was a similar increase in serum prestin levels as the mastoidectomy group. Also, a significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. These findings suggest that suction and ossicular manipulation trauma can lead to an increase in serum prestin levels and postoperative temporary or permanent SNHL at 2000 and 4000 Hz. LEVEL OF EVIDENCE: Level-4.

Endoscopic type 1 tympanoplasty; a composite graft technique for subtotal and total perforations.

OBJECTIVE: Demonstrate feasibility of performing endoscopic transcanal type 1 tympanoplasty in total and subtotal perforations, using an underlay technique that minimizes the risk of anterior medialization of the graft. Compare audiometric and clinical outcomes of this technique with our series of endoscopic tympanoplasty with classical underlay grafts, and with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty and other transcanal techniques. METHODS: We describe a surgical technique using an L-shaped cartilage and its perichondrium, with exclusive transcanal endoscopic approach. A retrospective review of patients undergoing this technique at the Centenario University Hospital of Rosario, Argentina between January 2017 and December 2019 was performed, and it was compared with a group of patients who underwent endoscopic tympanoplasty with classical underlay technique in a previous period of time. Patients with smaller perforations and other middle ear pathologies that required other techniques were not included in this study. Minimum follow up was 6 months. The main outcome measures were membrane closure rates and hearing results. RESULTS: 73 patients with total or subtotal perforations undergoing endoscopic transcanal tympanoplasty between 2015 and 2019 were included. The group of patients that underwent the technique described showed no anterior medialization of the graft, and better graft take rates. The hearing outcomes were similar in all successful graft patients, with postoperative average air-bone gap of 10db (+ - 10 dB). CONCLUSION: Transcanal endoscopic tympanoplasty with the technique described is an excellent option for closure of total and subtotal tympanic perforations. The rate of perforation closure is better than endoscopic tympanoplasty with classical underlay graft with similar audiometric outcome.

Use of nasal mucosa graft in tympanoplasty.

INTRODUCTION: Tympanoplasty techniques with different types of graft have been used to close tympanic perforations since the 19th century. Tragal cartilage and temporalis fascia are the most frequently used types of graft. They lead to similar functional and morphological results in most cases. Although little published evidence is present, nasal mucosa has also been shown to be a good alternative graft. OBJECTIVE: Surgical and audiological outcomes at the six-month follow-up in type I tympanoplasty using nasal mucosa and temporalis fascia grafts were analyzed. METHODS: A total of 40 candidates for type I tympanoplasty were randomly selected and divided into the nasal mucosa and temporalis fascia graft groups with 20 in each group. The assessed parameters included surgical success; the rate of complete closure of tympanic perforation and hearing results; the difference between post- and pre-operative mean quadritonal airway-bone gap, six months after surgery. RESULTS: Complete closure of the tympanic perforation was achieved in 17 of 20 patients in both groups. The mean quadritonal airway-bone gap closures were11.9 and 11.1 dB for the nasal mucosa and temporalis fascia groups, respectively. There was no statistically significant difference between the groups. CONCLUSION: The nasal mucosa graft can be considered similar to the temporal fascia when considering the surgical success rate of graft acceptance and ultimate audiological gain.

Comparação da abordagem endoscópica transcanal e microscópica na timpanoplastia tipo 1

Resumo Introdução: A timpanoplastia endoscópica é uma cirurgia minimamente invasiva que pode ser feita através de uma abordagem exclusivamente transcanal. O uso de endoscópios em procedimentos otológicos tem aumentado no mundo todo. A abordagem endoscópica facilita a timpanoplastia transcanal mesmo em pacientes com canal auditivo externo estreito e com uma protrusão da parede anterior. Objetivos: O presente estudo teve como objetivo comparar os resultados cirúrgicos e audiológicos das abordagens endoscópica transcanal e microscópica convencional na timpanoplastia tipo 1. Método: As taxas de sucesso do enxerto, os resultados auditivos, as complicações e a duração da cirurgia em pacientes submetidos a timpanoplastia endoscópica e microscópica entre outubro de 2015 e abril de 2018 foram analisados retrospectivamente. Resultados: As taxas de sucesso do enxerto foram de 94,8% e 92,9% para o grupo endoscópico e microscópico, respectivamente (p > 0,05). Os valores de gap aéreo-ósseo no pós-operatório melhoraram significantemente em ambos os grupos (p < 0,001). A duração média da cirurgia foi significantemente menor no grupo endoscópico (média de 34,9 minutos) em relação ao grupo microscópico (média de 52,7 minutos) (p < 0,05). O tempo médio de internação foi de 5,2 horas (variação de 3-6 horas) no grupo operado por endoscopia e de 26,1 horas (variação de 18-36 horas) no operado por microscopia (p < 0,05). Conclusão: A timpanoplastia transcanal via endoscópica é uma opção razoável à timpanoplastia microscópica convencional no tratamento da otite média crônica, com taxas de sucesso de enxertos e resultados auditivos comparáveis à microscópica.

Learning curve for endoscopic tympanoplasty type I: comparison of endoscopic-native and microscopically-trained surgeons.

PURPOSE: Type I tympanoplasty is one of the first operations to be performed by ear surgeons in training and is increasingly performed using the endoscopic technique. The aim of the present study is to assess and compare the learning curve for type I tympanoplasties between a microscopically trained and endoscopic native ear surgeon. We hypothesize comparable learning curves between the two surgeons regardless of previous microscopic experience. METHODS: Retrospective analysis and comparison of the 25 first consecutive cases of type I tympanoplasty performed by a microscopically trained ear surgeon (MTES) and a native endoscopic ear surgeon (NEES). RESULTS: Mean duration of surgery in MTES and NEES groups was 54 ± 12.3 min and 55.6 ± 17.5 min, respectively. Both surgeons achieved a reduction of the surgery duration over time with statistically significant reduction from the first five cases to the last five cases in both groups. Graft intake rate was 92% after 3 months. Preoperative and postoperative PTA revealed a mean improvement of air bone gap (ABG) of 11.5 ± 7.1 dB HL in MTES group versus 9.3 ± 8.5 dB HL in NEES group, whereby the difference between the two groups was not statistically significant. CONCLUSION: Endoscopic type I tympanoplasty shows comparable results and learning curves in two beginning endoscopic ear surgeons independent of the previous microscopic experience. We recommend if available the parallel learning of both techniques.

Comparison of endoscopic transcanal and microscopic approach in Type 1 tympanoplasty.

INTRODUCTION: Endoscopic tympanoplasty is a minimally invasive surgery that may be performed via a solely transcanal approach. The use of endoscopes in otologic procedures has been increasing worldwide. The endoscopic approach facilitates the transcanal tympanoplasty, even in patients having the narrow external ear canal with an anterior wall protrusion. OBJECTIVES: The present study aimed to compare the surgical and audiological outcomes of endoscopic transcanal and conventional microscopic approach in Type 1 tympanoplasty. METHODS: The graft success rates, hearing outcomes, complications, and duration of surgery in patients who underwent endoscopic and microscopic tympanoplasty between October 2015 and April 2018 were retrospectively analysed. RESULTS: Graft success rates were 94.8 per cent and 92.9 per cent for the endoscopic and microscopic group, respectively (p >  0.05). Postoperative air-bone gap values were improved significantly in both groups (p <  0.001). The average duration of surgery was significantly shorter in the endoscopic group (mean 34.9 min) relative to the microscopic group (mean 52.7 min) (p <  0.05). The average hospitalization period was 5.2 h (range 3-6 h) in Group I whereas it was 26.1 h (range 18-36 h) in Group II (p <  0.05). CONCLUSION: The endoscopic transcanal tympanoplasty approach is a reasonable alternative to conventional microscopic tympanoplasty in the treatment of chronic otitis media, with comparable graft success rates and hearing outcomes.

Resultados quirúrgicos de la timpanoplastia tipo I durante los años 2014 al 2019, en el Hospital Universitario Clínica San Rafael de Bogotá / Surgical results of type I tympanoplasty during 2014 to 2019, at Hospital Universitario Clínica San Rafael, Bogotá

Introducción: Las perforaciones timpánicas son una patología otológica frecuente tanto en población adulta como pediátrica. El daño hacia la membrana timpánica puede ser ocasionada por diversos factores como explosiones, traumas penetrantes, barotraumas e infecciones. Los síntomas más comunes incluyen el tinnitus, plenitud aural e hipoacusia. En los casos en los que es necesario realizar un tratamiento quirúrgico se opta por las timpanoplastias. El objetivo de este estudio es determinar la efectividad del cierre anatómico a través de esta técnica. Adicionalmente, identificar las comorbilidades asociadas, las causas por la que se decide realizar el procedimiento quirúrgico y las características sociodemográficas de la población intervenida. Objetivo general: Determinar la frecuencia de las reperforaciones timpánicas postoperatorias a los tres y seis meses, que fueron sometidos a timpanoplastia tipo I en el Hospital Universitario Clínica San Rafael de Bogotá, Colombia., durante los años 2014 al 2019. Materiales y métodos: estudio de tipo retrospectivo, descriptivo y de corte transversal, donde se incluyeron pacientes adultos y pediátricos del servicio de otorrinolaringología del Hospital Universitario Clínica San Rafael de Bogotá, Colombia, con antecedente de perforaciones timpánicas durante los años 2014 al 2019 y que fueron intervenidos con timpanoplastia tipo I. Se evaluaron resultados postquirúrgicos, principalmente las perforaciones posteriores a la cirugía con técnica medial "over-under" utilizando injerto de cartílago de concha y fascia temporal. Resultados: Se intervinieron 47 pacientes. 62% fueron de sexo femenino y 38% de sexo masculino. Se evidenció reperforación posoperatoria en 8.5% del total de la muestra. Ninguno antes de tres meses, 1 paciente entre 3 y 6 meses y 3 pacientes después de 6 meses posoperatorios. La causa más frecuente de la timpanoplastia tipo I fue la infecciosa, (66%). La comorbilidad asociada más frecuentemente a las perforaciones fue la otitis media crónica (OMC), en el 51%. Las audiometrías mostraron una mejoría del 17% y del 20% entre el PTA preoperatorio y posoperatorio, en el oído derecho y en el oído izquierdo, respectivamente. Conclusiones: La timpanoplastia tipo I con técnica over under se considera exitosa para el cierre anatómico de las perforaciones timpánicas, evaluado a los tres y seis meses posoperatorios, con porcentajes que se igualan a los reportados en estudios similares en la literatura. Los resultados audiométricos no mostraron una mejoría estadísticamente significativa en ambos oídos por lo cual se deben continuar realizando estudios para evaluar otros factores asociados a las perforaciones como otitis media crónica y colesteatoma, entre otros.

Introduction Tympanic perforations are a frequent otological pathology in both adult and pediatric populations. Damage to the tympanic membrane can be caused by various factors such as explosions, penetrating trauma, barotraumas, and infections. The most common symptoms include tinnitus, aural fullness, and hearing loss. In cases where surgical treatment is necessary, tympanoplasties are chosen. The objective of this study is to determine the effectiveness of anatomical closure through this technique. Additionally, to identify the associated comorbidities, the causes for which the surgical procedure was decided to be performed, and the sociodemographic characteristics of the intervened population. Main objective: to determine the frequency of postoperative tympanic perforations early (three months) and late (six months), in patients who underwent type I tympanoplasty in the ENT department of the San Rafael Clinical University Hospital in Bogotá, Colombia, during the years 2014 to 2019. Materials and methods: a retrospective, descriptive and cross-sectional study, that included adult and pediatric patients of the otolaryngology service of the San Rafael Clinical University Hospital of Bogotá, Colombia, with a history of tympanic perforations during the years 2014 to 2019 and who were operated with type I tympanoplasty were evaluated. Post-surgical results were evaluated. mainly the post-surgery perforations with "over-under" medial technique using ear cartilage graft and temporal fascia. Results: 47 patients were included in the study, of which 62% were female and 91% were older than 7 years. The percentage of reperforation was 8.5%, that is, 4 of 47 patients, and at 12.8 months on average. The most frequent cause of tympanic perforation was infectious with 66% and medium size 55.3%. The most frequent otolaryngological comorbidity was chronic otitis media with 51%. The audiological results showed a gain of 17% in the right ear and 20% in the left ear. Conclusions: Type I tympanoplasty with over under technique is considered successful for the anatomical closure of the tympanic perforations, evaluated at 3 and 6 months postoperatively, with percentages that are equal to those reported in similar studies in the literature. The audiometric results did not show a statistically significant improvement in both ears, so studies should continue to evaluate other factors associated with perforations such as chronic otitis media and cholesteatoma, among others.

Total Endoscopic Transcanal Cartilage Myringoplasty: A Prospective Study

Introduction: Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Objectives: The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results. Methods: This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months. Results: During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% ( n = 123) of the patients 6 months after the intervention. Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively. Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant ( p < 0.001). Conclusion: The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes (AU)

Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with plateletrich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which plateletrich fibrin was used. The postoperative infection rate was also lower in the same group. (AU)

Periosteal Graft Myringoplasty: Our Experience

Abstract Introduction Different types of autologous graft materials are used for myringoplasty, with the temporalis fascia and cartilage being the most frequently used tissues. Periosteal tissue has been used for a long time in our department, and many advantages support its use in myringoplasty. To the best of our knowledge, this issue is scarcely discussed in the previously published literature. Objective To present our experience with periosteal graft myringoplasty, describing the technique and the anatomical and functional outcomes. Methods A prospective clinical study involving 88 patients (72 females and 16 males) with a mean age 26.9 years. The patients underwent myringoplasty using the mastoid cortex periosteum; they were all operated using the postauricular approach, and the graft was applied using the underlay technique. The patients performed pre- and postoperative pure tone audiometry for tested frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). All patients were followed-up for at least 12 months after the operation. Results The anatomical success rate among all patients was of 93%, which is comparable to the rate of success in procedures using other usual grafting materials. In addition, there was a highly significant postoperative improvement in pure tone audiometry results as compared with the preoperative ones (the main hearing gain was of ∼ 11 dB; p< 0.001). Conclusion The periosteal graft is easily harvested, easy to apply, with excellent anatomical and functional success.

[Cartilage island versus temporalis fascia in high-risk tympanic perforation]. / Cartílago en isla frente a fascia temporal en la perforación de membrana timpánica de alto riesgo.

BACKGROUND: The tympanoplasty for high-risk tympanic membrane perforation is a challenge. It is necessary to compare the most useful and feasible surgical technics in our environment for these patients. The objective was to compare the cartilage island tympanoplasty for the treatment of high-risk tympanic membrane perforations versus the use of temporalis fascia. METHODS: Randomized controlled clinical trial in 69 patients of ten years or older, diagnosed with high-risk tympanic membrane perforation in a third level hospital. The MERI index was determined and an initial audiometry was obtained. 7, 30 and 60 days after the tympanoplasty the tympanic graft integrity was evaluated. The audiometry was only repeated at 60 days. RESULTS: 69 patients were included, 33 received cartilage island (group 1) and 36 temporalis fascia (group 2). 93.9% was the success rate for group 1 at 30 and 60 days and 83.3% for group 2 (p = 0.17). Hearing improvement was neither different between groups (33.1 vs. 33.6 dB; p = 0.88), for group 1 and 2, respectively. CONCLUSION: No difference in morphological and audiological outcomes using cartilage island tympanoplasty or temporalis fascia for the treatment of high-risk tympanic membrane perforation was found.

Introducción: la timpanoplastía para la perforación timpánica de alto riesgo es un reto. Es necesario comparar las técnicas más útiles y factibles en nuestro medio para estos pacientes. El objetivo fue comparar la timpanoplastía con cartílago en isla para tratamiento de perforación de membrana timpánica de alto riesgo frente al uso de fascia temporal. Métodos: ensayo clínico aleatorizado y controlado en 69 pacientes mayores de 10 años, con perforación timpánica de alto riesgo en un hospital de tercer nivel. Se estadificó el índice MERI (Middle Ear Risk Index) y se realizó audiometría inicial. A los 7, 30 y 60 días postoperatorios se valoró integración del injerto. La audiometría se repitió solo a los 60 días. Resultados: de los 69 pacientes, 33 recibieron cartílago en isla (grupo 1) y 36 fascia temporal (grupo 2). La tasa de éxito en el grupo 1 fue de 93.9% a los 30 y 60 días y de 83.3% en el grupo 2 (p = 0.17). Tampoco fue diferente la ganancia auditiva entre los grupos: 33.1 frente a 33.6 dB, en los grupos 1 y 2, respectivamente (p = 0.88). Conclusión: no hay diferencia en los resultados morfológicos y audiométricos con timpanoplastía con cartílago en isla frente a fascia temporal en el tratamiento de perforaciones timpánicas de alto riesgo.

Improved tympanic membrane regeneration after myringoplastic surgery using an artificial biograft.

Tympanic membrane perforations are due to common otologic problems. The current treatments to heal tympanic membrane perforation, such as myringoplasty, have some disadvantages, including the need for autologous grafting, which is rapidly absorbed by the organism before perforation recovery is complete. To improve the structural and functional tympanic membrane healing after surgery, we propose a new branch of artificial grafts. In this study, we report the development of artificial grafts using electrospun bioabsorbable polymers. Polymers such as poly (l-lactic acid) and poly (lactic-co-glycolic acid) acted as the scaffold for cell growth in a co-culture of fibroblasts and keratinocytes. This co-culture promoted the growth of an epithelial-equivalent tissue over the electrospun scaffold, which was used as an alternative graft in myringoplasty. The in vivo study was performed in Sprague Dawley rats. Ear endoscopy was performed 30days after surgery and showed that tympanic membrane perforations treated with artificial grafts healed naturally, completely and with the possibility of maintaining their actual functionality. In conclusion, our study described a new artificial graft created specifically to fulfill the requirements of perforated tympanic membrane healing processes, which are compatibility, proper durability and less intense side effects following myringoplasty.

Beneficios del abordaje endoscópico en miringoplastias / Endoscopic approach benefits in myringoplasties / Benefícios da abordagem endoscópica em miringoplastias

Introducción: la fisiopatología de las otitis medias crónicas simples está en estrecha relación con las rutas de ventilación del sistema tubo tímpano mastoideo, el cual tiene diversos estrechamientos o istmos que son suceptibles de presentar bloqueos de múltiples causas; por lo tanto es necesario que durante la resolución quirúrgica de esta patología se realice sistemáticamente la revisión de dichas rutas de ventilación. Objetivo: Demostrar los beneficios de la cirugía endoscópica de oído en la realización de miringoplastias. Material y métodos: Estudio descriptivo multicéntrico. Revisión de historias clínicas. Resultados: Se realizaron 54 miringoplastias mediante abordaje endoscópico transcanal con la correspondiente exploración de rutas de ventilación. Se evidenciaron 7,4% de casos con bloqueos en los diferentes diafragmas epitimpánicos. El porcentaje de reperforaciones fue del 9,25%. Conclusiones: Si bien la técnica de posicionamiento del injerto es similar a la utilizada tradicionalmente, en el presente estudio se evidenció un leve incremento del índice de reperforaciones a expensas del uso de pericondrio. El uso de técnica endoscópica en miringoplastia presenta una tasa de reperforación comparable a la de la biblografía actual, por lo tanto el principal beneficio sería la detección de bloqueos en las rutas de ventilación del oído medio.

Introduction: the pathophysiology of chronic otitis media simple is closely related with routes of ventilation of the tube tympanum mastoid system, which has several constrictions or istmus that are susceptible to have obstructions of multiple causes, therefore it is necessary that during the surgical resolution of this pathology the review of ventilation routes are systematically performed. Objective: To demonstrate the benefits of endoscopic ear surgery in the performance of myringoplasty. Material and methods: Multi-centre descriptive study, clinical histories review. Results: 54 cases of myringoplasty were performed using a transcanal endoscopic approach with ventilation routes exploration. 7,4% of cases presented blocks in the different epytimpanic diaphragms and the reperforation cases represented 9,25%. Conclusions: Although the technique of positioning the graft is the same as that traditionally used, in the present study there was a slight increase in the index of reperforation at the expense of perichondrium use. The use of endoscopic technique in myringoplasty has an index of reperforation comparable to the current bibliography. Therefore the main benefit would be the detection of blockages in the routes of ventilation in the middle ear.

Introdução: a fisiopatologia da otite média crônica simple esta estreitamente em relação com o sistema de ventilação mastóide tímpanico , que tem várias constrições ou istmos que são suscetíveis de apresentar fechaduras de múltiplas causas , portanto, é necessário que, durante a resolução cirúrgica desta patología a revisão das vias de ventilação seja realizada de forma sistemática. Objectivo: Demostrar os benefícios da cirurgia endoscópica na realização de miringoplastias. Material e métodos: Estudo descritivo multicenter, revisão de prontuários médicos. Resultados: 58 miringoplastias foram realizadas utilizando a abordagem endoscópica trasncanal com a correspondente exploração de rutas de ventilação. Em 7,4 % dos casos com bloqueios em os diferentes diafragmas epitimpánicos e o percentual de reperforaçoes foi de 9,25%. Conclusões: Enquanto a técnica de posicionamento de enxerto e semelhante aquela usada tradicionalmente, no presente estudo a um ligeiro aumento no índice de reperforaçoes a custa de usar pericondrio. A utilização da técnica endoscópica em miringoplastias tem una taxa de reperforação comparável com a bibliografia corrente, por conseguinte a principal vantagem seria a de detectar bloqueios nas rutas de ventilação do ouvido medio.

Decision making in patients with natural myringostapediopexy: A study of the contralateral ear.

Naturally occurring myringostapediopexy frequently results in minimal hearing loss and is asymptomatic. Management decisions in such ears, however, often hinge on an appraisal of evolution toward cholesteatoma. The study of the contralateral ear has been used by our research team to infer the progression of chronic otitis media. This cross-sectional, comparative study describes the clinical findings of the contralateral ear in a series of patients with myringostapediopexy. This study included a historical and current sample of 46 patients divided into a pediatric (≤18 years) and an adult group. Patient distribution according to sex was similar (52.2% male), and 56.5% were adults. Mean conductive hearing loss ranged from 14.1 to 21.2 dB in ears with myringostapediopexy and from 16.0 to 26.6 dB in the contralateral ears according to the frequency assessed. The contralateral ear was normal in only 19.6% of the cases of myringostapediopexy. Central tympanic membrane perforation was found in 6.5% of the cases; perforation-retraction, in 17.4%; moderate or severe retraction, in 28.3%; and cholesteatoma, in 28.3%. The prevalence of cholesteatoma in the contralateral ear in the pediatric and adult groups was not significantly different (p = 0.5; χ(2) test). The presence of significant abnormalities, particularly cholesteatoma, in the contralateral ears suggests a probable unfavorable progression in cases of myringostapediopexy and may influence management decisions.