Vein Graft Tympanoplasty: How a Transiently Used Graft Material Transformed Middle Ear Surgery.

The inception of medial grafting as a technique for tympanic membrane repair was a critical milestone in the history of otology. John Shea introduced the medial graft technique and the use of vein grafts for tympanoplasty in 1960 after realizing that the vein grafts that he used to repair the oval window after stapedectomy could also be utilized to repair tympanic membrane perforations. At the time, tympanoplasty often utilized skin grafts, which required placement of the graft lateral to the tympanic membrane annulus. Placement of the graft medial to the tympanic membrane annulus allowed for more efficient surgery and avoided the complications associated with lateral grafting, such as blunting and lateralization. The introduction of vein grafts in tympanoplasty prompted a fundamental shift in technique from lateral to medial grafting, paving the way for decades of innovation in tympanoplasty.

Rate of chronic otitis media operations and cholesteatoma surgeries in South Korea: a nationwide population-based study (2006-2018).

The aim of this study was to estimate the total number and rate of chronic otitis media (COM) operations and cholesteatoma surgeries in South Korea, using a nationwide survey which analysed a 13-year trend (2006-2018). This study also analysed the trend of COM operations and cholesteatoma surgeries according to year, sex, and age using a nationwide population-based database, and the 13-year trend was analysed according to age groups. This study used nationwide data from the National Health Information Database (NHID), which is a government-affiliated agency under the Korean Ministry of Health and Welfare that supervises all medical activities in Korea. Retrospective medical data of patients of all ages were extracted from the NHID from January 2006 to December 2018 (NHIS-2018). This study was conducted by the Research Committee of the Korean Society of Otorhinolaryngology-Head and Neck Surgery, and the Korean Audiological Society reviewed and confirmed the study. There was a 1.5 fold increase in COM operation rates in 2018, compared to 2007 figures. The annual total number of COM operations was 5,935 in 2007, 8,999 in 2012 (peak), and 8,870 in 2018 (17 in 100,000). Meanwhile, the total annual number of cholesteatoma surgeries decreased from 3,502 in 2006 to 3,199 in 2018 (6 in 100,000). The rate of COM operations was higher (1.27 fold) in the female population than in the males in 2018. However, cholesteatoma surgery rates were higher (1.2 fold) in the male population than in the females in 2018. According to the 2018 data, COM operations were most commonly performed in patients in their 50s. COM operation rates increased rapidly in patients aged 51-80. In other age groups however, rates were constant or showed a decrease in figures, especially in the 40s age group (1st rank in 2006 to 3rd rank in 2018). According to the 2018 data, cholesteatoma surgery was most commonly performed in patients in their 50s. Cholesteatoma surgery rates increased dramatically from 2006 to 2018 in patients aged 0-10 years due to congenital cholesteatoma. Cholesteatoma surgery rates also increased in patients aged 61-80 years due to ageing population. Cholesteatoma surgery rates decreased in patients aged 41-50 years, ranking 1st in 2006 and 4th in 2018. In conclusion, the annual rate of COM operations was 0.017%, and no longer increases, but stabilizes/decreased after a peak point in the advanced country. The mean rate of cholesteatoma surgery was 0.006%, and decreased annually. There was female dominance in COM operations, but male dominance in cholesteatoma surgery. Major age groups of patients who underwent COM/cholesteatoma surgery were the 50s and 60s, and congenital cholesteatoma (0-10 years) accounted for about 20% of all cholesteatoma surgery.

Day-surgery in otology: Impact study of a dedicated organizational model.

AIM: Day surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in "major otology" cases in a hospital center after launching a dedicated ENT DS unit. MATERIAL AND METHODS: This new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded. RESULTS: Between the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%). CONCLUSION: Major otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons' growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.

[Tympanoplasty - News And New Perspectives]. / Tympanoplastik ­ Neues und neu Beleuchtetes.

Techniques and biomaterials for reconstructive middle ear surgery are under steady, ongoing development. At the same time, clinical post-surgery results are evaluated to determine success or failure of the therapy. Routine quality assessment and assurance is of growing importance in the medical field, and therefore also in middle ear surgery. The exact definition and acquisition of outcome parameters is essential for both a comprehensive and detailed quality assurance. These parameters are not the audiological results alone, but also additional individual parameters which influence the postoperative outcome after tympanoplasty. Selection of patients and the preoperative clinical situation, the extent of the ossicular chain destruction, the chosen reconstruction technique and material, the audiometric frequency selection and the observational interval are only some of them. If these parameters are not well documented comparative analyses between different studies are of limited value. The present overview aims to describe, compare and evaluate some of the existing assessment and scoring systems for middle ear surgery. Additionally, new methods for an intraoperative quality assessment in ossiculoplasty and the postoperative evaluation of suboptimal hearing results with imaging techniques are available. In the area of implant development functional elements were integrated in prostheses to enable not only good sound transmission but also compensation of occurring atmospheric pressure changes. In combination with other components for ossicular repair they can be used in a modular manner which, so far show experimentally and clinically promising results.

Tympanoplasty: an up-to-date pictorial review.

The indications for tympanoplasty are mainly chronic ear pathologies, such as cholesteatoma, atelectasis and chronic tympanosclerotic otitis. Usually, modification of the mastoid and temporal tissues in general mostly involves bone work, which means bone removal by burs or appropriate bone curettes. It is for this reason that, in both the pre- and postoperative periods, the computed tomography (CT) scan is the primary radiological tool for studying the middle-ear, and temporal bone structures and pathologies. The aim of this review is to illustrate the most up-to-date postoperative results for tympanoplasty, including the emerging endoscopic techniques. The present work focuses on the five types of tympanoplasty that are likely to be encountered by the radiologist: radical surgery; open tympanoplasty; closed tympanoplasty; closed endoscopic tympanoplasty; and open endoscopic tympanoplasty. Understanding and interpreting temporal bone images in relation to the different types of surgery are important, especially at the postoperative stage, because of the high risk of recurrence of middle-ear pathologies, and a good working knowledge of surgical changes is fundamental for distinguishing iatrogenic bone demolition from complications and new pathological foci.

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.

Yatrogenia tímpano-osicular en la cirugía del oído / Tympano-ossicular iatrogeny in ear surgery

En toda cirugía que se realice puede ocurrir la yatrogenia incluso en las manos más expertas.Las lesiones en la cirugía del oído pueden afectar al oído interno, nervio facial, etc., nosotros en este artículo no vamos a referir únicamente a las posibles lesiones que pueden aparecer tanto en la membrana timpánica como en la cadena osicular durante la cirugía del oído. Expondremos algunos mecanismos por los que se pueden producir y posibilidades de reparación (AU)

Current status and future challenges of tympanoplasty.

Four decades after the introduction of tympanoplasty, the goal of achieving stable and long-term hearing improvement after tympanoplasty surgery for chronic otitis media continues to be elusive. In this review, we focus on the current status of our understanding of the mechanics and pathology of the middle ear after tympanoplasty surgery. We also analyze some problems and challenges faced by clinicians and basic scientists in the quest for improved postoperative hearing results.

Mastoidectomía de técnica cerrada: revisión de 5 años / Intact canal mastoidectomy: a five year review

Se realizo un estudio retrospectivo en 50 pacientes sometidos a mastoidectomía con técnica cerrada durante el período comprendido de 1986 a 1990. 62 por ciento de los pacientes obtuvieron buenos resultados; no satisfactorios predominaron en el grupo de escolares.

[Our current criteria in tympanoplasty surgery]. / Nuestro criterio actual en la cirugía de las timpanoplastias.

The choice of surgical techniques has gone through a great evolution during the last few years in our service. Closed techniques were formally used in 80 per 100 of our operations (1974-1979) and now this has dropped to 12.5 per 100 (1979-1983) motivated by the failures we obtained with the closed techniques. This is similar to the observations of other services. We have determined the causes of failure to be related to: difficulties in dominating the surgical field, treatment of the cavity, or reconstruction of the walls. We present the antro-exclusion attic elimination on demand (A.A.D) technique which is designed to resolve not only the elimination of the lesion, but also the cavity problem. We have also evaluated the possibility of reconstructing the mastoid and pneumatic cavities connected to the tympanic case.

The changing nature of otological practice in a teaching centre.

The impression that otologic surgical practice is a declining segment of the specialty of otolaryngology is widespread. In an attempt to assess objectively the validity of that assumption, the authors reviewed their own experience over the 12 years 1971-82 inclusive. Five representative years out of the 12 were examined--1971, 1974, 1977, 1979, and 1982. In each of these years, the relative and absolute frequency with which six common otological procedures were performed was determined. The procedures selected for study included myringoplasty, tympanoplasty Type I, II, III and IV, and stapedectomy. In addition the relative frequency of primary vs. revision operations was assessed. The data indicate a change in the pattern of otologic surgical practice over the period, most noticeably in the ratio of primary to revision procedures. These changes have significant implications for the teaching and practice of otology in the future.

A decade of tympanoplasty: progress or regress?

The surgery of chronic ear disease has continued to be a popular topic during the seventies. The literature for this period has been collected and organized by both surgical topics and disease topics. The changes in technique, particularly for ossiculoplasty, are discussed in the light of the author's experiences. The surgical approaches to a particular disease process are likewise reviewed. Changes in surgical philosophy are discussed both for particular authors as well as for the overall trends.