Endoscopic tympanoplasty with inlay cartilage graft in an university hospital / Timpanoplastia endoscópica com enxerto de cartilagem inlay em hospital universitário

Abstract Introduction Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.

Resumo Introdução Timpanoplastia é o procedimento cirúrgico voltado para a reconstrução da membrana timpânica e restauração do mecanismo condutor do som. Pode ser executada através de diversos tipos de acesso e de enxertos e é considerada bem-sucedida quando obtém fechamento completo da perfuração timpânica e melhoria na condução sonora. Objetivo Descrever a prevalência de sucesso no fechamento completo das perfurações timpânicas e os resultados auditivos das timpanoplastias endoscópicas com enxerto de cartilagem de tragus inlay. Metodologia Estudo retrospectivo desenvolvido em hospital terciário de referência. Pacientes com perfurações timpânicas centrais e com cadeias ossiculares íntegras submetidos a timpanoplastias endoscópicas com enxerto de cartilagem de tragus inlay foram incluídos. Foram avaliados o índice de integridade do neotímpano e os parâmetros auditivos pré e pós-operatórios foram comparados com o teste t de Student pareado. Resultados Foram identificadas 83 timpanoplastias endoscópicas com cartilagem inlay, 63 (76%) obtiveram neotímpano íntegro e 20 (24%), perfurações residuais. O gap aéreo-ósseo pré-operatório foi, em média, 18 ± 8,9 dBNA e o pós-operatório 11 ± 10 dBNA (p = 0,0005), sofreu redução em 71% e recuperação completa em 27%. O SRT pré-operatório médio foi 35 ± 13,5 e o pós-operatório 27 ± 14,4 (p = 0,0002). A média tritonal pré-operatória foi 34 ± 14,3 e a pós-operatória 24 ± 15 (p = 0,0002). Conclusão Nesta casuística, as timpanoplastias endoscópicas com cartilagem de tragus inlay apresentaram fechamento completo da perfuração timpânica em 76% dos casos, com melhoria significativa dos parâmetros auditivos.

Endoscopic tympanoplasty with inlay cartilage graft in an university hospital.

INTRODUCTION: Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. OBJECTIVE: To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. METHODS: Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. RESULTS: We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ±â€¯8.9 dBHL, and the postoperative 11 ±â€¯10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ±â€¯13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ±â€¯14.3 and the postoperative was 24 ±â€¯15 (p = 0.0002). CONCLUSION: In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.

Prognostic and Evolutive Factors of Tinnitus Triggered by Sudden Sensorineural Hearing Loss.

INTRODUCTION: The association between sudden sensorineural hearing loss (SSNHL) and tinnitus is frequent. Its correlation with the auditory prognosis remains controversial. The objective of the study is to evaluate tinnitus of which onset is concurrent with SSNHL and analyze it as a prognostic factor and its correlation with hearing recovery. MATERIALS AND METHODS: A prospective cohort study was conducted with 30 patients with SSNHL. Serial audiometry was performed and the Tinnitus Handicap Inventory (THI) was applied at the initial consultation and after treatment. RESULTS: Tinnitus had an incidence of 93.3%, with an initial mean THI of 63.6%. The mean decrease in THI was significant in all scale domains. However, there was no statistically significant difference between the degrees of tinnitus and hearing loss, as well as between hearing recovery percentage in relation to the degree of tinnitus. The correlation of THI gain with the hearing recovery rate was negative (the greater the decrease in the level of tinnitus discomfort, the greater the hearing recovery rate), being significant only in the emotional domain of THI, but showing a poor correlation. DISCUSSION: There was a reduction in the level of tinnitus discomfort, as measured by THI, after treatment of SSNHL. There is a correlation between tinnitus and hearing improvement in patients with SSNHL only in the emotional domain of THI, but this correlation is considered poor. The degree of tinnitus severity as measured by THI was not proportional to the hearing loss and is not a prognostic factor for hearing improvement.