Prophylactic antibiotics has no benefit for outcome in clean myringoplasty-A register-based cohort study from SwedEar.

OBJECTIVES: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6-24 months after surgery. DESIGN: A retrospective cohort study of prospectively collected data. SETTING: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013-2019. PARTICIPANTS: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit. MAIN OUTCOME MEASURES: The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery. RESULTS: In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. CONCLUSION: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.

The outcomes of endoscopic myringoplasty: packing with gelatin sponge versus packing with nothing.

Background: Packing with gelatin sponge has long been widely used in myringoplasty. However, there is no research on packing with nothing.Aims/objectives: To analyse the differences between packing with gelatin sponge and packing with nothing.Material and methods: Patients with tympanic membrane perforation were randomly divided into a packing with gelatin sponge group and a packing with nothing group. Differences between the groups were compared.Results: The operation time of group A (34.00 ± 1.05 min) was significantly shorter than that of group B (42.20 ± 1.40 min; p < .00); 1 patient (2.86%) in group A and 35 patients (100%) in group B had a dry ear time of longer than 1 week (p < .001). Ten patients (28.57%) in group A and 24 patients (68.57%) in group B had aural fullness after the operation (p < .001). The air-bone gap (ABG) in group A was smaller than that in group B at 1 week, 1 month, 2 months and 3 months after the operation (p < .05).Conclusion and significance: Group A achieved the same good results, but it had a short operation time, an early dry ear time, a low incidence of aural fullness and early recovery of hearing.

Determinants influencing success rates of myringoplasty in daily practice: a retrospective analysis.

OBJECTIVES: The aim of this study was to determine influencing factors on tympanic membrane closure and their consequence on absolute risks of closure and hearing improvement in myringoplasties. DESIGN: Retrospective cohort. SETTING: Medium-sized medical centrum. PARTICIPANTS: 195 patients were analysed who underwent a myringoplasty between January 2015 and February 2017 at the Jeroen Bosch Hospital in The Netherlands. MAIN OUTCOME MEASURES: Patient-related data, descriptions of the tympanic defect, surgical data, and the most important follow-up data were collected. Primary outcome is successful closure of the tympanic membrane and the secondary outcome is the amount of air-bone gap improvement after surgery. RESULTS: The overall success rate of the myringoplasty graft was 74.9%. If cartilage and butterfly graft were used, higher success rates of 85.4% and 85.5% were achieved compared to temporalis fascia (61.3%). Success rate of the operation was dependent of the skills of the surgeon. Chances of success are 91.9% if the operation is performed by an experienced surgeon using cartilage and 66.7% if a less experienced surgeon uses fascia. If a postoperative complication occurs or when silastic sheets are used, this might have a negative effect on the success of the operation. The mean ABG improved 10.10 dB if the perforation was closed compared to 3.38 dB after an unsuccessful procedure. CONCLUSION: The success rate of a myringoplasty is dependent of the skills of the surgeon and type of graft used and varies between 91.9 and 52.0% depending on these factors.

Results of revision myringoplasty: are they different to those of primary myringoplasty?

Audit question: Does revision myringoplasty have worse outcomes than primary surgery? METHODS: The International Otology Database has been used to record data on surgery for middle-ear disease in Norfolk, UK, over nine years. The data show the results of all myringoplasty cases and the results of revision cases. Outcome measures are perforation and hearing change. Comparison is made with benchmark centres of excellence. RESULTS: A total of 611 operations included myringoplasty; 356 (58 per cent) of cases had a recorded follow up at 3 months. Twenty-nine patients (8.1 per cent) had a post-operative perforation. Benchmark centres performed 2319 operations; 1284 (55 per cent) of these had a follow up at 3 months, and 82 patients (6.4 per cent) had a perforation at follow up. Sixty-nine of the Norfolk patients were revision cases. Six of the 69 patients (8.7 per cent) had a perforation at follow up. The average hearing gain in the revision myringoplasty patients in Norfolk was 7 dB. CONCLUSION: The results of the revision myringoplasty cases are the same as those for the primary myringoplasty cases in this series.

Factors affecting myringoplasty success.

OBJECTIVE: To identify factors that significantly influence myringoplasty success. METHODS: A retrospective study was performed of all adults and children who underwent myringoplasty from January 2005 to January 2010 in a teaching hospital. Outcome measures were tympanic membrane perforation closure and air-bone gap closure to within 20 dB HL. The factors assessed were the surgeon grade, pre-operative condition of the ipsilateral and contralateral middle ears, perforation site, perforation size, graft material, and whether simultaneous cortical mastoidectomy was performed. Factors with statistically significant effects were determined by logistic regression analysis. RESULTS: In the adult group, the perforation site significantly influenced tympanic membrane closure (p = 0.016): anterior (p = 0.008) and subtotal (p = 0.017) sites had the greatest influence. None of the factors proved to have a significant influence on tympanic membrane closure in the paediatric group. CONCLUSION: There was a significant association between perforation site and tympanic membrane perforation closure in adults. Anterior and subtotal perforations had a significantly reduced closure rate.

[Clinical analysis of bilateral same-day myringoplasty for 22 cases with bilateral tympanic membrane perforation].

OBJECTIVE: To investigate the feasibility of bilateral same-day myringoplasty and the indications for myringoplasty for patients with bilateral tympanic membrane perforation, and to summarize relevant experience. METHODS: Twenty-two patients underwent bilateral same-day underlay myringoplasty, and all cases were consistent with the indications for myringoplasty. The preoperative hearing and postoperative hearing at three months were compared, and the postoperative symptoms and complications were observed. Forty patients underwent monaural myringoplasty as the control group over the same period. All cases were followed up for 1 - 3 years. RESULTS: The postoperative hearing was increased by an average of 18 dB, and the rate of closure of tympanic membrane perforation was 93.2% (41/44). There were seven patients with ear fullness after operation in the bilateral myringoplasty group and two patients in the control group (χ(2) = 4.5374, P = 0.0332). There were no differences in the postoperative hearing improvement, the rate of closure and the rates of other discomfort symptoms except for ear fullness between the two groups (P > 0.05). CONCLUSION: It was feasible and safe to perform bilateral same-day myringoplasty for bilateral tympanic membrane perforation, but the postoperative temporary discomfort of bilateral ear fullness should be informed the patients in advance.

Timpanoplastía: revisión y experiencia de 4 años en el Hospital Clínico de la Universidad Católica de Chile / Tympanoplasty: review and experience of 4 years at the Hospital Clínico de la Universidad Católica de Chile

Introducción: Desde la introducción de esta técnica quirúrgica en la segunda mitad del siglo XIX ha habido múltiples publicaciones sobre diversas experiencias y nuevas técnicas a nivel nacional e internacional. En nuestro hospital esta cirugía es parte de la práctica clínica habitual. Objetivo: El objetivo general es revisar la experiencia en timpanoplastías en el Hospital Clínico de la Universidad Católica de Chile en los últimos 4 años. Los objetivos específicos son revisar la epidemiología de los pacientes intervenidos, las técnicas quirúrgicas utilizadas y los resultados anatómicos y audiológicos conseguidos. Material y método: Estudio retrospectivo y descriptivo. Se revisó la totalidad de las fichas y audiometrías de los pacientes sometidos a timpanoplastías que cumplieron criterios de inclusión y exclusión bien definidos. Se incluyeron sólo pacientes cuya cirugía fue realizada entre enero de 2007 y diciembre de 2010. Resultados: Se obtuvo éxito anatómico en 82,4 por ciento de nuestros pacientes, con una tasa de complicaciones de 17,57 por ciento. Con respecto a los resultados auditivos, se observó un éxito auditivo total de 87,08 por ciento, y sólo en 13 por ciento de los pacientes empeoró su audición. Conclusiones: Los resultados anatómicos y auditivos obtenidos son comparables a lo publicado en la literatura nacional en la última década. Nuestra experiencia muestra un buen rendimiento con las técnicas e injertos utilizados, así como un buen resultado en las cirugías realizadas por médicos residentes, similares a los obtenidos por médicos staff.

Introduction: Since the introduction of this surgical technique in the second half of the nineteenth century, there have been many national and international publications on various experiences and new techniques. In our hospital this surgery is part of the routine clinical practice, so we decided to conduct this study to review our experience over the last 4 years. Aim: The general objective is to review the experience of tympanoplasty in the Hospital Clínico de la Universidad Católica de Chile in the last 4 years. The specific objectives are to review the epidemiology of patients undergoing this surgery, the surgical techniques used and the anatomical and audiological results achieved. Material and method: Descriptive and retrospective study. We reviewed all the clinical records and hearing tests in patients undergoing tympanplasty who met inclusion and exclusion criteria clearly defined. We only included patients whose surgery was performed between January 2007 and December 2010. Results: Anatomical success was archieved in 82.4 percent of our patients, with a complication rate of 17.57 percent. With regard to hearing results, there was a total audiological success of 87.08 percent and only 13 percent of our patients experienced worsening of their audition. Conclusions: The anatomical and audiological results obtained are comparable to those published in the national literature in the last decade. Our experience shows a good performance with the techniques and grafts used, and good results in surgeries performed by residents, similar to those obtained by staffs.

[Myringoplasties. A retrospective analysis of our surgical outcomes]. / Miringoplastias. Un análisis retrospectivo de nuestros resultados.

OBJECTIVE: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. MATERIALS AND METHODS: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. RESULTS: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. CONCLUSIONS: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results.

Surgery for otitis media among Indigenous Australians.

Otitis media with effusion and recurrent acute otitis media are ubiquitous among Indigenous children. Otitis media causes conductive hearing loss that may persist throughout early childhood and adversely affect social interactions, language acquisition and learning. Control of otitis media usually restores hearing to adequate levels. Surgery is to be considered when otitis media has not responded to medical treatment. In non-Indigenous populations, tympanostomy tubes ("grommets"), with or without adenoidectomy, can control otitis media; how these findings relate to Indigenous Australians is not known. Tympanic membrane perforation is a frequent sequela of early childhood otitis media among Indigenous children. It occurs as early as 12 months of age and causes conductive hearing loss. Perforation is associated with recurrent aural discharge, particularly in the tropics and in desert regions. Medical and public health management is required until a child is old enough to undergo surgical closure of the perforation, usually by an age of 7-10 years. Surgical closure of the tympanic membrane stops the aural discharge and improves the hearing sufficiently to avoid the need for hearing aids in most cases. The success rate of surgery conducted in rural and remote Australia is below urban benchmarks; improving this will probably require funding for community-based follow-up.

Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years.

OBJECTIVE: To compare the incidence and outcomes of myringotomy plus ventilation tube insertion (MVTI) alone and that concurrent with pharyngeal surgery (adenoidectomy, adenotonsillectomy, or tonsillectomy) at a population level. STUDY DESIGN: Observational, retrospective, population-based study using hospital administrative data. METHODS: All hospital morbidity information was obtained for children who underwent a first MVTI procedure while less than 10 years of age in any Western Australian hospital from 1981 to 2004. Further MVTI procedures and additional pharyngeal surgery were subsequently identified for each child. RESULTS: There were 51,373 children less than 10 years of age who underwent at least one MVTI procedure from 1981 to 2004. Twenty-nine percent underwent pharyngeal surgery at the time of first MVTI procedure, and of these, 7.4% (1,096) had pharyngeal surgery in the absence of adenoid or tonsil disease. Adenoid surgery at time of MVTI was associated with reduced odds of subsequent MVTI procedures in children with or without adenoid/tonsil disease. In more recent calendar periods, no differences in the length of hospital stay between MVTI alone and with adenoidectomy was observed, whereas procedures involving tonsils required an additional bed day per procedure and were associated with more episodes of operative and postoperative hemorrhage. CONCLUSION: Having adenoidectomy or adenotonsillectomy surgery at time of first or subsequent MVTI was associated with reduced risk of further MVTI surgery. The low complication rates for adenoidectomy and short hospital stays make adjunctive adenoidectomy a potentially cost-effective first line management option for otitis media with effusion.

Timpanoplastía en niños: experiencia de 10 años en el Hospital Clínico de la Universidad de Chile / Tympanoplasty in children: 10 years' experience at the Clinical Hospital of Universidad de Chile

El objetivo de este trabajo fue conocer el resultado anatómico y audiológico de las timpanoplastías, evaluar factores pronósticos asociados a la intervención y comparar los resultados con la literatura publicada. Para ello se revisaron las fichas clínicas de los pacientes menores de 14 años intervenidos en el Hospital Clínico de la Universidad de Chile entre 1994 y 2003 en quienes se realizó timpanoplastía, sin mastoidectomía. Se incluyeron sólo aquellos pacientes que tuvieron control audiométrico pre y postoperatorio y un seguimiento clínico mínimo de 6 meses postoperatorio. Se trabajó con un total de 41 oídos operados, consignando edad, sexo, tipo de perforación, tipo de cirugía (vía de abordaje, tipo de injerto y colocación del injerto), resultado anatómico, resultado auditivo y complicaciones postoperatorias. El promedio de edad fue de 8,3 años (rango entre 4 y 14 años). No hubo diferencias según género. El éxito anatómico alcanzó el 90 por ciento y la mejoría auditiva fue significativa en 78 por ciento de los casos. No se encontró relación entre la vía de abordaje, tipo de injerto y su técnica de colocación con el éxito postoperatorio. Se observó un mayor porcentaje de éxito anatómico y auditivo en niños menores de 8 años (p <0,05). Los resultados del estudio son concordantes con la literatura, siendo la edad el único factor que influye en el éxito postquirúrgico. Los mejores resultados se obtuvieron en niños menores de 8 años, siendo este resultado anatómico incluso mejor que los observados en la población general.

Middle-ear disease in remote Aboriginal Australia: a field assessment of surgical outcomes.

Chronic middle-ear disease is highly prevalent among Australian Aboriginal people, and many undergo surgical treatment. However, the outcomes of surgery in this group have not been fully evaluated. This is a descriptive study of operations for middle-ear disease (excluding grommets) on Aboriginal patients in Kimberley hospitals between 1 October 1986 and 31 December 1995. Logistic regression was used to model predictors of surgical outcome. Success was defined by an intact tympanic membrane and air-bone gap of < or = 25 dB at review at, or later than, six months post-operation. A success rate of 53 per cent was observed; increasing age was the only variable predictive of success. Successful outcomes were more likely in adults and children aged > 10 years, however, this does not take into account the necessity of hearing for language acquisition and learning. Dedicated resources must be allocated for post-operative follow-up of Aboriginal patients so that much-needed, rigorous evaluations of ENT surgery can be conducted.

Myringoplasty in children: factors influencing surgical outcome.

Age, size, and site of perforation, condition of the ear, status of the contralateral ear, grafting materials, and more are considered factors influencing the success rates in myringoplasties in children. The ambivalence in results is mainly due to nonhomogeneous patient groups. In an effort to compose groups as homogeneous as possible for analysis of influencing factors, a retrospective study of 51 pediatric myringoplasty cases (51 ears) was undertaken. All patients had perforations caused by simple chronic otitis media. The overall surgical success rate was 82.3% at 18 months, and for young (5 to 10 years) and older (11 to 16 years) children it was 77.2% and 86.2%, respectively. Anterior, central, and total perforations healed without significant differences. Outcome in unilateral perforations was better than bilateral: 96.9% and 55%, respectively (p < 0.01). Discharging ears (100%) healed better compared with dry ears (75%) (p < 0.05). Analysis of the literature also revealed significant difference in success rates of discharging and dry ears: 92.5% and 80.6%, respectively (p < 0.01). We conclude that, contrary to comments in the literature, discharging ears in children favor good outcome and they should be operated on regardless of age and site of perforation. However, in bilateral perforations results may not be so rewarding.

Education, practice reviews needed to reduce surgical intervention, Quebec report says.

Clinical uncertainty may be the reason for large variations in the rates of tonsillectomy, adenoidectomy and myringotomy in Quebec, a report prepared for the provincial government states. Methods used in other jurisdictions, such as informing physicians about geographic differences in intervention rates and developing clinical practice guidelines, could reduce the variations and save millions of dollars, researchers suggest.

Prognostic factors in tympanoplasty: a statistical evaluation.

In a group of 52 patients with chronic otitis media that underwent a myringoplasty, pressure equalization mucociliary clearance of the Eustachian tube and degree of pneumatisation of the mastoid have been studied, and their statistical relationship with surgical outcome evaluated. The only statistically being significant correlation was mucociliary clearance time.

[Sandwich-graft myringoplasty: the authors' personal technic and results]. / Miringoplastica a sandwich: tecnica personale e risultati.

The authors describe the anatomic and functional results obtained with a sandwich myringoplasty technique (MPL) employing an endaural approach. The suggested technique is a modified sandwich MPL by endaural approach with a reduced Shambaugh incision, a systematic profiling of the canal wall bulge and separation of the meatal and tympano-meatal flaps that are maintained pedunculated. The temporal fascia is inserted between the fibrous layer of the tympanic remnant and a single pedunculated tympano-meatal cutaneous flap replaced in the original location. The authors present 72 cases operated between January 1987 and December 1989 for perforations involving up to three quadrants. In 93.1% of the cases a complete and lasting resolution of the perforation was obtained. Of the 5 failures, 4 presented a perforation smaller than the original one. An average (250, 500, 1000 Hz) functional recovery of 14.1 dB was observed compared to an average pre-operatory gap of 21.6 dB. In 25% of the cases, average recovery was greater than 25 dB and in 5 patients a slight worsening with an average difference of -3.3 dB was observed. On the whole, in 41 patients a residual post-operatory gap of only 10 dB was achieved. The anatomical results obtained with the MPL presented are similar to those found in the literature describing the classical overlay technique. However, the cases reported do not present those inconveniences associated to the latter technique (lateralization of the graft and blunting). The anatomic and functional results obtained with the technique discussed are on the whole superior to those described with the underlay and the classical overlay techniques. The Authors believe that this is mainly due to the absence of the gelfoam in the middle ear and to the double contention and vascularization of the temporal fascia graft. By means of the profiling of the canal wall the endaural approach permits a good view of the operating field. Furthermore, it is less traumatic and more acceptable to the patient than the postauricular one that has to be limited to the MPL where there are clinical indications for the exploration of antrum. The personal technique here presented implies, however, a certain presence of epithelial pearls. Their localization is nevertheless facilitated by the absence of blunting, thickening and lateralization of the graft. This allows for an early and easy removal on an out-patient basis. Other inconveniences of the technique are the length of the procedure and a more difficult control of the ossicular chain.(ABSTRACT TRUNCATED AT 400 WORDS)

[Myringoplasty. A prospective study of 238 cases]. / Miringoplastia. Estudio prospectivo de 238 casos.

It has been made a review of 238 myringoplasties done in the last three years (1988-90) at the Santa Creu i Sant Pau Hospital. In this work are only contemplated the plain myringoplasties. Tympanoplasties because cholesteatoma and ossiculoplasties are excluded. Some characteristics are studied: age, sex, ear state, kind of perforation, ossicular chain state and others. Anatomical and functional results are analyzed as also the relationship between the type of perforation with the audiometric loose and anatomic success.