Analysis of Risk Factors for Myringosclerosis Formation after Ventilation Tube Insertion.

BACKGROUND: This study examined possible risk factors for myringosclerosis formation after ventilation tube insertion (VTI). METHODS: A retrospective study was performed in a single tertiary referral center. A total of 582 patients who underwent VTI were enrolled in this study. Patients were divided into two groups based on the presence or absence of myringosclerosis: MS+ and MS-. Characteristics of patients were collected through medical chart review; these included age, gender, nature and duration of effusion, type of ventilation tube (VT), duration and frequency of VTI, incidence of post-VTI infection, incidence of intraoperative bleeding, and presence of postoperative perforation. Incidences of risk factors for myringosclerosis and the severity of myringosclerosis in association with possible risk factors were analyzed. RESULTS: Myringosclerosis developed in 168 of 582 patients (28.9%) after VTI. Patients in the MS+ group had an older mean age than those in the MS- group. The rates of myringosclerosis were higher in patients with older age, serous otitis media, type 2 VT, post-VTI perforation, and frequent VTI. However, there were no differences in occurrence of myringosclerosis based on gender, duration of effusion, duration of VT placement, incidence of post-VTI infection, or incidence of intraoperative bleeding. The severity of myringosclerosis was associated with the duration of effusion and frequency of VTI. CONCLUSION: Older age, serous effusion, type 2 VT, presence of post-VTI perforation, and frequent VTI may be risk factors for myringosclerosis after VTI; the severity of myringosclerosis may vary based on the duration of effusion and frequency of VTI.

Is there any effect of montelukast on prevention of myringosclerosis after myringotomy in a rat model?

OBJECTIVES: In this study, our aim was to identify the possible effects of montelukast sodium (ML) on the prevention of experimentally induced myringosclerosis. MATERIALS AND METHODS: Twenty-eight female Wistar albino rats were used and they were divided into four groups randomly. Tympanic membranes (TM) of all animals were perforated and then group 1 received no treatment (control group), group 2 was treated with a topical saline solution, group 3 received topically ML and group 4 received orally ML. On the 15th day, all animals were euthanized. Tympanic membranes were evaluated otomicroscopically and histopathologically. RESULTS: The histopathological findings, compared against a control and saline groups, showed the topically and orally ML groups had statistically significant differences of degree of myringosclerosis (p < 0.002) and median thickness of the TMs (p < 0.001). Suppression of inflammation was statistically significant only in the oral ML treatment group (p < 0.002). CONCLUSION: Oral and topically administration of ML reduced myringosclerosis formation in myringotomies rats.

Narrow band imaging endoscopy improves visualization of vessels of the perforated tympanic membrane.

PURPOSE: Because successful healing of a tympanic membrane perforation (TMP) depends upon the maintenance of blood supply to the injured area, we assessed the usefulness of narrow band imaging (NBI) video endoscopy to evaluate its vascularization. To our knowledge, the use of NBI to assess tympanic membrane (TM) vascular patterns has never been attempted. METHODS: Prospective observational study. NBI and cold white light (CWL) flexible videoendoscopy was used to explore perforated TMs of 100 patients. Main outcome measures were visualization of vessels among abnormal TM findings: monomeric areas (MA) (n = 6), myringosclerosis plaques (MP) (n = 65) and perforation edges (n = 100). They were graded by a vascular otoendoscopic score (VOS) comparing both types of lights (Wilcoxon test). Location and vascularization patterns were analyzed (Fisher's test). RESULTS: NBI was better to observe vascularization of 32% of perforation edges and 75.4% of MP (p < 0.001). NBI displayed higher (better) VOS when evaluating TMP edges (1.05 vs. 0.73) and MP (1.56 vs. 0.81, p < 0.001). The majority of TMP edges showed a ring pattern (66%), followed by irregular (19%), avascular (12%) and radial patterns (3%). The avascular pattern was more frequent in posterior perforations (p = 0.003). The radial pattern was most frequently found in MP, especially at posterior quadrants (p = 0.048). MA presented an irregular pattern in 83.3% of TMs. CONCLUSIONS: NBI videoendoscopy is a promising non-invasive technique, superior to CWL for visualizing vessels among TMP edges and MP, based on further study, could become a supplementary diagnostic tool in the workup of TMP and the decision-making surgical field.

The effects of fibroblast growth factor-2 delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic eardrum perforations lying close to the malleus.

OBJECTIVE: We evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus. STUDY DESIGN: A prospective, randomized, controlled clinical study. SETTING: A university-affiliated teaching hospital. SUBJECTS AND METHODS: We prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only. RESULTS: We analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group. CONCLUSIONS: FGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.

Predictive factors for the appearance of myringosclerosis after myringotomy with ventilation tube placement: randomized study.

Myringotomy with the insertion of ventilation tubes is the most frequent surgical procedure performed in children, and the appearance of myringosclerosis is one of its most frequent long-term complications. The objective of this study is to identify clinical factors and technique variations that may have a relation with the appearance of myringosclerosis, after tube insertion. Patients submitted to myringotomy with transtympanic short-term tube insertion were studied in a longitudinal prospective and analytical cohort study with the prospective randomized open, blinded endpoint (PROBE) methodology, to study the influence of the location of myringotomy (anterior-inferior quadrant or posterior-inferior), directions of the incision (radial or non-radial) and aspiration or not of the middle ear. Our study included 156 patients (297 ears). Myringosclerosis was observed in 35.7 % of the operated ears. It appeared more often in patients with greater number of otitis (p = .001) and with greater number of otorrhea episodes (p = .029) and in patients in whom the tympanogram after the tube extraction was type A (according to Jerger´s classification) (p = 0.016). We identified myringosclerosis in less patients, if the tube was in the tympanic membrane for less than 12 months (p = .009). Myringosclerosis was present more extensively if the tympanic incision was located in the anterior-inferior quadrant, with tympanic involvement superior to 25 % (p = .015). The results observed prove that, underlying the appearance of myringosclerosis, there exists an early inflammatory or infectious process and a final cicatricial process. It was also found that when myringotomy is made in the anterior-inferior quadrant, myringosclerosis appears in a higher percentage of the tympanic membrane; therefore, it is not recommended to do the incision in this quadrant, because it may lead to a reduction of the tympanic membrane vibration.

The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis.

The objective of this study is to investigate the effect of topical and systemic enoxaparin sodium on the healing pattern of experimentally induced tympanic membrane perforation and formation of myringosclerosis. A total of 24 Wistar-Albino strain rats were included in the study. Standard myringotomies were performed on each rat. In the first group, isotonic serum physiologic was dropped on external ear canal (control group). Topical enoxaparin was dropped on external ear canal and daily topical doses of enoxaparin were dropped on external ear canal of the rats for 14 days (topical treatment group). Third group received subcutaneous injections of enoxaparin for 14 days (systemic treatment group). Five micrometer thick sections of the bullae of the rats were stained with H&E. Inflammation, edema and sclerotic lesions and neovascularization observed in the lamina propria layer of the tympanic membrane, and total thickness of the tympanic membrane were evaluated. In intergroup comparisons, significant difference in the distribution pattern of severity of inflammation in all three groups was not observed (p = 0.784, p > 0.05). Total TM thickness differed among all three groups (p = 0.028, p < 0.05). A statistically significant difference was observed between the systemic enoxaparin and the control groups (p = 0.022, p < 0.05). A statistically significant difference was observed between the topical enoxaparin and the control groups (p = 0.037, p < 0.05). However, comparison between the topical and systemic treatment groups could not reveal any statistically significant intergroup difference (p = 0.682, p > 0.05). A significant difference was not observed among three groups as for the distribution of myringosclerotic plaques, severity of edema and neovascularization in the lamina propria (p = 0.539, p > 0.05), (p = 0.063, p > 0.05), (p = 0.152, p > 0.05). Topical and systemic enoxaparin treatment did not prevent formation of sclerotic plaques; however, it decreased TM thickness significantly in comparison with the control group.

Does myringosclerosis affect the success of butterfly myringoplasty?

OBJECTIVES: Butterfly inlay myringoplasty is a simple and practical surgical technique used in the repair of tympanic membrane perforation offering good outcomes in terms of hearing. The present study evaluates the effects of myringosclerosis on the success of surgery by reviewing demographic data, perforation size and hearing outcomes of patients undergoing endoscopic inlay butterfly myringoplasty due to chronic otitis media. METHODS: The study included 75 patients who underwent endoscopic inlay butterfly myringoplasty with the diagnosis of chronic suppurative otitis media in the Department of Otorhinolaryngology at Firat University Faculty of Medicine between March 2018 and July 2021. The patients were divided into three groups as the following. Group I: Patients without a myringosclerotic focus in the neighborhood of tympanic membrane perforation, Group II: Patients with a less than 50% myringosclerotic focus in the neighborhood of tympanic membrane, and Group III: Patients with a more than 50% myringosclerotic focus in the neighborhood of tympanic membrane. RESULTS: The comparison of all preoperative and postoperative parameters and the reduction in air-bone gap between the groups did not show statistically significant difference (p>0.05). The comparison of air-bone gaps between preoperative and postoperative measurements showed a statistically significant difference in all groups (p<0.05). The grafting success rate was 100% in Group I, 96.4% in Group II, and 95.6% in Group III. The mean operation time was 28.57±2.54 min in Group I, 32.14±2.44 min in Group II, and 30.69±3.43 in Group III; there was a statistically significant difference only between Group I and Group II (p = 0.001). CONCLUSIONS: The graft success rate and hearing gain in patients with myringosclerosis were similar to those in patients without myringosclerosis. Therefore, butterfly inlay myringoplasty is applicable to patients with chronic otitis media regardless of the presence or absence of myringosclerosis.

Laser, radiofrequency or tympanostomy knife? Comparison of surgical methods in tympanostomy treatment of young children and predictive value of tympanometry.

OBJECTIVES: To investigate tympanostomy tube (TT) treatment in young children, with special interest in bloodless surgical methods (laser and radiofrequency), myringosclerosis formation and tympanometric testing. METHODS: This prospective study includes 76 children whose 121 ears with middle ear effusion were treated with tympanostomy tubes. Myringotomy was performed with CO2 laser in 37, radiofrequency in 40 and myringotomy knife in 44 ears. The ears were evaluated with otomicroscopy and tympanometry preoperatively and postoperatively every 3-4 months until spontaneous tube extrusion. RESULTS: All tubes extruded spontaneously (mean 12.8 months, range 3-36 months), with no persistent perforations or cholesteatomas. CO2 laser and radiofrequency inserted tympanostomy tubes extruded faster (mean 11 months) compared to incisional myringotomy (mean 15 months, p = 0.002). Myringosclerosis was noted in 25 (21%) ears after treatment. There was a tendency to less myringosclerosis with bloodless techniques, but the difference was not significant. Flat tympanograms on the day of procedure predicted continuation of ventilation problems also after TT treatment (p = 0.003). Ears with preoperative type B tympanogram had significantly more myringosclerosis 21/75 (28%) compared with type A and C tympanograms 4/41 (10%) (p = 0.032). CONCLUSIONS: While all myringotomy methods were effective and safe, the traditional incisional myringotomy with a tympanostomy knife is still a good, feasible and cost-effective myringotomy method. No surgical removal of tympanostomy tubes is needed before 3 years of uncomplicated tympanostomy treatment. Tympanometry turned out to be a useful tool in prediction of post TT treatment ventilation problems of the middle ear.

Myringosclerosis as a predictor of the requirement for a permanent pacemaker in patients with drug-related atrioventricular block.

AIMS: Drug-related atrioventricular block (DR-AVB) may develop in patients with underlying latent degenerative conduction disorders, especially with antiarrhythmics and antihypertensives. Although, according to the current guidelines, reversal is achieved with cessation of the inducing agent, this is not the case for nearly half of the patients. The pathophysiological processes of DR-AVB and myringosclerosis include systemic inflammation and degeneration. This study investigated the role of myringosclerosis in predicting irreversible high-grade DR-AVB despite drug cessation. METHODS: This observational, non-randomized, prospective study involved 152 patients with high-grade DR-AVB, 72 of whom had reversible DR-AVB and 80 had irreversible DR-AVB and required permanent pacemakers. The patients' demographic, clinical, echocardiographic, and laboratory characteristics were recorded. Otoscopic tympanic membrane examinations for myringosclerosis were performed. RESULTS: There were no major differences in demographic, echocardiographic or laboratory characteristics between the two groups or previous medications. The median monitoring time with a temporary pacemaker was significantly longer in the irreversible than in the reversible group (5 [4-7] days vs. 2 [1-5] days; P<0.001). The incidence of myringosclerosis was significantly higher in the irreversible than in the reversible group (61.3% vs. 22.2%; P=0.001). Multivariate logistic regression analysis showed that myringosclerosis was an independent predictor of irreversible DR-AVB (odds ratio: 1.703, 95% confidence interval: 1.194-3.058; P=0.01). CONCLUSION: Myringosclerosis is a readily available, inexpensive, and non-invasive assessment and is a marker of inflammation and degeneration that can predict irreversible DR-AVB.