”Anatomofunctional results of endoscopic ear surgery in patients with Simple Chronic Otitis Media in the Otorhinolaryngology Service of the Hospital de Clínicas”
Abstract
Introduction: Perforations of the tympanic membrane (PMT) repre-sent a serious ear condition that can lead to conductive hearing loss, chronic infections and irreversible damage to the eardrum. Treatment for perforations is surgical reconstruction of the eardrum, known as myringoplasty and / or tympanoplasty.
Objective: To evaluate the results anatomofunctional surgery tympanic perforation closure under endoscopic vision in patients with Chronic Otitis Media Simple of the Department of Otolaryngology at the Hos-pital de Clinicas.
Methodology: Study observational and descriptive design transver-sal cross -cut retrospective association. Simple random probability sampling method. The sample size was 52 patients who underwent endoscopic surgery to close the
tympanic perforation.
Results: 52 patients were included in the study, of which 63.5% were female and 36.5% male. The average age was 28 years. 88.5% had a diagnosis of unilateral simple chronic otitis media and 11.5% bilateral. Regarding the type of surgery, 65.4% of the surgeries performed were myringoplasty and 34.6% were Type I tympanoplasty; 57.7% were from the left ear and 42.3% from the right side. The grafts used were cartilage with atrial concha perichondrium (48.1%), followed by carti-lage with tragus perichondrium (30.8%), and in smaller proportions the temporal muscle fascia (19.2%) and lastly ear lobe fat (1.9). Regarding the data
analysis, the association between the type of graft used and the complete closure of the perforation, which was 94.2%, was not found to be significant (p> 0.05). Comparatively, the pre and postoperative audiometric controls show significant differences according to the two-tailed analytical calculation, but the results are not statistically significant (p ›0.05) when comparing the type of graft used.
Conclusion: Almost all of the patients presented complete closure of the perforation at 6 months of control. The pre-surgical tonal audiometry reports presented moderate conductive hearing loss in the majority. The most frequently used grafts were cartilage and perichondrium of the tragus and atrial shell, with high anatomical and functional success rates, but without statistically significant differences between them. There were differences with a tendency to improve the tonal hearing averages between the pre and post-surgical controls, but this difference was not statistically significant when comparing the type of graft.
References
de Borborema Garcia L, Moussalem GF, de Andrade JSC, Mangussi-Gomes J, Cruz OLM, de Oliveira Penido N, et al. Transcanal endoscopic myringoplasty: a case series in a university center. Brazilian Journal of Otorhinolaryngology.
;82(3):321–325. Available from: https://dx.doi.org/10.1016/j.bjorl.2015. 05.012. doi:10.1016/j.bjorl.2015.05.012.
Kuo CY, Wilson E, Fuson A, Gandhi N, Monfaredi R, Jenkins A, et al. Repair of Tympanic Membrane Perforations with Customized Bioprinted Ear Grafts Using Chinchilla Models. Tissue Engineering Part A. 2018;24(5-6):527–535. Available from: https://dx.doi.org/10.1089/ ten.tea.2017.0246. doi:10.1089/ten.tea.2017.02 46.
Bourdure P, Robier A, Malard O. Bourdure, P.; Robier, A.; Malard, O. Cosmetic otologic and otoneurological. 1st ed. 2007. Page 73. 2007.
Kozin ED, Gulati S, Kaplan AB, Lehmann AE, Remenschneider AK, Landegger LD, et al. Systematic review of outcomes following observational and operative endoscopic middle ear surgery. The Laryngoscope. 2015;125(5):1205– 1214. Available from: https://dx.doi.org/10. 1002/lary.25048. doi:10.1002/lary.25048.
Basterra ZM. Elsevier / Masson; 2009. Available from: https://seorl.net/PDF/Otologia/016% 20-%20OTITIS%20MEDIA%20CR%C3% 93NICA.%20ASPECTOS%20GENERALES. %20OTITIS%20MEDIA%20CR%C3% 93NICA%20SIMPLE.pdf.
Hasegawa M, Shinnabe A, Kanazawa H, Iino Y, Yoshida N. Clinical Characteristics of Chronic Perforated Otitis Media in Different Age Groups. AVES Publishing Co.; 2017. Available from: https://dx.doi.org/10.5152/iao. 2017.3513. doi:10.5152/iao.2017.3513.
Ikarashi F, Nakano Y, Okura T. The relationship between the degree of chronic middle ear inflammation and tympanic bulla pneumatization in the pig as animal model. European Archives of Oto-Rhino-Laryngology. 1994;251(2):100– 104. Available from: https://dx.doi.org/10.1007/ bf00179901. doi:10.1007/bf00179901.
Suárez C, Gil-Carcedo LM, Marco J, Medina J, Ortega P, Trinidad J;. Available from: https: //axon.es/ficha/libros/9788498350784/tratadode- otorrinolaringologia-y-cirugia-de-cabeza-ycuello- tomo-iv-cirugia-oncologica-de-cabezay-cuello-y-de-la-base-del-craneo.
Basterra Alegría J Treatise on otorhinolaryngology and cervicofacial pathology. 2009.
Myers E, Carrau R, Surgical.
Tasleem M, Rahman A, Aslam M. Comparative Study of Outcome of Endoscopic Myringoplasty in Active and Inactive Mucosal Chronic Otitis Media Patients. Springer Science and Business Media LLC; 2017. Available from: https://dx. doi.org/10.1007/s12070-017-1121-6. doi:10.1007/s12070-017-1121-6.
Mer SB, Derbyshire AJ, Brushenko A, Pontarelli DA. Fiberoptic endotoscopes for examining the middle ear. Archives of otolaryngology. 1960;85(4):387–393.
Vining EM, Kennedy DW. The Transmigration of Endoscopic Sinus Surgery from Europe to the United States. Ear, Nose & Throat Journal. 1994;73(7):456–460. Available from: https://dx. doi.org/10.1177/014556139407300708. doi:10. 1177/014556139407300708.
Chandra RK, Conley DB, Kern RC. Evolution of the Endoscope and Endoscopic Sinus Surgery. Otolaryngologic Clinics of North America. 2009;42(5):747–752. Available from: https://dx.doi.org/10.1016/j.otc.2009.07.010. do i:10.1016/j.otc.2009.07.010.
Kozin ED, Gulati S, Kaplan AB, Lehmann AE, Remenschneider AK, Landegger LD, et al. Systematic review of outcomes following observational and operative endoscopic middle ear surgery. The Laryngoscope. 2015;125(5):1205– 1214. Available from: https://dx.doi.org/10. 1002/lary.25048. doi:10.1002/lary.25048.
Khan MM, Parab SR. Concept, Design and Development of Innovative Endoscope Holder System for Endoscopic Otolaryngological Surgeries. Springer Science and Business Media LLC; 2015. Available from: https://dx.doi.org/ 10.1007/s12070-014-0738-y. doi:10.1007/s12070-014-0738-y.
Kozin ED, Lehmann A, Carter M, Hight E, Cohen M, Nakajima HH, et al. Thermal effects of endoscopy in a human temporal bone model: Implications for endoscopic ear surgery. The Laryngoscope. 2014;124(8):E332–E339. Available from: https://dx.doi.org/10.1002/lary.24666. doi:10.1002/lary.24666.
Kozin ED, Lee DJ, Cohen MS. In response to Pediatric endoscopic ear surgery in clinical practice: Lessons learned and early outcomes. Wiley; 2017. Available from: https://dx.doi.org/ 10.1002/lary.26766. doi:10.1002/lary.26766.
Shekharappa MK, Siddappa SM. Cartilage Myringoplasty: An Ideal Grafting Technique for Complex Perforations. Journal of clinical and diagnostic research. 2017;11(7):6–08.
Mauricio CR, Meléndez P, Carmen, Morales S, Cristian, Torres M, et al. Experience in transcanal myringoplasty with tragai inlay perichondrium. Rev Otorhinolaryngol Cir Head Neck. 2012;72(2):151–156.
Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Springer Science and Business Media LLC; 2007. Available from: https://dx.doi.org/10.1007/s00405-007-0291-3. doi:10.1007/s00405-007-0291-3.
Yurttas V, Yakut F, Kutluhan A, Bozdemir K. Preparation and placement of cartilage island graft in tympanoplasty. Brazilian Journal of Otorhinolaryngology. 2014;80(6):522– 526. Available from: https://dx.doi.org/10.1016/ j.bjorl.2014.08.007. doi:10.1016/j.bjorl.2014.08.007.
