TYPE-I TYMPANOPLASTY BY UNDERLAY TECHNIQUE – FACTORS AFFECTING OUTCOME
Abstract
Background: Type-I Tympanoplasty is an operation which is widely done to close a persistent tympanic membrane perforation after clearing the disease from the middle ear. It is very safe and effective procedure. The success rate varies in different setups and there are some confounding factors which affect the result of Type-I tympanoplasty like the size, type and location of perforation. By conducting this study, we aimed to calculate the success rate of Type-I Tympanoplasty in Ayub Teaching Hospital and assess which confounding factors affect the success rate. Methods: This case series study was conducted at Ayub teaching hospital from 1st January 2014 to 31st December 2015. All the patients who presented with dry ears, no nasal disease and persistent tympanic membrane perforations during this period were operated upon and overall success rate was calculated. In addition, the relationship between the site of perforation, size of perforation and the type of perforation and the success rate of Type-I Tympanoplasty was also calculated. Results: One hundred and thirteen patients were included in this study. Out of these 91 (80.5%) showed complete healing after surgery. Anterior perforations were found to fail the procedure in 41.7% of the cases, while central perforation failed in only 5.4% of the cases. In cases of marginal perforations healing was significantly decreased, i.e., only 47.1% while it was 94.9% in cases where annulus was not involved. Larger perforations also showed poor surgical outcome. 100% of the small perforation healed completely while only 58.3% of the large perforations showed successful result after surgery. When p-value was calculated all of these findings were more than 95% significant. Conclusion: There is a significant association between the healing of tympanic membrane after Type-I Tympanoplasty and site, size and type of perforation. Anterior perforations, marginal perforation and large perforations reduce the chances of successful outcome of Type-I Tympanoplasty.Keywords: Type-I Tympanoplasty; size of perforation; site of perforation; outcome percentagesReferences
Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital 2011;31(6):366–71.
Vercillo NC, Xie L, Agrawal N, Nardone HC. Pediatric Tympanostomy Tube Removal Technique and Effect on Rate of Persistent Tympanic Membrane Perforation. JAMA Otolaryngol Head Neck Surg 2015;141(7):614–9.
Ur-Rehman H, Ullah N, Said M, Shahabi IK, Ullah H, Saleem M. Factors influencing the success rate of myringopasty. J Pak Med Inst 2007;21(2):117–21.
Wiatr M, Oles K, Tomik J, Skladzien J, Morawska A, Strek P, et al. [Prognostic factors in patients operated on eardrum perforation with intact ossicular chain]. Otolaryngol Pol 2011;65(4):266–71.
Castro O, Perez-Carro AM, Ibarra I, Hamdan M, Melendez JM, Araujo A, et al. Myringoplasties in children: our results. Acta Otorrinolaringol Esp 2013;64(2):87–91.
Phillips JS, Yung MW, Nunney I. Myringoplasty outcomes in the UK. J Laryngol Otol 2015;129(9):860–4.
Koc S, Akyuz S, Gurbuzler L, Aksakal C. Fat graft myringoplasty with the newly developed surgical technique for chronic tympanic membrane perforation. Eur Arch Otorhinolaryngol 2013;270(5):1629–33.
Chen Y, Wang X, Zhao D, Wu J, Wang J, Lu L, et al. [Retrospective study on the hearing improvement and postoperative perforation rates in 121 myringoplasty cases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014;49(10):854–7.
Becker J, Lubbe D. Success rate of myringoplasty at Groote Schuur Hospital. S Afr Med J 2011;101(10):740.
Nassif N, Berlucchi M, Redaelli de Zinis LO. Tympanic membrane perforation in children: Endoscopic Type-I tympanoplasty, a newly technique, is it worthwhile? Int J Pediatr Otorhinolaryngol 2015;79(11):1860–4.
Migirov L, Lipschitz N, Slonimsky G, Yakirevitch A, Wolf M. Efficacy of myringoplasty in older people. Aging Clin Exp Res 2014;26(6):661–4.
Andersen SA, Aabenhus K, Glad H, Sorensen MS. Graft take-rates after tympanoplasty: results from a prospective ear surgery database. Otol Neurotol 2014;35(10):e292–7.
Boronat-Echeverria NE, Reyes-Garcia E, Sevilla-Delgado Y, Aguirre-Mariscal H, Mejia-Arangure JM. Prognostic factors of successful tympanoplasty in pediatric patients: a cohort study. BMC Pediatr 2012;12:67.
Said Al-Jaaf SM, Mustafa Shem AA, Dabbagh LA. Myringoplasty [Risk factors and the effect of post-operative follow up on the outcome of success rate in Erbil / Kurdistan of Iraq]. Zanco J Med Sci 2010;14(3):1–9.
Nardone M, Sommerville R, Bowman J, Danesi G. Myringoplasty in simple chronic otitis media: critical analysis of long-term results in a 1,000-adult patient series. Otol Neurotol 2012;33(1):48–53.
Konstantinidis I, Malliari H, Tsakiropoulou E, Constantinidis J. Fat myringoplasty outcome analysis with otoendoscopy: who is the suitable patient? Otol Neurotol 2013;34(1):95–9.
Carr SD, Strachan DR, Raine CH. Factors affecting myringoplasty success. J Laryngol Otol 2015;129(1):23–6.
Janiak-Kiszka J, Kazmierczak W. [The results of myringoplasty using underlay technique]. Otolaryngol Pol 2014;68(1):30–3.
Hardman J, Muzaffar J, Nankivell P, Coulson C. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis. Otol Neurotol 2015;36(5):796–804.
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