Objective:To compare the differences in postoperative healing rates, hearing improvement, and complication rates between endoscopic butterfly inlay cartilage tympanoplasty and underlay cartilage tympanoplasty in Small-to-Medium-Sized Tympanic Membrane Perforations, and to provide clinical basis for indication of the butterfly inlay cartilage tympanoplasty. Methods:This study enrolled patients with chronic suppurative otitis media or traumatic tympanic membrane perforations who were treated at the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, between January 2022 and May 2023. Inclusion criteria comprised a dry ear period exceeding 3 months, absence of middle ear or mastoid pathology confirmed by temporal bone CT, and an air-bone gap of less than 40 dB. All surgeries were performed by the same surgeon using tympanoplasty techniques. Based on the surgical approach and perforation size, patients were categorized into four groups: Group A（butterfly cartilage tympanoplasty, perforation ≤3 mm）: 23 cases. Group B（butterfly cartilage tympanoplasty, perforation 3-5 mm）: 17 cases. Group C（full-thickness cartilage underlay tympanoplasty, perforation ≤3 mm）: 12 cases. Group D（full-thickness cartilage underlay tympanoplasty, perforation 3-5 mm）: 22 cases. Data collected included perforation duration, preoperative Eustachian Tube Score（ETS）, pure-tone audiometry, otoscopic findings, and postoperative follow-up data on pure-tone thresholds, otoscopic outcomes, and complications such as graft infection and otorrhea. Results: The mean postoperative follow-up period was 4 months （range: 3-12 months）. A total of 74 patients were enrolled, including 40 undergoing butterfly cartilage tympanoplasty and 34 receiving full-thickness cartilage inlay tympanoplasty. In the <3 mm perforation subgroup, the patients receiving butterfly technique （23 cases） exhibited a postoperative air-bone gap （ABG） improvement of （2.33±8.21） dB, and those receiving the inlay technique （12 cases） showed an ABG improvement of （2.49±7.9） dB, with no statistically significant difference between the two groups （P>0.05）. In the 3-5 mm perforation subgroup, the patients receiving butterfly technique （17 cases） demonstrated an ABG improvement of （8.16±5.69） dB, and those receiving the inlay technique （22 cases） achieved an ABG improvement of （8.08±10.42） dB, which were not significantly different （P>0.05）. Tympanic membrane healing rates across the four subgroups were 95.65%, 94.12%, 100%, and 95.45%, respectively, with no statistically significant differences （P>0.05）. Conclusion:In patients with tympanic membrane perforations ≤3 mm and 3-5 mm, butterfly cartilage tympanoplasty achieves comparable audiological outcomes to full-thickness cartilage underlay tympanoplasty. Compared with the underlay technique, the butterfly method is less invasive, preserves the normal anatomical structure of the tympanic membrane, requires a shorter dry ear period, and yields higher patient satisfaction. Therefore, it can be safely recommended for perforations ≤5 mm that do not require tympanotomy exploration.
Humans ; Tympanic Membrane Perforation/surgery* ; Tympanoplasty/methods* ; Treatment Outcome ; Endoscopy ; Cartilage/transplantation* ; Male ; Female ; Adult ; Middle Aged ; Myringoplasty/methods* ; Otitis Media, Suppurative/surgery* ; Aged

Objective:To investigate the clinical value of tympanic membrane repairment with modified ear canal flap under endoscope. Methods:A retrospective analysis was conducted on the clinical data of 62 patients who underwent simple tympanic membrane perforation repair surgery in our hospital from August 2019 to January 2023. All patients were divided into two groups: 37 cases in the otoscopy group and 25 cases in the microscope group. The surgical duration, postoperative pain response, and postoperative tympanic membrane healing and hearing recovery were compared between the two groups. Results:Compared with the microscope group, the total surgical duration of the otoscopy group was significantly shortened[（70.4±13.2） min vs. （102.8±17.5） min, P<0.001], and there was a statistically significant difference in postoperative VAS pain score[（3.1±1.2） vs. （6.5±1.4）, P<0.001]. The two groups achieved tympanic membrane healing and no infection occurred after operation. There was no significant difference in postoperative hearing recovery between the two groups（P>0.05）. Conclusion:Modified tympanic membrane repairment through otoscope can greatly shorten the operation time and reduce the hospitalization cost, which is more suitable for the application of primary hospitals.
Humans ; Retrospective Studies ; Female ; Male ; Tympanic Membrane Perforation/surgery* ; Surgical Flaps ; Ear Canal/surgery* ; Tympanic Membrane/surgery* ; Endoscopy/methods* ; Adult ; Middle Aged ; Operative Time ; Otoscopy/methods* ; Dissection/methods*

OBJECTIVE: To observe the clinical effect of endoscope-guided low temperature plasma ablateing adenoidectomy with tympanic membrane incision drainage and tympanic membrane indwelling catheter to treat secretory otitis media of children. METHOD: Fifty-two cases (98 ears) of secretory otitis media in children with adenoid hypertrophy were treated. Respectively endoscope-guided tympanic membrane incision drainage parallel low temperature plasma ablateing adenoidectomy and endoscope-guided tympanic membrane indwelling catheter parallel low temperature plasma ablateing adenoidectomy. RESULT: In group A, 30 cases of 58 ears, cure 36 ears, improving 14 ears, invalid 8 ears, the effective rate was 86.2%. In group B, 22 cases of 40 ears, cured 32 ears, improvement in 6 ears, invalid 2 ears, the effective rate was 95.0%. According to statistical analysis of curative effect, there was no significant difference by effective rate between two groups. CONCLUSION For the patients with secretory otitis media caused by adenoidal hypertrophy, the endoscope-guided tympanic membrane incision drainage parallel low temperature plasma ablateing adenoidectomy can be regarded as a kind of method to reduce the risk of tympanic membrane perforation.
Adenoidectomy ; methods ; Adenoids ; pathology ; Catheters, Indwelling ; Child ; Cold Temperature ; Humans ; Middle Ear Ventilation ; methods ; Otitis Media with Effusion ; surgery ; Tympanic Membrane Perforation

OBJECTIVE: To investigate the reconstruction method of lateral attic wall with tragal cartilage and temporalis fascia graft. And analyze the postoperative result of its clinical application. METHOD: From Jan 2005 to Jul 2014, 45 patients whose middle ear disease were limited to attic received this surgery in our department. Among 31 cases of cholesteatoma otitis media and 14 cases of external auditory canal cholesteatoma were included. In order to expose the attic fully, we operated epitympanotomy through retroauricular incision and then removed the scutum and lateral attic bone wall. After eliminating the lesions, we reconstructed the lateral attic bone wall with tragal cartilage, covered the cartilage with temporalis fascia and then repaired the tympanic membrane and external ear canal skin. After surgery, all patients were followed up at 10 days, 1 month, 2 months, 6 months and 1 year. RESULT: Two months after surgery, 45 patients' achieved one-stage wound healing. Six months later, all of the patients' operation area had epithelized completely. After 1 year, 37 patients had recovered the normal shapes and stable audition; 7 cases patients have different level tympanic membrane retraction; 1 patient suffered from tympanic membrane retraction and recurrent cholesteatoma. CONCLUSION With regard to the lesion limited to the attic, we can remove it by operating epitympanotomy through retroauricular incision, and then reconstruct the lateral attic wall with tragal cartilage and temporalis fascia. By the support of the cartilage, we can keep the epitympanic aeration, reduce the retraction of pars flaccida membrana tympani, and maintain the fundamental shape of lateral attic wall.
Cartilage ; transplantation ; Cholesteatoma ; surgery ; Ear Auricle ; Ear Canal ; Ear Diseases ; surgery ; Ear, Middle ; pathology ; Fascia ; transplantation ; Humans ; Mastoid ; Otitis Media ; surgery ; Tympanic Membrane ; surgery ; Tympanic Membrane Perforation ; surgery

OBJECTIVE: To evaluate effectiveness of endoscopic tragus cartilage-perichondrium in the treatment of large tympanic membrane perforations. METHOD: Patients with large tympanic membrane perfortations who had underwent cartilage-perichondrium myringoplasty were retrospectively retrieved from our department. Those with a follow-up of equal to or greater than 12 months after surgery were included in the study. Hearing test results were reported using a four-frequency air conduction and bone-air conduction gap. Patients were labeled as treatment success if the tympanic membrane was intact without lateralization or anterior blunting after surgery. RESULT: Of the 35 patients with large tympanic membrane perforations treated by endoscopic tragus cartilage-perichondrium, 33 (94.3%) were treatment success. There was no graft lateralization, anterior blunting, neocholesteatoma, and sensorineural hearing loss in these patients after surgery. The air conduction and bone-air conduction gap before surgery in the study cohort were (43.8 ± 5.7) dB and (28.5 ± 3.1) dB, respectively. Postoperative air conduction and bone-air conduction gap of the cohort were (31.4 ± 6.4) dB HL and (16.2 ± 4.1) dB, respectively. The postoperative air conduction and bone-air conduction gap decreased significantly after surgery (P < 0.01). Overall postoperative air-bone gap in 27 of the 35 patients (77%) were less than 20 dB after surgery. CONCLUSION Endoscopic cartilage-perichondrium myringoplasty is an effective procedure in the treatment of large tympanic membrane perforations.
Bone Conduction ; Cartilage ; Cohort Studies ; Ear Auricle ; Endoscopy ; Hearing ; Hearing Tests ; Humans ; Myringoplasty ; Postoperative Period ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; Tympanic Membrane Perforation ; surgery ; Tympanoplasty

OBJECTIVE: To investigate the effect of plasma eardrum perforation homochronous with palatoplasty on hearing and tympanic cavity pressure in cleft palate children with secretory otitis media. METHOD: Fifty-six cases of cleft palate children with secretory otitis media were randomly divided into observation group and control group. For the control group, palatoplasty was carried out alone. For the observation group, homochronous with palatoplasty, plasma eardrum perforation was performed with the diameter of the aperture 2-3 mm, which was decided by observing viscosity of tympanum fluid under microscope or otoscope. RESULT: Compared with the simple cleft palate repairing palatoplasty, the perforation in the observation group could keep for 6-8 weeks after the surgery. Followed up 6 months later, the children in observation group improved better in terms of hearing restoration and tympanometry. CONCLUSION By means of plasma eardrum perforation homochronous with palatoplasty, the children of cleft palate with secretory otitis media could improve hearing and tympanometry in a short period, recovering the function of middle ear.
Acoustic Impedance Tests ; Child ; Cleft Palate ; surgery ; Ear, Middle ; Humans ; Middle Ear Ventilation ; Otitis Media with Effusion ; surgery ; Palate ; surgery ; Tympanic Membrane Perforation

Humans ; Stents ; Tympanic Membrane ; Tympanic Membrane Perforation ; surgery

OBJECTIVE: To explore the clinical effectiveness of endoscopic myringoplasty with homoplastic amniotic membrane. METHOD: A retrospective study in 43 patients underwent endoscopic myringoplasty with homoplastic amniotic membrane was observed at the wound healing of tympanic membrane perforation and the hearing improve-threshold audiometry in 43 patients after surgery. RESULT: The tympanic membrane's perforation healing rate was 95.3% (41/43), and air conduction threshold audiometry in language frequency improved average 10 dB. The follow up was 1--4 years, and no recurrence or complications had occurred. CONCLUSION The endoscopic myringoplasty could be able to simple myringoplasty whose air conduction threshold audiometry in language frequency was less than 40 dB. It could be used to repair not only the central perforation in tympanic membrane, but also the marginal perforation which has residual tympanic membrane in most of the regional. Human amniotic membrane is an ideal materials for repair of tympanic membrane.
Adolescent ; Adult ; Amnion ; transplantation ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Myringoplasty ; methods ; Otitis Media, Suppurative ; surgery ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome ; Tympanic Membrane Perforation ; surgery ; Young Adult

OBJECTIVE: To explore the curative effect of endoscopic myringoplasty with modified sandwich technique. METHOD: Endoscopic myringoplasty was performed with modified sandwich technique for traumatic perforation of tympanic membrane and chronic suppurative otitis media (simple type) of 43 patients. RESULT: All the perforating tympanic membranes were repaired successfully in one time. Six months after the operation, 1 case was out of follow-up and 2 cases were failed: one got a small perforation when the transplantation shifted and the transplantation of the other one was lost because of infection. The closure rate of tympanic membrane perforations was 95.2%. The air-bone gap of speech frequency of 28 ears increased by > 15-20 dB, 8 ears were enhanced by 10-15 dB, while 6 ears (including 2 failed cases) without improvement. The acoustic immittance test showed that "Type A", "Type As", "Type Ad", "Type B" and "Type C" tympanogram were in 30 ears,12, 4, 6 and 4, respectively. CONCLUSION The endoscopic myringoplasty with modified sandwich technique has the advantages of simple operation, better security, less trauma and better efficacy, and it is worth popularizing.
Adolescent ; Adult ; Aged ; Ear ; surgery ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Myringoplasty ; methods ; Tympanic Membrane Perforation ; surgery ; Young Adult

BACKGROUNDThe main risk factors for postoperative failure in tympanoplasties are large perforations that are difficult to repair, annular perforations, and a tympanic membrane (TM) with extensive granular myringitis that require middle ear exploration and mastoidectomy. The aim of this study was to investigate a novel technique of perichondrium/cartilage composite graft for repairing the large TM perforation in the patient of otitis media.

METHODSRetrospective chart reviews were conducted for 102 patients with large tympanic membrane perforations, who had undergone tympanoplasty from August 2005 to August 2008. Tympanoplasty or tympanomastoidectomy using a perichondrium/cartilage composite graft was analyzed. The tragal or conchal perichondrium/cartilage was used to replace the tympanic membrane in patients.

RESULTSPatients aged from 13 to 67 years were followed up in average for 24 months (10 - 36 months). Seventy-four ears (72.61%) were used the tragal perichondrium/cartilage as graft material and 27 ears (27.39%) were used the conchal perichondrium/cartilage. Graft take was successful in all patients. Postoperative complications such as wound infection, hematoma, or sensorineural hearing loss were not identified. Nine patients (8.82%) had the partial ossicular replacement prosthesis, 14 patients (13.72%) using the autologous curved incus and 79 patients (77.45%) without prosthesis. Successful closure occurred in 92% of the ears. A total of 85.8% patients achieved a postoperative hearing improvement.

CONCLUSIONSThe graft underlay tympanoplasty using perichondrium/cartilage composite is effective for the majority of patients with large perforation. The hearing was improved even if the mastoidectomy was required in the patients with otitis media with extensive granulation.

Adolescent ; Adult ; Aged ; Cartilage ; transplantation ; Female ; Hearing Loss ; surgery ; Humans ; Male ; Middle Aged ; Otitis Media ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane Perforation ; surgery ; Tympanoplasty ; methods ; Young Adult