Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty in adhesive perforation: retrospective case series

Abstract

Background

The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation.

Objectives

To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation.

Materials and methods

In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months.

Results

The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4–6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up.

Conclusions

Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.

Chinese abstract

背景：粘膜穿孔可能是粘膜性中耳炎的后遗症, 部分鼓膜残留物通过纤维粘连完全结合到中耳内侧壁上。但是, 很少有报道修复粘膜穿孔的研究。

目的：评价用于粘膜穿孔的内镜全层软骨膜双层移植鼓膜成形术的远期疗效。

材料和方法：包括26例单侧粘膜穿孔伴发慢性中耳炎行全层软骨膜双层移植鼓膜成形术。根据12和24个月时的听力增益和移植成功率来评估结果。

结果：移植成功率在12个月时为96.15％（25/26）, 24个月时88.46%（23/26）。术前4周可见 新血管形成和覆盖在软骨移植物侧面的上皮, 浅表软骨移植物在4-6个月内完全上皮化。CT显示, 术后24个月所有患者均获得了良好的气动化中耳和乳突细胞, 患者在随访期间未发现中耳胆脂瘤形成和角蛋白珠。

结论：内镜下无鼓室瓣提升术的全层软骨膜双层移植鼓膜成形术 是修复粘膜穿孔的可行方法, 具有更高的移植成功率和令人满意的听力结果。

Keywords:

• Endoscopes
• myringoplasty
• cartilage
• tympanic membrane perforation
• adhesions

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Science and Technology Agency of Yiwu City, China [Grants#2018-3-76].