고막성형술 및 재수술에서 예후인자에 관한 연구

이민구,원중연,김형종 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.7

Background and Objectives There is no consensus on the prognostic factors regarding pos-toperative recurrence after myringoplasty. In this study, we investigated the preoperative clinical findings and postoperative results after primary myringoplasty and compared them with those of revision myringoplasty. Subjects and Method Computerized database of 861 clinical records of last 20 years were analyzed retrospectively for the subjects who underwent myringoplasty at the Department of Otolaryngology, University of Korea. All the surgeries were done under general or local anesthesia by senior surgeons. Primary and revision cases of myringoplasty or type 1 tympanoplasty followed up at least for longer than 3 months were only included in the study. Those other cases of tympanoplasty types, concomitant ossiculoplasty and/or mastoidectomy, or those with the presence of cholesteatoma and those that required repair during exploratory tympanotomy were excluded. Results 535 primary and 101 revision cases have met our inclusion criteria. Overall, in this study, the failure rates of primary and revision myringoplasty were 11.02% and 5.94%, respectively. Significantly different among the prognostic factors were such as sex, age, anesthesia, surgical approach, the presence of otorreha, size of eardrum perforation, external auditory canal narrowing, valsalva test, degree of pneumatization, graft materials, tympanoplasty type, previous mastoidectomy, the presence of bilateral otitis media influencing on myringoplasty revision, and the presence of otorrhea and sclerotic type of mastoid pneumatization. Conclusion Among various prognostic factors of myringoplasty, poor prognostic factors were preoperative otorrhea and poor pneumatization. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(7):454-9

Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

이민규,김태민,임성진,박동현,나윤찬,최준 대한이비인후과학회 2021 대한이비인후과학회지 두경부외과학 Vol.64 No.10

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedurefor repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate thesurgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and reviewthe current knowledge regarding fat myringoplasty, with consideration of the effectivenessof additional substances used in the treatment of small TM perforations. Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplastyat our hospital from March 2008 through April 2019 and were followed up for atleast 2 months thereafter. Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male,9-75 years; female, 16-65 years). All perforations were classified as small perforations, rangingfrom 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients(7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwentboth preoperative and postoperative pure tone audiometric examinations. The meanABG was 4.42 dB (n=24; paired-t test, p=0.001; 95% confidence interval, 1.77-7.07). The literaturereview revealed that TM closure success rate of over 80% was associated with pure-fatmyringoplasty, while the TM closure success rate for fat myringoplasty with additional substanceswas 85% to 100%. Conclusion Our study revealed a high TM closure success rate and good hearing outcomesare associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient forrepairing small TM perforations.

Fibrinogen-Based Collagen Fleece Graft Myringoplasty for Traumatic Tympanic Membrane Perforation

최승효,송형용,송찬일 대한청각학회 2016 Journal of Audiology & Otology Vol.20 No.3

Background and Objectives: The aim of this study was to investigate how fibrinogenbased collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP). Subjects and Methods: Between August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty. Results: The TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative airbone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent. Conclusions: FCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.

Postoperative Nausea and Vomiting after Myringoplasty under Continuous Sedation Using Midazolam with or without Remifentanil

장지수,이재준,이준호,박원재,황성미,이수경,임소영 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.5

Purpose: This prospective study evaluated the effects of continuous sedation using midazolam, with or without remifentanil, on postoperative nausea and vomiting (PONV) in patients undergoing myringoplasty. Materials and Methods: Sixty patients undergoing myringoplasty were sedated with midazolam in the presence of remifentanil (group MR), or after saline injection instead of remifentanil (group M). Results: Three patients (10%) in group M complained of nausea; two vomited. Four patients (13%) in group MR complained of nausea and vomited within 24 h after surgery. Rescue drugs were given to the six patients who vomited. No significant difference was detected between the two groups regarding the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs. Conclusion: Midazolam-based continuous sedation can reduce PONV after myringoplasty. Compared with midazolam alone, midazolam with remifentanil produced no difference in the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.

Cartilage Graft in Myringoplasty: What Are the Factors Influencing Hearing Gain?

Kolsi Naourez,Bouaziz Nawress,Ferjaoui Mahdi,Harrathi Khaled,Bouatay Rachida,Koubaa Jamel 대한청각학회 2022 Journal of Audiology & Otology Vol.26 No.4

Background and Objectives: We present the anatomical and functional results on the use of cartilage in myringoplasty and use the data to analyze the factors influencing hearing gain. Subjects and Methods: This retrospective study included 161 cases of cartilage myringoplasties collected over an 11-year period (2010-2020). Of the 161 cases, the etiology of the tympanic perforations was simple chronic otitis media in 154 (95.65%) ears and traumatic in 7 (4.35%) ears. The mean preoperative Rinne was 26.20±7.05 dB. The most commonly used approach was retroauricular, and the common graft material was tragal or conqual cartilage. Results: After the follow-up period (mean:15 months), the anatomical success rate was 93.2%; there were nine cases of reperforation, of which three were reoperated with a good final result. The hearing success rate (residual Rinne ≤20 dB) was 91.9% with an average gain of 11.48±8.62 dB. The only factor significantly influencing the anatomical outcome was the history of chronic rhinosinusitis. In univariate studies, several factors influencing the functional result were revealed; the only one retained after elimination of bias was the anatomical result. Conclusions: We recommend cartilage as the material of choice for myringoplasties as it has been shown to be resistant to predictive factors of failure after tympanic repair surgery. We recommend the adequate management of all chronic rhinosinusitis before performing myringoplasty.

Can Endoscopic Tympanoplasty Be a Good Alternative to Microscopic Tympanoplasty? A Systematic Review and Meta-Analysis

이상연,이도영,서유주,김영호 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.2

Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, –3.84 to –0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.

작은 크기의 만성고막천공 환자에서 자가지방조직과 연골막을 이용한 고막성형술 치료 성적의 비교

김정은,오솔길,장원익,박영주,박재홍,박무균,이종대,Tan Sokeng 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.5

Background and Objectives There are several techniques to perform myringoplasty for tympanic membrane perforations as an outpatient procedure. The aim of this study is to compare the results of fat and perichondrium myringoplasty for the treatment of chronic small tympanic membrane perforations. Subjects and Method This investigation included 46 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 2 main groups according to surgical procedures. The patients underwent fat, or perichondrium myringoplasty without skin incision via transcanal approach under local anesthesia. The healing results of perforation and hearing improvement were investigated. Results Closure rates of the perforations in the fat, perichondrium myringoplasty groups were all the same as 87% (20/23). There were no significant differences between techniques in tympanic membrane closure rates with regard to size and location and in hearing improvement. However, the recovery time was a little faster in perichondrium myringoplasty during follow up. Conclusion Conservative myringoplasty using fat and perichondrium is a feasible procedure that can be perfomed on outpatient basis for chronic small tympanic membrane perforations.

자가지방조직을 이용한 고막성형술의 치료성적

박철원,이상훈,이승환,안경성,정승원 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.9

중이수술후 발생한 고막천공에서 귓불지방을 이용한 고막성형술

우훈영,이종엽,김영민,이창환 대한이비인후과학회 2000 대한이비인후과학회지 두경부외과학 Vol.43 No.4

단순 내면이식 고막성형술의 임상적 유용성

김태군,권중근,강병철,김순준,김진일 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.9

Background and Objectives Recently, myringoplasty, which does not require elevation oftympanomeatal flap, has drawn attention again as a minimally invasive surgery. This studyassessed clinical usefulness of simple underlay myringoplasty in repairing dry perforated eardrumor chronic suppurative otitis media in aged and/or frail patients. Subjects and Method This retrospective study included patients who underwent simpleunderlay myringoplasty from February 1, 2017 to September 30, 2020, and who were monitoredfor more than 6 months after surgery. Major outcome measurements were determinedby graft success and hearing results. Results A total of 106 cases were studied. The overall graft success rate was 84.0% and themean air-bone gap decreased by 7.8 dB postoperatively. The graft take was quite successfuleven in the cases of recurrent or chronic otorrhea in aged (≥70 years old) and/or frail patients. Conclusion Simple underlay myringoplasty could be used as a minimally invasive surgeryin dry perforated eardrum. It could be also considered as the first surgical choice for recurrentor chronic otorrhea in chronic suppurative otitis media in aged and/or frail patients.