Search Results (29)

This study aimed to design a bioabsorbable, biocompatible poly(lactic-co-glycolic acid) (PLGA)-based tissue stabilizer for a new tympanoplasty method and to evaluate its feasibility. A PLGA copolymer with a lactic acid: glycolic acid ratio of 50:50 was used to fabricate the stabilizers via melt molding using custom-designed molds. The surface morphology of the fabricated stabilizers was analyzed by scanning electron microscopy (SEM). In vitro degradation profiles were evaluated over a 60-day period in phosphate buffered saline (PBS), simulated body fluid (SBF), and trypsin environments, and biocompatibility was assessed using direct and indirect proliferation assays with human fibroblasts. SEM analyses revealed a smooth and homogeneous surface morphology. Degradation studies demonstrated a controlled and progressive decrease in residual mass over time. Cell proliferation assays indicated that the PLGA stabilizer exhibited no cytotoxic effects. In rabbit models, the tissue stabilizer improved fascia graft stabilization, resulting in more regular epithelialization and higher tympanic membrane closure rates compared with the control and fat myringoplasty groups. This approach may improve surgical efficiency and patient comfort by enabling shorter operative times, reduced surgical invasiveness, and the potential use of local anesthesia. Full article

Objectives: This study aimed to determine whether the surgical approach used significantly affected postoperative pain and quality of life. Methods: This retrospective study included 45 adult patients undergoing type I tympanoplasty for chronic tympanic membrane perforation. The patients were divided into two groups: transcanal (n = 24) and retroauricular (n = 21). Postoperative pain was assessed using the Wong–Baker FACES^® Pain Rating Scale. Additional outcomes included analgesic use and activity limitation. Results: The graft success rates in the transcanal and retroauricular groups were 95.8% and 95.2%, respectively. The transcanal group reported significantly lower pain scores between postoperative days 5 and 8 (p < 0.05) and discontinued analgesic use earlier (mean 3.1 versus 4.3 days; p < 0.05). Furthermore, the transcanal group had fewer activity limitation events during recovery. Operative time was significantly shorter in the transcanal group (55.4 ± 10.1 versus 90.2 ± 10.6 min; p < 0.001). No major complications were observed in either group. Conclusions: A transcanal approach is associated with reduced postoperative pain, earlier recovery, and shorter analgesic use than a retroauricular approach in tympanoplasty type I. Full article

Ear surgery has historically been performed with a microscope, an approach which often requires a post-auricular incision and represents a relatively invasive form of access to the middle ear. Over the past three decades, the advent of endoscopic techniques has allowed for a minimally invasive alternative. Endoscopic ear surgery (EES) has emerged as an innovative approach in otology, transforming the way surgeons address ear disorders and improving patient outcomes. EES provides enhanced visualization and exceptional precision during otologic procedures. This article examines the technical aspects of EES, its impact on contemporary otology practice, and the future direction of this technology. Full article

Background/Objectives: Mastoid obliteration (MO) after canal wall down (CWD) tympanoplasty for chronic otitis media with cholesteatoma (COMC) enables simultaneous surgical management of the pathology and shaping of a new external ear canal (EEC) that is similar to the natural one. The aim of the present work is to describe the results of a new MO technique that involves using homologous bone (HB) material and a Palva flap (“Cupeta technique”). Methods: A retrospective study was conducted on 12 patients undergoing MO for COMC, either during the same operation or in a second-time surgery after CWD. The surgical technique, patient demographics, audiometric data, the EEC volume, and clinical outcomes were analyzed. Results: The MO technique resulted in good outcomes in terms of healing at three months after surgery. Fewer clinical complications were observed compared with similar MO methods described in the literature. HB reabsorption was observed in two patients and was defined as only partial. Measurements of the EEC volume were normal in all patients. The preoperative and postoperative hearing thresholds were similar. Conclusions: Performing MO with the Cupeta technique after CWD is a suitable surgical management method for COMC and demonstrates good clinical postoperative results. We plan to conduct further studies with a longer follow-up and a larger group of patients in order to confirm our findings. Full article

Background: Chronic otitis media (COM) with tympanic perforation sometimes requires tympanoplasty. Many factors can interfere with surgical success; however, the histological status of the remaining epithelium of the perforation has not been studied as a risk factor for surgical failure. Methods: This was an observational, longitudinal, and analytical study in patients with COM, candidates for tympanoplasty who met the inclusion criteria, between August and December 2024. Tympanoplasty was performed, and the tympanic ring epithelium was sent for histological analysis. After 30 days, closure or non-closure of the perforation was determined, and the results were collected. Descriptive and analytical statistics were performed according to data distribution using the SPSS 26.0 statistical package. Results: Twenty subjects were included, 80% with tubal dysfunction, 60% with central perforation, and 65% with medium-sized. In total, 13 were successful, and 7 failed. Histopathological analysis revealed dystrophic calcification, chronic lymphocytic infiltrate, histiocytic infiltrate, fibrosis, loose keratin sheets, metaplasia, and spongiosis. The logistic regression model showed an OR of 7.3 for marginal perforation and 3.4 for the OPSS score. Of the patients with surgical failure, 57.4% had epithelial inflammation. Conclusions: epithelial inflammation affected surgical success in more than 50%. Full article

Objectives: This study aimed to investigate the impact of platelet-rich plasma (PRP) and platelet-rich gel (PRG) on tympanic membrane closure rates, hearing improvement, and quality of life following tympanoplasty. Methods: Seventy-two patients with chronic tympanic membrane perforations were enrolled in a double-blinded, randomized controlled trial at a single tertiary referral center. All patients underwent tympanoplasty using a temporalis fascia graft and were randomly assigned to one of two groups: one group received standard tympanoplasty alone, while the other received intraoperative application of autologous PRP and PRG, in addition to the standard procedure. Results: The PRP group demonstrated a significantly higher rate of complete tympanic membrane closure compared to the control group (32/36; 88.9% vs. 24/36; 66.7%; p < 0.05). Bone conduction hearing remained unchanged in both groups, while air conduction hearing improved significantly from pre- to post-treatment in each group. However, the difference in air conduction improvement between the PRP group and the control group was not statistically significant (PRP group: Mdn = −8.25; control group: Mdn = −12.20; U = 618; z = −0.54; p = 0.30). Quality of life improved in both the PRP and control groups; however, the difference between the groups was not statistically significant (PRP group: 10.44 ± 10.46; control group: 10.47 ± 8.22; 95% CI [−4.45; 4.40]; t(66) = −0.01; p = 0.16). Conclusions: Our findings suggest that intraoperative application of autologous PRP and PRG may improve tympanoplasty outcomes, particularly in cases with lower expected success rates or when performing minimally invasive transcanal procedures under local anesthesia. However, variability in PRP preparation, application methods, and graft materials across studies limits direct comparisons. Standardized protocols and further controlled studies are necessary to clarify PRP’s clinical value in tympanoplasty. Full article

Background/Objectives: Using transcanal endoscopic ear surgery to manage middle ear disease in children remains a controversial topic. The aim of this study was to compare the efficacy of transcanal endoscopic ear surgery between children and adults. Methods: The aim of this study was to compare the efficacy of transcanal endoscopic ear surgery between children and adults. Results: We observed no significant difference between pediatric and adult patients with regard to the rates of surgical success, postoperative hearing gain, and postoperative complications in all surgical procedures. As for ventilation tube insertion, the pediatric patients had shorter surgical times compared to adult patients. With respect to tympanoplasty, the pediatric group had a longer surgical time than adults did. Conclusions: Our study showed that transcanal endoscopic ear surgery can be successfully applied to manage various middle ear diseases in children. Full article

Background/Objectives: This study evaluates the anatomical and functional outcomes of type 1 tympanoplasty using an autologous two-piece perichondrium-cartilage (CP) graft in pediatric and adult patients with tympanic membrane (TM) perforations. Methods: A retrospective review of 74 patients (59 children, 15 adults) undergoing type 1 tympanoplasty with CP by a single surgeon (IF) was conducted. Preoperative and postoperative audiological outcomes, perforation size, prognostic factors, and complications were analyzed. Success was defined as an intact TM and an air–bone gap (ABG) < 20 dBHL at 12 months postoperatively. Results: TM closure was achieved in 93.2% of patients, with 93.1% attaining an ABG < 20 dBHL. The combined success rate was 86.3%, with no significant differences between children and adults. Larger perforations (>50%) had significantly lower closure rates (55.6% vs. >97%, p < 0.002). Children who underwent prior adenoidectomy had significantly higher success rates (p = 0.04). Conclusions: Tympanoplasty with a CP graft provides high success rates in both children and adults. The procedure can be performed from age five, considering patient cooperation. In children, simultaneous adenoidectomy is recommended if significant adenoid hypertrophy is present to optimize outcomes. Larger perforations were associated with reduced success, while age had no significant impact. Full article

Background/Objectives: The endoscopic repair of the tympanic membrane is an established method for addressing perforations in the tympanic membrane. However, there are limited studies in the literature examining the success rate of this procedure in the pediatric population. Methods: This study retrospectively analyzed data from the tertiary referral center at the University Hospital of Verona, Italy. This medical record contains data from 84 type 1 transcanal endoscopic tympanoplasties performed in pediatric patients between November 2014 and February 2022. Seventy-seven pediatric patients aged 4 to 16 years who underwent type 1 transcanal endoscopic tympanoplasty (seven of whom underwent bilateral surgery at different time points) were included in the study. Our study did not include more extensive procedures than type 1 endoscopic tympanoplasty. Only patients with tympanic membrane perforation due to simple chronic otitis media, trauma or when no apparent cause was found were included. Chronic otitis with cholesteatoma and other pathologies of the external or middle ear were exclusion criteria. Patients with a follow-up of less than 12 months were excluded from this study. The technique was based on the endoscopic placement of an underlay graft of temporal fascia or tragal cartilage to repair a tympanic membrane perforation. Demographic, clinical, audiologic, and surgical data were collected from each patient. In the study, we considered the reduction of the air-bone gap (ABG) as a functional outcome and the integrity of the reconstruction as an anatomic outcome of success. Results: The primary surgery had a closure rate of 92.9% (78 of 84). All patients underwent audiological evaluation 4–6 months post-surgery, with 84 ears tested. The mean preoperative ABG was 17.13 dB HL, reduced to 9.16 dB HL postoperatively, showing a mean reduction of 7.97 dB HL. No significant complications occurred. Conclusions: Transcanal endoscopic type 1 tympanoplasty should be considered a safe procedure with a high success rate for the repair of tympanic membrane perforations, even in pediatric patients. Full article

Ossiculoplasty (OPL) aims to restore ossicular chain continuity to improve hearing in patients with conductive or mixed hearing loss, often performed during tympanoplasty. The current training methods, including cadaveric temporal bone models, face challenges such as limited availability, high costs, and biological risks, prompting the exploration of alternative models. This study introduces a novel training platform for OPL using 3D-printed temporal bones and incudes, including a magnified (3:1) model to enhance skill acquisition. Sixty medical students were divided into two groups: one trained on magnified models before transitioning to real-sized ones, and the other used only real-sized models. Training performance was quantitatively assessed using post-remodeling cone-beam CT imaging and mesh distance analysis. The results showed a significant improvement in performance for students with preliminary training on magnified models (87% acceptable results vs. 37%, p = 0.001). Qualitative feedback indicated higher confidence and skill ratings in the magnified model group. This study highlights the effectiveness of scalable, anatomically accurate synthetic models for complex surgical training. While further validation is required with experienced trainees and broader scenarios, the findings support the integration of 3D printing technologies into otologic education, offering a cost-effective, reproducible, and innovative approach to enhancing surgical preparedness. Full article

Artificial Intelligence (AI) is a concept whose goal is to imitate human intellectual activity in computers. It emerged in the 1950s and has gone through three booms. We are in the third boom, and it will continue. Medical applications of AI include diagnosing otitis media from images of the eardrum, often outperforming human doctors. Temporal bone CT and MRI analyses also benefit from AI, with segmentation accuracy improved in anatomically significant structures or diagnostic accuracy improved in conditions such as otosclerosis and vestibular schwannoma. In treatment, AI predicts hearing outcomes for sudden sensorineural hearing loss and post-operative hearing outcomes for patients who have undergone tympanoplasty. AI helps patients with hearing aids hear in challenging situations, such as in noisy environments or when multiple people are speaking. It also provides fitting information to help improve hearing with hearing aids. AI also improves cochlear implant mapping and outcome prediction, even in cases of cochlear malformation. Future trends include generative AI, such as ChatGPT, which can provide medical advice and information, although its reliability and application in clinical settings requires further investigation. Full article

Background: This study presents a comprehensive analysis of cholesteatoma of the middle ear, focusing on its clinical presentation, diagnostic imaging, and treatment outcomes. Cholesteatomas are defined by the keratinized squamous epithelium within the middle ear, leading to significant bone erosion, often affecting the ossicular chain and surrounding structures. Methods: The study explores various mechanisms involved in cholesteatoma progression, including enzymatic lysis, inflammatory responses, and neurotrophic disturbances. The study conducted a retrospective clinical and statistical review of 580 patients over a 20-year period (2003–2023), highlighting the role of advanced imaging, including computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI), in preoperative planning and postoperative follow-up. Results: Findings revealed that early detection and intervention are crucial in preventing severe complications such as intracranial infection and hearing loss. Surgical treatment primarily involved tympanoplasty and mastoidectomy, with a recurrence rate of 1.55% within two years. The study underscores the importance of integrating imaging advancements into clinical decision-making to enhance patient outcomes and suggests further investigation into molecular mechanisms underlying cholesteatoma progression and recurrence. Histopathological and microbiological analysis was performed to identify pathological patterns and microbial agents. Conclusions: The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients. Full article

Cholesteatoma is a benign tumor of the middle ear. Tympanoplasty is performed to remove cholesteatoma, prevent recurrence, and avoid complications. Previously, microscopy was used for tympanoplasty; however, endoscopy has become increasingly popular for this procedure. The effectiveness of endoscopy and the appropriate candidacy for endoscopic ear surgery remain controversial. In this retrospective chart review study, we enrolled 107 patients with cholesteatoma who underwent tympanoplasty and compared the microscopic approach (71 patients) and the endoscopic approach (36 patients) at different stages to clarify the benefits of using endoscopy and to determine candidacy for endoscopic ear surgery. Approach selection, complication rate, recurrence rate, and postoperative hearing threshold were compared between microscopic and endoscopic approaches in stages I, II, and III. Endoscopy was used more often than microscopy for early-stage (stage I) cholesteatoma (p = 0.005) and less frequently for advanced-stage (stage II) cholesteatoma (p = 0.02). Endoscopy surgery resulted in chorda tympani injury less often than microscopic surgery (p = 0.049); however, there were no significant differences between these two groups in terms of recurrence rate or postoperative hearing outcome. Endoscopy is particularly useful for early-stage cholesteatoma, and both approaches show no difference in hearing outcome in stage I and II; nevertheless, further research is required to determine an appropriate approach for more advanced stages (stage III). Full article

Background: The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not indicated for all cases with mastoid extension. In addition, predicting the extent of external auditory canal (EAC) removal needed for cholesteatoma resection is not always easy. The purpose of this study was to use augmented reality (AR) to project the lesion onto an intraoperative endoscopic image to predict EAC removal requirements and select an appropriate surgical approach. Methods: In this study, patients showing mastoid extension were operated on using a navigation system with an AR function (Stryker). Results: The results showed that some cases with lesions slightly extending into the antrum required extensive resection of the EAC, while cases with lesions extending throughout the antrum required smaller resection of the EAC, indicating TEES. Conclusions: By predicting the extent of the needed EAC removal, it is possible to determine whether TEES (a retrograde approach) or canal wall-up mastoidectomy, which preserves as much of the EAC as possible, should be performed. We believe that our findings will contribute to the success of middle ear surgeries and the implementation of robotic surgery in the future. Full article