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Simple in-office closure of small intractable tympanic membrane perforations after myringoplasty
1Department of Otorhinolaryngology, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract:
Perforations produced following myringoplasty are very difficult to close by ordinary cautery or patching even if they are small. Therefore we decided to close these intractable perforations with a skin graft from the cartilaginous ear canal. Our method is an in-office operation under local anesthesia. After the removal of epithelium from around the perforation a skin graft was placed by the over-lay method. A total of 11 patients were treated, of which 81.8% (9/11) demonstrated successful closure in the initial surgery and two re-perforations were successfully closed by a second and third operation, respectively. The technique used in this surgery is relatively easy and appropriate for in-office operations. The method's advantages include decreased invasiveness with minimal anesthesia and no requirement for ear canal packing or fixatives, and cosmetic benefit. This method also can be applied to perforations caused by chronic otitis media, traumatic perforations, and perforations after inserting tubes.
Insights
This study introduces a minimally invasive technique using ear canal skin grafts to close difficult ear drum perforations. The in-office procedure offers a high success rate for treating persistent tympanic membrane perforations.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Regenerative Medicine
Background:
- Myringoplasty often fails to close persistent tympanic membrane perforations.
- Standard closure methods like cautery or patching are frequently ineffective for intractable perforations.
Purpose of the Study:
- To evaluate the efficacy of using a skin graft from the cartilaginous ear canal for closing intractable tympanic membrane perforations.
- To present a minimally invasive, in-office surgical technique for tympanic membrane perforation repair.
Main Methods:
- An in-office procedure under local anesthesia was performed.
- Epithelium surrounding the perforation was removed, followed by the overlay placement of a skin graft from the cartilaginous ear canal.
- The technique was applied to 11 patients with persistent tympanic membrane perforations.
Main Results:
- Successful closure was achieved in 81.8% (9/11) of patients during the initial surgery.
- Two cases of re-perforation were successfully managed with subsequent operations.
- The technique demonstrated ease of performance and suitability for an office setting.
Conclusions:
- Skin grafting from the cartilaginous ear canal is an effective and minimally invasive method for closing intractable tympanic membrane perforations.
- This technique offers advantages such as local anesthesia, reduced invasiveness, and cosmetic benefits.
- The method is applicable to various perforation types, including those from chronic otitis media and trauma.
