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Myringoplasty Techniques
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
6 sections · 86 slides
Definitions and Goals
- Definition of myringoplasty
- Definition of tympanoplasty
- Two routes to closing a perforation
- Settings in which myringoplasty is performed
- Goals of myringoplasty
- Evidence for myringoplasty in acute perforation
Historical Development
- Earliest attempts at tympanic membrane repair
- Origin of the term tympanoplasty
- Nineteenth century surgery for conductive loss
- Reasons for opposition to hearing surgery
- Infection surgery contemporaneous with hearing surgery
- Revival of surgery for hearing loss
- Two basic principles of tympanoplasty
- German origins of tympanoplasty for chronic otitis media
- Evolution of grafting materials
- Development of ossicular reconstruction
- Modern ossicular prostheses
Patient Assessment
- Normal tympanic membrane at otoscopy
- Causes of tympanic membrane perforation
- Elements of the history
- Otomicroscopic examination of the perforation
- Contralateral ear and audiological workup
- Medical optimisation before repair
- Subtotal perforation of the right tympanic membrane
- Indications for myringoplasty
- Contraindications for myringoplasty
- Canal stenosis as a relative contraindication
Principles and Office Technique
- Kartush's three guiding principles
- Office procedure: preparation
- Freshening the perforation edges
- Sequence of office myringoplasty
- Freshening the rim of the perforation
Grafting Techniques
- Chemical cauterization of the perforation
- Silver nitrate cauterization
- Paper patch myringoplasty
- Securing and sizing the patch
- Synthetic patch materials
- Silicone tympanic membrane patcher
- Limits of cautery and patch techniques
- Fat graft myringoplasty
- Harvesting the fat graft
- Placing the fat graft
- Fat graft with hyaluronic acid
- Gelfoam myringoplasty
- Outcomes with Gelfoam plugging
- Removing a retained tympanostomy tube
- Gelfoam packed into the perforation
- Cartilage butterfly inlay myringoplasty
- Seating and results of the butterfly graft
- Endoscopic myringoplasty
- Advantages of the angled endoscope
- Rationale for growth factor therapy
- Evidence for growth factors
Aftercare, Complications and Outcomes
- Postoperative management
- Follow-up schedule
- Complications of myringoplasty
- Infection after myringoplasty
- Nerve and vestibular risks
- Hearing in the early postoperative period
- Swedish national registry outcomes
- Aetiology as a predictor of closure
- Tube and patient factors affecting closure
- Closure by graft material
- Factors found not to affect outcome
- What determines success
- Conclusions
- Key numbers to remember
- Choosing a technique by perforation size
- References
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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