A Post-Tympanoplasty Evaluation of the Factors Affecting Development of Myringosclerosis in the Graft: A Clinical Study

Abstract

OBJECTIVE: Myringosclerosis (MS) is a pathological condition characterized by hyaline degeneration and calcification of the collagenous structure of the fibrotic layer of the tympanic membrane, which may develop after trauma, infection, or inflammation as myringotomy, insertion of a ventilation tube, or myringoplasty. The aim of our study was to both reveal and evaluate the impact of the factors that might be effective on the post-tympanoplasty development of myringosclerosis in the graft. MATERIALS and METHODS:In line with this objective, a total of 108 patients (44 males and 64 females) aged between 11 and 66 years (mean age, 29.5 years) who had undergone type 1 tympanoplasty (TP) with an intact canal wall technique and type 2 TP, followed up for an average of 38.8 months, were evaluated. In the presence of myringosclerosis, in consideration of the tympanic membrane (TM) quadrants involved, the influential factors were analyzed in our study, together with the development of myringosclerosis, including preoperative factors, such as the presence of myringosclerosis in the residual and also contralateral tympanic membrane, extent and location of the perforation, and perioperative factors, such as tympanosclerosis in the middle ear and mastoid cavity, cholesteatoma, granulation tissue, and type of the operation performed. For statistical analysis of data, independent samples t-test was used. RESULTS:Our study comprised 44 male and 64 female patients. Median postoperative follow-up period was estimated as 38.8 months. The rate of postoperative development of myringosclerosis in grafts was significantly higher in patients with already existing sclerotic foci in TM (p=0.001). The location of the perforation had no effect on the postoperative development of MS in the graft (p=0.521). No statistically significant difference was detected between the size of the perforation and formation of MS (p=0.581). Statistical analysis of both groups could not discern any significant intergroup difference as to the impact of the presence or absence of cholesteatoma on the development and extent of MS (p=0.604). Impact of tympanosclerosis on the postoperative development and extent of MS in the graft was significant (p=0.001). Presence or absence of granulation tissue on the development or extent of myringosclerosis was not detected (p=0.697). Myringosclerotic foci in the contralateral ears had a statistically significant effect on the postoperative development and extent of MS in the grafts (p=0.001). Type of surgery performed did not exert any significant effect on the development or extent of myringosclerosis (p=0.765). CONCLUSION:We have determined that the presence of myringosclerosis in the residual membrane and in the contralateral tympanic membrane and tympanosclerosis in the middle ear have a significant role in the development of postoperative myringosclerosis in the tympanic membrane, contrary to the type of the surgical intervention, location and extent of perforation, presence of cholesteatoma, and granulation tissue.

Investigation of myringosclerosis development in different grafting materials after myringo-/tympanoplasty

“…In a recent study, Ozbay et al [16] demonstrated that the presence of MS in the residual membrane and in the contralateral tympanic membrane and tympanosclerosis in the middle ear cleft have a significant role in the development of postoperative MS in the neo-tympanum. Additionally they also determined that type of the surgical intervention, location and extent of perforation, presence of cholesteatoma, and granulation tissue in the middle ear have no significant role in the development of postoperative MS in the neo-tympanum.…”