Use of multilayer auto- and allografts for repair  of tympanic membrane defects

Dvoryanchikov, V. V.; Kireev, P.V.; Balatskaya, K. A.; Tkachuk, I. V.; Korovin, P. A.

doi:10.18692/1810-4800-2021-6-41-47

2021

DOI: 10.18692/1810-4800-2021-6-41-47

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Use of multilayer auto- and allografts for repair of tympanic membrane defects

V. V. Dvoryanchikov¹,

P.V. Kireev²,

K. A. Balatskaya³

et al.

Abstract: There is the large number of publications on the short- and long-term anatomical and functional outcomes of using different grafts in the closing of total and subtotal tympanic membrane defects. This confirms the continuing relevance of choosing the material for a graft. During the study done in the otorhinolaryngology clinic of the Kirov Military Medical Academy, we had analyzed the results of different cartilage grafts in myringoplasty: auricular autocartilage, nasal septum autocartilage, and allogeneic tiss… Show more

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On the issue of effective engraftment of tissues in the plastic of the tympanic membrane

et al. 2022

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For a long time for otolaryngologists, the issues of identifying and treating such a formidable disease as chronic suppurative otitis media (CSOM) have been topical. This disease still haunts many specialists, as it leads to acquired hearing loss in people of working age. Only in the last ten years, the number of children of younger age groups with already manifested acquired hearing loss has increased. Along with the correct and timely diagnosis, it is very important to cure this disease once and for all, since exacerbations often disrupt not only the performance, but also the quality of life of the patient. The gold standard for the treatment of patients with CHSO is surgical – tympanoplasty. In the process of studying the pathological process in chronic suppurative otitis media and methods of its more effective surgical treatment, the results of tympanoplasty were analyzed. An illustrative clinical example has been chosen, with the help of which it is possible to trace all the stages of surgical intervention in chronic suppurative otitis media. An otoscopic examination was carried out at several stages of observation of this patient, as well as the determination of auditory function. The presented clinical case shows step by step the effectiveness of the scheme of surgical treatment and postoperative management. Thus, these steps are applicable to any myringoplasty with tympanic membrane defects of any size. It is tympanoplasty and control in the postoperative period that makes it possible to completely close the defect of the tympanic membrane and prevent chronic otitis media from recurring.

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On the issue of effective engraftment of tissues in the plastic of the tympanic membrane

et al. 2022

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On the issue of preoperative preparation of patients with chronic suppurative otitis media

2023

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Introduction. In the otosurgeon practice, there are often cases of exacerbation of chronic suppurative otitis media (CSOM) refractory to conservative therapy. The direct irritant effect of gastric contents due to the gastroesophageal reflux disease (GERD) often leads to alteration of the middle ear mucosa and persistence of the inflammation process.Aim. To substantiate the significance of GERD therapy in the treatment of CSOM exacerbation refractory to the standard conservative therapy protocols.Materials and methods. The study group included 42 patients aged 19 to 67 years (mean age 47.6 years), 13 men and 29 women, who received treatment and daily observations of the attending otorhinolaryngologist. Of these, 31 patients were users of oral nicotine products (chewing gum, smoking, tobacco heating systems). The conservative treatment of CSOM was carried out in accordance with the medical care standards and clinical guidelines as in force on the time of the treatment process. The conservative treatment of GERD was carried out in accordance with the clinical guidelines approved by the Russian Gastroenterological Association.Results and discussion. 25 patients were diagnosed with isolated incompetence of the gastric cardia, 13 — with incompetence of the gastric cardia accompanied by reflux esophagitis, 4 — with hiatal hernia. The efficacy of anti-reflux therapy for chronic otitis media exacerbation was assessed on Day 10 after start of the therapy. Due to the gastroenterological therapy, the “dry” ear status could be achieved in 34 patients, which made it possible to offer them reconstructive intervention in the future. 5 patients achieved the CSOM remission by the end of the first month of anti-reflux therapy. 3 patients failed to achieve the state of CSOM remissionConclusions. The high efficacy of anti-reflux therapy for the management of CHSO exacerbation refractory to the standard conservative therapy regimens at the level of 81% allows us to recommend further research to prove the causal relationship between GERD and ineffectiveness of treatment of ear pathology.

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The use of a combined flap in closed-type tympanoplasty

Komarov,

Dvorianchikov,

Anikin

2023

Medicinskij sovet

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Introduction. Cartilage graft has been used in otosurgery since 1959. Cartilage resistance to pressure drops in the tympanic cavity and blood supply deficit in the early postoperative period favorably distinguish it from autofascia. When performing myringoplasty, it is important to create conditions for the formation of a neotympanic membrane that has the same three-dimensional spatial configuration as the native tympanic membrane with full contact of the membrane with the bone tympanic ring and the handle of the malleus. Also, the formation of the neotympanic membrane (myringoplasty) is a key step in tympanoplasty with ossiculoplasty, which ensures not only the restoration of the tightness of the tympanic membrane, but also the contact and proper fixation of the distal part of the prosthesis used to replace the lost elements of the auditory ossicular chain.Objective. Evaluate the effectiveness of closed-type tympanoplasty by using a combined autofascial-autocartilaginous flap.Materials and methods. A study group was formed, including patients who underwent tympanoplasty of types 1–3 according to M. Tos according to the proposed method of using an autofascial-autocartilaginous flap (343 patients), and a comparison group, including patients who underwent type 1 tympanoplasty with using autofascia (54 patients).Results. Long-term anatomical results showed greater stability of the neotympanic membrane formed by the proposed method (2% reperforations). Functional results in the range of speech frequencies had no significant differences. Comparison of functional results in the high frequency range demonstrated a significant advantage of the proposed technique.Conclusion. The conclusion is drawn that the proposed method of forming a neotympanic membrane close in configuration to the native tympanic membrane provides a high functional result with a reduction in the gap in sound conduction between the diseased and healthy ear to 5–10 dB at frequencies of 0.5–16 kHz.

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Use of multilayer auto- and allografts for repair of tympanic membrane defects

Cited by 4 publications

References 0 publications

On the issue of effective engraftment of tissues in the plastic of the tympanic membrane

On the issue of effective engraftment of tissues in the plastic of the tympanic membrane

On the issue of preoperative preparation of patients with chronic suppurative otitis media

The use of a combined flap in closed-type tympanoplasty

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