Tympanic Membrane Perforation Clinical Trial
Official title:
Evaluation of Prognostic Factors and Middle Ear Risk Index in Tympanoplasty
Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum
and/or the ossicles. Tympanoplasty is classified into five different types, originally
described by Horst Ludwig Wullstein. 1,2 Type 1 involves repair of the tympanic membrane
alone, when the middle ear is normal. A type 1 tympanoplasty is synonymous to myringoplasty,
Type 2 involves repair of the tympanic membrane and middle ear in spite of slight defects in
the middle ear ossicles, Type 3 when mallus and incus are absent graft place directly on
stapes head., Type 4 describes a repair when the stapes foot plate is movable, but the crura
are missing. The resulting middle ear will only consist of the Eustachian tube and
hypotympanum, Type 5 is a repair involving a fixed stapes footplate.
There are various prognostic factors reported in the literature that may influence the
surgical success of tympanoplasty.
Some studies report significance for some of these factors whereas others report the
contrary. The reported incidence of surgical success of tympanoplasty ranges from 60% to 99%
in adults Belluci described four separate stages for prognosis of tympanoplasty 4 according
to otorrhea
. Austin proposed a prognostic stratification according to disease categories, stage
categories, and disease descriptors.
Black introduced the surgical, prosthetic, infection, tissues, and eustachian tube system
(SPITE), and more recently Kartush developed middle ear risk index (MERI).
Smoking is added as a middle ear risk. Furthermore, cholesteatoma and granulation tissue or
effusion risk value has been increased in MERI 2001.
Prognostic factors such as age, sex, presence of systemic diseases, location and size of
perforation, duration of dry period, presence of myringosclerosis, presence of septal and
conchal pathology, operation type, and status of the opposite ear and middle ear risk index
were investigated. 9
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