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Table of Contents
CLINICAL CASE REPORT
Year : 2010  |  Volume : 12  |  Issue : 2  |  Page : 73-75

The outcome of myringoplasty in a residency training program in Saudi Arabia


Department of Otolaryngology &Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi Arabia

Date of Web Publication2-Jan-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.274636

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  Abstract 


Objective: The purpose of this study was to evaluate the outcome of myringoplasty performed by residents in a training program in a tertiary referral hospital in Saudi Arabia, and to compare the results with other published reports in the literature. Design: A retrospective chart review. Setting: King Abdulaziz University Hospital, Riyadh, Saudi Arabia.
Patients & Methods: A retrospective chart review of 356 patients who underwent myringoplasty as a primary surgery between January 2002 and December 2007. Cases involving cholesteatoma, retraction pocket or ossicular chain reconstructions were excluded. Dry ear and intact tympanic membrane were considered to be successful outcome.
Results: Closure of perforation was achieved in 87.9% of the ears and 81.5 % of patients achieved postoperative air bone gap closure to <20 dB.
Conclusion: The success rate of myringoplasty performed by residents in our centre is comparable to other published reports.

Keywords: Myringoplasty, resident training.


How to cite this article:
Alsanosi A. The outcome of myringoplasty in a residency training program in Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2010;12:73-5

How to cite this URL:
Alsanosi A. The outcome of myringoplasty in a residency training program in Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2010 [cited 2022 Nov 30];12:73-5. Available from: https://www.sjohns.org/text.asp?2010/12/2/73/274636




  Introduction Top


The otolaryngology training program of our institute was the first one to be established in the country and it has been going on for more than two decades. As a general rule, the residents start to get involved in ear surgery by the 2nd year of training. Prior to doing ear surgery, they should have done at least one temporal bone dissection course in order to be familiar with the anatomy of the temporal bone and should have mastered simple microscopic ear procedures (myringotomy, ventilation tube insertion, suction clearance etc.). After assisting in some tympanoplasties and mastoidectomies the resident will be given the chance to do ear surgery under strict supervision of a staff member or a senior resident.

Myringoplasty has been generally considered to be a relatively easy operation performed by residents and senior surgeons in training institutes. It is considered to be the first middle surgery to be done by resident in training [1].

Despite the high success rate and the routine nature of this procedure, the relative role of many factors on the outcome remains unresolved [2]. These factors include the age of the patient, site and size of perforation, the length of time the ear has been dry prior to surgery, presence of infection at the time of surgery and status of the opposite ear.

The purpose of this study was to evaluate outcomes of myringoplasty in the residency training program in a-tertiary referral hospital in Saudi Arabia and compare that with other published reports in the literature.


  Materials and Methods Top


The charts of five hundred patients who had myringo-plasty between January 2002 and January 2007 were analyzed. Only patients who had myringoplasty as the only procedure for a dry ear, normal looking middle ear mucosa on the day of surgery, were operated by residents, and have been followed for minimum of 12 months were studied. Patients who had previous ear surgery for chronic otitis media, cholesteatoma or ossicular chain immobility or discontinuity were excluded.

Data collected included age of the patient, size of the perforation, and the hearing outcome. The size of perforation was classified into small and large (less than 50% or more than 50 % of tympanic membrane), respectively. The preoperative and the postoperative air bone gap ( ABG) over 500,1000,2000,4000 Hz were classified into three subtypes <20 dB, ( 20-30) dB and >30 dB. The outcome of surgery was considered successful if the tympanic membrane was intact and the average ABG of < 20 dB at 12 months postoperative in the operated ear.

Statistical analysis:

SPSS ( 16.0) was used for analysis.

Surgical procedure:

All patients were operated under general anesthesia through postauricualr approach. The temporalis fascia was used for repair of tympanic membrane. The graft was inserted using underlay technique (either medial or lateral to the handle of malleus). Postoperatively, patients were seen a week after surgery for removal of stitches and the ear wick. The following visit is carried out after 6 weeks to assess the status of tympanic membrane and the hearing by doing pure tone audiogram. Patients then are followed after 3 months, 6 months and 12 months.


  Results Top


Three hundred fifty six patients met the inclusion criteria with age range 6 and 65 years and the mean age was 29.55 years. The tympanic membrane closure was achieved in 87.9% and 12.1% failed . The size of tympanic perforation was found to be small 53.7%) and large in 46.3% of cases and the relation between the perforation closure rate and size of pefroration is shown in [Table 1]. The preoperative and postoperative hearing result is shown in [Table 2]. In general, the success rate of myringoplasty done by residents at our institute was 87.9%.
Table 1: Preoperative and postoperative air bone gap

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Table 2: The relation between size of perforation and closure of tympanic membrane

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  Discussion Top


In this study we analyze our result of myringoplasty in a tertiary and training center where most of these procedures are done by residents. Many factors influencing the outcome of myringoplasty including age, sex, status of ear at the time of surgery, site and size of perforation and experience of surgeons, but their role is still unclear [3],[4].

In the literature, there are some variations on the effect of the surgeons’ experiences on the results of tympanoplasty. Ophir et al found that the results on pediatric age group ears operated on by residents were considerably poorer than those ears operated on by staff members [5]. On the contrary, other authors reported that the success rate was significantly poorer in ears operated by senior surgeon [6]. In between, however, there are reports that the outcome in terms of an intact tympanic membrane and hearing results in those ears operated upon by residents were statistically equal to those operated on by the faculty staff [7],[8]. In another study, between 88.4% to 90.74% [9]; our result fell within that range . Many authors in the last few years have continued to find no association between patients’ age and successful tympanoplasty and our result is compatible with that. On the other hand, children younger than 16 years old had a significant decrease in the success of the graft when compared with adults (83.2% compared with 89.5 %). Moreover, children in this study actually had significantly better postoperative hearing in terms of closure of the air-bone gap and hearing gain when compared with adults [10]. In our study, the majority of patients were adult and only 49 were children (less than 18 years). By comparison, both overlay and underlay techniques, as well as transcanal and postauricular approaches were the same. Both overlay and postauricular techniques were found to have significantly higher rates of success [11], in our study there was no correlation between technique and the result of myringoplasty. The outcomes of middle ear surgery are influenced by multiple factors; one of them is the experience of surgeon and his surgical skills which require both theoretical knowledge and developing technical skills. These skills are acquired by attending temporal bone dissection courses and learning the anatomy of temporal bone.


  Conclusion Top


In general, the performance of residents at our local training program with special interest to myringoplasty is successful and fell within international range..

Acknowledgment

The author acknowledges Prince Sultan Research Chair for Hearing Disability, Faculty of Medicine, King Saud University for the support it made in data collection and statistical analysis.



 
  References Top

1.
Eero Vartianen E, Nuutinen J. Success and pitfalls in myringoplasty: follow-up study of 404 cases. Am J Otol. 1993;14:301-305.  Back to cited text no. 1
    
2.
Adkins WY, White B. Type 1 tympanoplasty: influencing factors. Laryngoscope. 1984; 94:916-918.  Back to cited text no. 2
    
3.
Pignataro L, Berta LGD, Capaccio P, Zagthis A. Myringoplasty in children : anatomical and functional result. J Laryngol Otol. 2001; 115:369-373.  Back to cited text no. 3
    
4.
Caylan R, Titiz A, Falcioni M, Dedonato G, Russo Taibah AA. Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg. 1998; 118:709-713.  Back to cited text no. 4
    
5.
Ophir D, Porat M, Marshak G. Myringoplasty in paediatric population. Arch Otolaryngol Head Neck Surg. 1987;113:1288-1290.  Back to cited text no. 5
    
6.
Emir H, Ceylan K, Kizilkaya Z, et al. Success is a matter of experience: type 1 tympanoplasty: influencing factors on type 1 tympanoplasty. Eur Arch Otorhinolaryngol. 2007; 264:595-599.  Back to cited text no. 6
    
7.
De S, Karkanevatos A, Srinivasan VR, Lesser THJ. Myringoplasty using subcutaneous soft tissue graft. Clin Otolaryngol. 2004; 29:314-317.  Back to cited text no. 7
    
8.
Merenda D, Koike K, Shafiei M, Ramadan H. Tympanometric volume: a predictor of success of tympanoplasty in children. Otolaryngol Head Neck Surg. 2007; 136:189-92.  Back to cited text no. 8
    
9.
Erkati Karatas, MD; Cengiz Durucu, MD; Tekin Baglam, MD; Yildirim A. Bayazit, MD; Semih Mumbug, MD; Muzaffer Kanlikama, MD. Outcomes of Otologic Surgeries With Special Interest in Learning Curves of Residents in a Tertiary Referral Setting. Ann Otol Rhinol Laryngol. 2008;117(2): 103-105.  Back to cited text no. 9
    
10.
Podoshin L, Fradis M, Malatskey S, Ben-David J. Type 1 tympanoplasty in children. Am J Otol. 1996;17:293-296.  Back to cited text no. 10
    
11.
Albera R, Ferrero V, Lacilla M, Canale A. Tympanic reperforation in myringoplasty: evaluation of prognostic factors. Ann Otol Rhinol Laryngol. 2006; 115:875-879.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Materials and Me...
Results
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