Kozin Elliott D, Lee Daniel J, Remenschneider Aaron K
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
OTO Open. 2019 Aug 27;3(3):2473974X19869911. doi: 10.1177/2473974X19869911. eCollection 2019 Jul-Sep.
Tympanic membrane (TM) perforations may result in significant patient morbidity. While intraoperative myringoplasty or tympanoplasty allow for effective repair, not all patients are candidates for general anesthesia. Herein, we describe a novel graft design and technique for in-office repair of TM perforations in the clinic setting. Two pieces of porcine submucosa material were interdigitated to create a bilayer design with lateral and medial flanges. Topical and injected lidocaine were used for local anesthesia. The perforation was rimmed. Grafts were grasped, and medial flanges were placed through the perforation, with lateral flanges resting on the TM surface. TM repair occurred in 5 awake patients with a mean age of 72 years. There were no complications. All perforations healed, with 1 case requiring a minor in-office revision. Audiometry was performed at 4 weeks. The preoperative air-bone gap (mean 0.25, 0.5, 1, 2, and 4 kHz) was 12.2 ± 4.1 dB, and postoperatively, it was 4.2 ± 2.4 dB ( = .001). Novel design of available graft material may allow for effective in-office TM repair.
鼓膜（TM）穿孔可能导致患者出现明显的发病率。虽然术中鼓膜成形术或鼓室成形术可实现有效的修复，但并非所有患者都适合全身麻醉。在此，我们描述一种用于在临床环境中在诊室修复TM穿孔的新型移植物设计和技术。将两片猪黏膜下层材料相互交错以形成具有外侧和内侧凸缘的双层设计。使用局部和注射用利多卡因进行局部麻醉。对穿孔边缘进行处理。抓取移植物，将内侧凸缘穿过穿孔放置，外侧凸缘置于TM表面。5名平均年龄为72岁的清醒患者进行了TM修复。未出现并发症。所有穿孔均愈合，1例患者需要在诊室进行 minor in-office revision。在4周时进行了听力测定。术前气骨导间距（平均0.25、0.5、1、2和4 kHz）为12.2±4.1 dB，术后为4.2±2.4 dB（P = 0.001）。可用移植物材料的新颖设计可能允许在诊室有效地修复TM。 （注：“minor in-office revision”此处原文未准确解释其含义，暂保留英文。）
