ENT - September 2020 - 523

Deniz et al

523

packing postoperatively causes severe conductive hearing loss,
resulting in transient social handicap for the patient.7,8
In the present study, we investigated the outcomes of bilateral same-day endoscopic myringoplasty using tragal cartilage
from one ear in 22 patients with bilateral chronic otitis media
(COM) and analyzed the possible factors affecting the outcomes of this surgery.

Materials and Methods
We retrospectively reviewed 67 patients aged between 18 and
65 years with bilateral TM perforations who underwent endoscopic myringoplasty under general anesthesia from January
2015 to December 2017. Retrospectively collected data
included patient age and sex, type (central/marginal) and site
of perforation regarding its relation to the handle of the malleus
(anterior/posterior/inferior), surgical procedure (unilateral/
bilateral same day), preoperative and postoperative hearing
levels, air-bone gaps (ABGs), graft take, and operation time.
Our exclusion criteria were presenting with discharging ear,
history of previous otologic surgery, ossicular defects, stapes
or malleus fixation, tympanosclerosis, or cholesteatoma and
being younger than 18 or older than 65 years old at the time
of surgery.
The patients were categorized into 2 groups based on the
surgical procedure: group 1 (44 patients) underwent unilateral
endoscopic myringoplasty and group 2 (23 patients) underwent
bilateral same-day endoscopic myringoplasty, both using the
underlay technique. Four patients in group 1 and 1 patient in
group 2 did not have follow-up data and thus were excluded
from further analysis, leaving 40 patients for group 1 and 22
patients for group 2.
The joint institutional review board approved the study protocol (decree no: 2018/250), and the study was conducted in
accordance with the ethical principles stated in the Declaration
of Helsinki. Prior to surgery, written informed consent was
obtained from all individual participants.
An endoscopic system (Karl Storz, Tuttlingen, Germany)
and 0 rigid endoscopes (3.0 mm diameter, 14 cm long; Karl
Storz) were used. Perforation edges were refreshed and a lateral
circumferential incision was performed 4 to 6 mm laterally
from the tympanic annulus. This incision was integrated with
radial incisions at the 6-o'clock and 12-o'clock positions. The
middle ear cavity was visualized after the tympanomeatal skin
flap was elevated. Ossicular continuity was evaluated by eliciting the round window reflex. In group 1, an incision through
the skin and cartilage was made on the medial side of the
tragus, leaving 2 mm of cartilage in the dome of the tragus for
cosmesis. Tragal cartilage was harvested with perichondrium
on both sides and the tragal cartilage perichondrium at its convex side was peeled. An absorbable material was used to suture
the incision. The cartilage graft was carefully thinned with a
scalpel and shaped according to the size and shape of the perforation (Figure 1). The graft was placed via the underlay technique after placing an absorbable gelatin sponge (AGS) medial
to the graft. After repositioning the tympanomeatal flap, the

Figure 1. Photograph showing harvested tragal cartilage with intact
perichondrium on both sides.

Figure 2. Photograph showing preparation of cartilage grafts for use
in bilateral perforations. Tragal cartilage obtained from one ear was
sliced into 2 pieces with the help of a #15 surgical scalpel.

external ear canal was packed with AGS. In group 2, to harvest
the tragal cartilage, perichondrium was used and kept intact on
both sides. The tragal cartilage obtained from one ear was
sliced into 2 pieces with the help of a #15 surgical scalpel
(Figure 2), and 2 pieces of cartilage graft were obtained
(Figure 3). One piece of cartilage graft was shaped according
to the size of perforation of the first ear. After placing AGS in
the middle ear cavity, the graft was placed using the underlay
technique. The tympanomeatal flap was then repositioned and
the external ear canal was packed with AGS. After surgery was
performed on the first ear, the head was turned to the opposite
side and a similar procedure was performed using the other
piece of the tragal cartilage graft. Mastoid dressing was not
necessary. The patients were discharged on the day of surgery.
Each patient was prescribed systemic antibiotics (amoxicillin/



ENT - September 2020

Table of Contents for the Digital Edition of ENT - September 2020

The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - Intro
ENT - September 2020 - Cover1
ENT - September 2020 - Cover2
ENT - September 2020 - 489
ENT - September 2020 - 490
ENT - September 2020 - 491
ENT - September 2020 - 492
ENT - September 2020 - 493
ENT - September 2020 - 494
ENT - September 2020 - 495
ENT - September 2020 - 496
ENT - September 2020 - 497
ENT - September 2020 - 498
ENT - September 2020 - 499
ENT - September 2020 - 500
ENT - September 2020 - The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
ENT - September 2020 - 502
ENT - September 2020 - Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
ENT - September 2020 - 504
ENT - September 2020 - Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
ENT - September 2020 - 506
ENT - September 2020 - 507
ENT - September 2020 - Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
ENT - September 2020 - 509
ENT - September 2020 - 510
ENT - September 2020 - 511
ENT - September 2020 - 512
ENT - September 2020 - Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
ENT - September 2020 - 514
ENT - September 2020 - 515
ENT - September 2020 - 516
ENT - September 2020 - 517
ENT - September 2020 - Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
ENT - September 2020 - 519
ENT - September 2020 - 520
ENT - September 2020 - 521
ENT - September 2020 - Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
ENT - September 2020 - 523
ENT - September 2020 - 524
ENT - September 2020 - 525
ENT - September 2020 - 526
ENT - September 2020 - 527
ENT - September 2020 - A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
ENT - September 2020 - 529
ENT - September 2020 - 530
ENT - September 2020 - 531
ENT - September 2020 - A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
ENT - September 2020 - 533
ENT - September 2020 - 534
ENT - September 2020 - 535
ENT - September 2020 - 536
ENT - September 2020 - Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
ENT - September 2020 - 538
ENT - September 2020 - 539
ENT - September 2020 - 540
ENT - September 2020 - 541
ENT - September 2020 - 542
ENT - September 2020 - Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - 544
ENT - September 2020 - 545
ENT - September 2020 - 546
ENT - September 2020 - 547
ENT - September 2020 - 548
ENT - September 2020 - 549
ENT - September 2020 - 550
ENT - September 2020 - 551
ENT - September 2020 - 552
ENT - September 2020 - Cover3
ENT - September 2020 - Cover4
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