Myringoplasty – May 23, 2024

Myringoplasty – May 23, 2024

The following Wispr digital otoscope video and image are obtained from a 43-year-old male attending a medical conference. He reports having complicated auditory issues and, as a young adult, underwent a procedure to help improve his hearing. While he continues to require hearing assistance, he reports the procedure was successful.

True or False

This subject has extensive myringosclerosis which is likely the etiology of his hearing deficits.

Answer: False

The Wispr image and video demonstrates extensive shiny, white “lumps” obscuring all bony landmarks of the subject’s tympanic membrane (TM). One gets the sense these are located just deep to the outer layer of his TM. While myringosclerosis can also be very extensive, it typically appears as white scarred areas on the superficial epithelium of the TM and does not impressively obscure the normal bony landmarks. A review of the images with an ENT specialist confirmed the subject of this case had a cartilage myringoplasty as part of the management of his complex hearing problems.

Cartilage myringoplasty may be performed for several indications including chronic perforations or conditions causing TM collapse. With its perichondrium intact, cartilage provides a good balance of stiffness to support the TM and elasticity to conduct sound. The surgeon may choose to harvest cartilage from a number of sites, including the patient’s own tragus or concha. Once the graft has been attached to the remnant TM, peripheral micro-vessels provide nutrients and help to minimize reabsorption. Hearing often improves with time as the graft continues to soften, enhancing its elasticity and sound conductive properties. The subject of this case reports significant hearing improvement following his surgery and was amazed at the Wispr otoscope being able to visualize the results of his procedure.

Here is the complete video exam.

Shekharappa MK, Siddappa SM. Cartilage Myringoplasty: An Ideal Grafting Technique for Complex Perforations. J Clin Diagn Res. 2017 Jul;11(7):MC06-MC08. doi: 10.7860/JCDR/2017/26877.10264. Epub 2017 Jul 1. PMID: 28892941; PMCID: PMC5583939.