Publications by authors named "Es-Hak Bedri"

6 Publications

  • Page 1 of 1

Concerns of Patients With Ménière Disease in Ethiopia, India, and the United States.

JAMA Otolaryngol Head Neck Surg 2020 05;146(5):496-497

Department of Otolaryngology-Head and Neck Surgery, University of Illinois Hospitals, Chicago, Chicago.

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May 2020

The effect of surgeon experience on tympanic membrane closure.

Laryngoscope Investig Otolaryngol 2019 Oct 27;4(5):526-531. Epub 2019 Jul 27.

Department of OHNS University of Illinois-Chicago Chicago Illinois U.S.A.

Objective: Review of the English language literature finds little documentation of the relation of otology or otolaryngology outcomes to a surgeon's age, years in practice, or numbers of cases previously performed. Because of one surgeon's adoption of a new tympanoplasty technique for uncomplicated tympanic membrane perforations, our institution was situated to report an example of a surgical learning curve with its outcome. Experience versus outcome is worth establishing objectively because these relationships reflect on training and certification.

Design: This retrospective review of the medical records tallied preoperative risk factors and perforation sizes for four consecutive 100-blocks of double-layer tympanoplasties.

Setting: An otology specialty care facility in Addis Ababa, Ethiopia.

Participants: Participants were 359 patients with tympanic membrane perforations without ossicular discontinuity or erosion who underwent 400 primary simple tympanoplasties.

Intervention: A double-layer tympanoplasty was performed in each operation using an endaural approach.

Outcome Measures: The outcomes were closure of the perforation and change in hearing.

Results: There were no statistically significant differences between the four 100-block case cohorts in preoperative risk factors and perforation sizes. Preoperative, postoperative, and change of hearing were also the same between the four groups; and statistically there was no significant difference between the four 100-block cohorts. Perforation closure for each successive 100-block increased from 74% to 98%. The closure rates of the second, third, and fourth 100-block were each statistically significantly different from the first 100-block, but not from each other.

Conclusion: This simple study demonstrates the surgical learning curve with increased surgeon experience, and is one of very few such documentations. With each additional 100 cases, the outcomes improved, and sheds light on the numbers of cases necessary for competency.

Level Of Evidence: 3.
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October 2019

Double-Layer Tympanic Membrane Graft in Type I Tympanoplasty.

Ann Otol Rhinol Laryngol 2019 Sep 16;128(9):795-801. Epub 2019 Apr 16.

4 Addis Ababa University, Tikkur Anbessa, Addis Ababa, Ethiopia.

Background: Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques.

Materials And Methods: A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement.

Results: A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( < .0001). Preoperative hearing levels ( = .179), postoperative hearing ( = .857), and decibels of hearing improvement ( = .356) were the same for all 3 groups.

Conclusion: Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.
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September 2019

Ossicular Chain Reconstruction in a Developing Country.

Ann Otol Rhinol Laryngol 2018 May 5;127(5):306-311. Epub 2018 Mar 5.

1 University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.

Objectives: In Ethiopia, 2-stage operations with middle ear prostheses are economically unfavorable. We hypothesized that single-stage autologous ossiculoplasty results in acceptable tympanic membrane (TM) and hearing improvements in a setting of limited resources.

Methods: One hundred eighty-eight patients (197 ears) who underwent 1-stage autologous ossiculoplasty for ossicular dysfunction are presented. All but 14 of these ears also had perforations of the TM. Conditions of the middle ear were granulation tissue, ossicular disruption only, tympanosclerosis, and cholesteatoma. Reconstructions of the ossicular chain were performed with autologous ossicles only.

Results: The closure rate of TM perforations was 95%. Preoperative air bone gaps were 27 to 60 dB (mean [SD] = 44 [7] dB); postoperative air bone gaps were 0 to 50 dB (average [SD] = 23 [10] dB), for an average improvement of 21 dB across all reconstruction types ( P < .001). The largest favorable changes in air bone gaps were with incus and malleus columellas from the footplate to the TM (33 and 23 dB, respectively) ( P < .001). No patient had worsening of sensorineural hearing levels or extrusion of the reconstructed ossicles.

Conclusion: Autologous ossiculoplasty performed well in this setting. Acceptable TM closure rates and improvement of air bone gaps were seen in 1-stage operations without the use of prostheses.
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May 2018

HIV Positivity per se Does Not Affect Tympanoplasty Outcomes.

Ann Otol Rhinol Laryngol 2018 Apr 6;127(4):249-252. Epub 2018 Feb 6.

4 Department of Otolaryngology/Head and Neck Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.

Background: The English language literature finds no clear protocols for otologic surgery for HIV+ patients.

Objective: To demonstrate that simple tympanoplasty and type III tympanoplasty in HIV+ patients with CD4 >400 cells/cc results in tympanic membrane closures and hearing improvements equivalent to the same procedures in controls.

Materials And Methods: This retrospective review documents the otologic conditions and operative results of 32 HIV+ patients and 32 controls. The controls were healthy and had no opportunistic infections or other medications.

Results: Genders, ages, sizes of tympanic membrane perforations, severity of air bone gaps, and type of operation were equivalent between the HIV+ and the control groups. Thirty of 32 patients in each group had closure of their perforations after 1 operation. Air bone gaps improved significantly for each group ( P = .001): 22 dB (SD = 11 dB) in the HIV+ group and 26 dB (SD = 10 dB) in the control group. And there was no statistically significant difference in change in hearing between the 2 groups. There were no complications of infection, wound dehiscence, worsened sensorineural levels, dizziness, or facial weakness in either group.

Conclusion: HIV+ patients whose CD4 counts are above 400 cells/cc can undergo simple tympanoplasty or type III tympanoplasty with acceptable outcomes.
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April 2018

Stapes Release in Tympanosclerosis.

Otol Neurotol 2018 02;39(2):184-188

Louis J. Mayer Professor of Otolaryngology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.

: Tympanosclerosis in the middle ear space is common in Ethiopia and often involves the ossicles and particularly the stapes. Ear operations in Ethiopia are relatively expensive in this country of limited medical resources and a low average living wage. In this setting, 2-stage operations using prostheses become prohibitively expensive. Therefore, the recommended 2-stage approach for tympanic membrane perforation with tympanosclerosis and stapes fixation is impractical for Ethiopia.We present a series of 67 patients who had a single stage tympanoplasty, removal of tympanosclerosis from the stapes suprastructure, and ossicular chain reconstruction using ossicular interposition. Crucial is the surgical technique employed for peeling the mound of tympanosclerotic plaque off of the stapes, which we term the stapes release. Controls were 67 patients with similar perforations and air-bone gap, but no tympanosclerosis. Most controls had ossciular discontinuity and were reconstructed with type III tympanoplasty.Air-bone gap improved in both groups: 18 dB (11 dB standard deviation) in the stapes release group, and 23 dB (11 dB standard deviation) in the control group. Paired t test found these improvements in each group significant at p < 0.001. Among the preoperative subjects there were 40 with air-bone gap greater than 45 dB, and none less than 20 dB. Among the postoperative subjects, none had air-bone gap worse than 45 dB, while 25/67 (37%) stapes release and 44/67 (66%) controls had air-bone gap better than 20 dB. Three patients in each group failed to close their perforations completely (96% closure rate).The only complications were two early cases of transient facial nerve weakness, which was avoided in subsequent cases by an alteration in technique. There was no deterioration of sensorineural hearing levels in either group's subjects postoperatively.In conclusion, stapes release with ossicular interposition can be performed at the same time as tympanoplasty without exacerbation of sensorineural hearing loss. Tympanic membrane closure and hearing levels were similar between patients with and without stapes fixation from tympanosclerosis.
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February 2018