Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery · 2026
Is Routine Umbo Resection Necessary During Over-Underlay Tympanoplasty? A Histopathological and Clinical Study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Gündüz Emrah, Çiçek Mehmet Turan, Tan Mehmet, Aslan Mehmet, Koca Çiğdem Fırat, Demir İsmail, Akatlı Ayşe Nur, Schiavo Gloria
Аннотация
BACKGROUND: The necessity of routine umbo resection during over-underlay tympanoplasty remains controversial.
OBJECTIVE: To evaluate histopathological persistence of epithelial remnants according to perforation-umbo relationship and to estimate the risk of postoperative cholesteatoma.
METHODS: Prospective cohort of 148 consecutive Type I over-underlay tympanoplasties with minimum 24-month follow-up. Patients were grouped by perforation relation to the umbo. All resected specimens were examined with haematoxylin-eosin (H&E); pan-cytokeratin immunohistochemistry was not performed in this series. Categorical comparisons used Fisher's exact test; proportions are reported with 95% confidence intervals (CI). Post hoc upper 95% bound for cholesteatoma incidence was calculated using the Poisson approximation.
RESULTS: Histopathology revealed epithelial remnants in 33.3% (12/36; 95% CI 18.6-51.0) of Group 1 and 21.9% (7/32; 95% CI 9.3-40.0) of Group 2; none were detected in Group 3. No cholesteatoma developed during mean follow-up of 24 months; the upper 95% confidence bound for true cholesteatoma incidence was 2.02%.
CONCLUSION: Umbo-involving perforations are associated with higher rates of microscopic epithelial remnants, but microscopic remnants did not translate into cholesteatoma within the observed follow-up. Routine umbo resection is not mandatory when meticulous de-epithelialisation is achievable; selective resection based on intraoperative assessment is recommended. Longer follow-up and larger multicentre cohorts are required to exclude rare adverse events.
OBJECTIVE: To evaluate histopathological persistence of epithelial remnants according to perforation-umbo relationship and to estimate the risk of postoperative cholesteatoma.
METHODS: Prospective cohort of 148 consecutive Type I over-underlay tympanoplasties with minimum 24-month follow-up. Patients were grouped by perforation relation to the umbo. All resected specimens were examined with haematoxylin-eosin (H&E); pan-cytokeratin immunohistochemistry was not performed in this series. Categorical comparisons used Fisher's exact test; proportions are reported with 95% confidence intervals (CI). Post hoc upper 95% bound for cholesteatoma incidence was calculated using the Poisson approximation.
RESULTS: Histopathology revealed epithelial remnants in 33.3% (12/36; 95% CI 18.6-51.0) of Group 1 and 21.9% (7/32; 95% CI 9.3-40.0) of Group 2; none were detected in Group 3. No cholesteatoma developed during mean follow-up of 24 months; the upper 95% confidence bound for true cholesteatoma incidence was 2.02%.
CONCLUSION: Umbo-involving perforations are associated with higher rates of microscopic epithelial remnants, but microscopic remnants did not translate into cholesteatoma within the observed follow-up. Routine umbo resection is not mandatory when meticulous de-epithelialisation is achievable; selective resection based on intraoperative assessment is recommended. Longer follow-up and larger multicentre cohorts are required to exclude rare adverse events.