More from August 2013 - Vol. 32 No. 08
Michael Hoa, MD; Eric P. Wilkinson, MD; and John W. House, MD
House Research Institute and House Clinic, Los Angeles, CA
The conceptual origins of the lateral graft tympanoplasty exist in early approaches to the repair of tympanic membrane (TM) perforations with artificial drumheads as reviewed extensively by E.A. Chu, MD, and Robert K. Jackler, MD. Of note, physicians Marcus Banzer, James Yearsley, and Joseph Toynbee all proposed and utilized various artificial drumheads to TM perforations (pig bladder, cotton-wool pellet, and India rubber disc, respectively).
Subsequently, C. J. Blake utilized a paper patch in 1875 to occlude a TM perforation. The use of the paper patch presaged the first true tympanoplasty—”myringoplasty”—performed in 1878 by E. Berthold, who described two essential elements of the technique: preparation of the margin of the perforation and application of the graft.
This technique languished in obscurity due to an inability of Berthold’s contemporaries to replicate his results until 1952, when Horst Wullstein and Fritz Zöllner, who coined the term tympanoplasty, popularized the technique using split-thickness and full-thickness skin grafts.
The advent of sulfonamide antibiotics in the 1930s and advances in surgical technique to control infections of the middle ear and mastoid, along with the use of operating microscopes in the U.S., set the stage for development, refinement, and codification of the modern technique for lateral graft tympanoplasty.
While Americans Howard P. House, MD, William F. House, MD, and James L. Sheehy, MD, were not the first to detail aspects of the lateral graft tympanoplasty technique, particularly considering German literature, these individuals were innovative in detailing the lateral graft or overlay approach.
In particular, Drs. Bill House and Sheehy codified the technique into four distinct steps:
Raising the vascular strip,
Removal of the canal wall skin and the squamous layer of the TM remnant,
Enlarging the ear canal, ensuring that the entire TM annulus is visible, and
Application of ear canal skin.
While some controversy exists in the English literature on the origin of using temporalis fascia as a graft for perforation repair, this use of temporalis fascia is attributed to J. Heermann in Germany and Lloyd A. Storrs in the U.S. in 1963. Dr. Sheehy acknowledged this advance and transitioned from canal skin grafts to temporalis fascia grafts, with dramatic improvement in surgical results.
This resulted in the final codification of the modern lateral graft tympanoplasty technique, replacing application of ear canal skin to the perforation with placement of the fascia graft and replacement of the ear canal skin.
This article was presented as an Otolaryngology Historical Society paper in 2010. For sources and further reading, visit www.entnet.org/Bulletin for a longer version of the article.
William F. House, MD, 1923-2012.
Besides his later work with cochlear implants, William House helped codify technical aspects of the lateral graft tympanoplasty.
James L. Sheehy, MD, 1926-2006.
Dr. Sheehy brought an outcomes research approach to the realm of otologic surgery and helped define how otologic research is conducted today. His codification of lateral graft tympanoplasty made the technique more accessible to later generations of surgeons. David J. Crockett, MD
Resident Physician at the University of Utah
Throughout my life I have enjoyed assisting and serving those less fortunate. I have also felt an obligation to use the skills I have learned to benefit others. One of my mentors at the University of Utah, Harlan R. Muntz, MD, has worked closely with and participated in multiple humanitarian missions with an organization titled Operation Restore Hope (ORH). Since 1992, ORH has been dedicated to the management and care of underprivileged children with cleft lip and palate deformities in the Philippines. In February, I had the opportunity to assist ORH by participating in a humanitarian trip to Cebu, Philippines. The team consisted of surgeons from the United States, including Dr. Muntz, Robin A. Dyleski, MD, Craig W. Senders, MD, and Shane A. Zim, MD. Anesthesiogists, nurses, and medical assistants from Australia also donated their expertise. Finally, many local nurses, students, and other volunteers also participated in the care of the patients.
The Rotary Club of Cebu helped organize the trip in conjunction with ORH. The Rotary Club was an amazing host and without their local participation such a trip would have been difficult. A Seventh-Day Adventist hospital (H.W. Miller Hospital) volunteered two rudimentary operating rooms. Two operating beds were placed in each room in order to perform four cases simultaneously. An old gymnasium was turned into a recovery room using cots, and student nurses assisted the patients.
Our weeklong trip involved the assessment, medical and surgical management, and post-operative care of children with cleft deformities. All patients originated from poor socioeconomic circumstances. The need for cleft surgery is greater than I imagined in this region of the world. The turnout of patients and families desiring treatment was overwhelming. In the end, we were able to complete 85 cleft surgeries.
This mission trip was not a sacrifice, but an inspiring, rewarding, and defining experience. The capability of these children to enjoy life and have fun in spite of their deformity was inspiring. The overpowering gratitude expressed by the parents and families after the surgeries was extremely rewarding. The experience to refine my skills by collaborating and working with proficient medical caretakers, who have a strong desire to serve those less privileged, has motivated me to continue with further humanitarian efforts throughout my life. On the last day, we performed a cleft lip repair on a 10-year-old girl. The change in her countenance, when we saw her on rounds after surgery, confirmed my conviction of how important these mission efforts are to the people that they treat. I only wish that she could have had such a surgery much earlier in her life.
I highly recommend taking advantage of any opportunity to perform humanitarian service. The satisfaction you will receive by making such a large impact on a person, who is unable to compensate you, will be extremely satisfying and gratifying. I would like to thank my supervising physician, Dr. Muntz, for the invitation to participate in this rewarding humanitarian mission and the AAO-HNSF Humanitarian Efforts Committee and the Alcon Foundation for sponsoring my trip. To learn more about Operation Restore Hope, visit www.operationrestorehope.org. The 2013 Annual Meeting and OTO EXPOSM is the world’s best gathering of otolaryngologists, together with the world’s largest collection of products and services for the specialty. In keeping with this tradition, many of the education products offered through AcademyU® will be on display at the AcademyU® Learning Station.
AcademyU®, the Foundation’s comprehensive otolaryngology education source, contains hundreds of learning options presented in a variety of formats to complement different learning styles. Developed by leading expert volunteers, the materials are designed to deliver relevant education that is meaningful to your practice. The education resources are divided into five platforms: Knowledge Resources, Subscriptions, Live Events, eBooks, and Online Education.
In this article, we will explore some of the various education resources that will be demonstrated at the Vancouver Convention Center by the knowledgeable Academy staff.
The AcademyU® Learning Station will demonstrate AcademyQ: Otolaryngology Knowledge Assessment Tool™. The award-winning app was developed by nationally recognized otolaryngology-head and neck surgery experts and offers otolaryngology-head and neck surgeons the opportunity to review information they need to prepare for certification examinations. More than 400 questions are presented in eight specialty sections. Every question is accompanied by an explanation of the correct answer with references for further study. The user can highlight text, mark questions for future review, and record audio and text notes.
Also on display will be our library of more than 100 online courses and lectures covering all aspects of the specialty. Online courses are self-paced learning activities developed through the AAO-HNSF education committees. Online lectures are based on the annual meeting instruction courses of the same name. Each lecture provides the highlights of these key sessions. Online courses and lectures can be taken to earn AMA PRA Category 1 Credit™ and are available at no charge to all Academy members.
Six eBooks will be available for review. These include the Resident Manual of Trauma to the Face, Head, and Neck and Primary Care Otolaryngology, 3rd edition. All eBooks are available for free download on the website and can be viewed in PDF form on most computers and mobile devices.
The ENT Exam Video SeriesSM, designed for medical students, residents, non-otolaryngologist health professionals and staff, will also be on display at the Learning Center. The series depicts how to perform a thorough examination of the ear, oral cavity, face, nose, neck, nasopharnyx, and larynx. Images and video of normal anatomy, normal variances, and common abnormalities have been added to enhance the learning experience. The ENT Exam Video SeriesSM is hosted on the official AAO-HNS YouTube page and is linked to the AcademyU® homepage.
The Academy staff onsite will be able to give attendees information about and opportunities to subscribe to all the various education products offered through AcademyU®, including Home Study Course, Patient Management Perspectives in OtolaryngologySM (PMP), COOLSM, and others. For a complete listing of all AcademyU® education resources visit www.entnet.org/academyu. The AAO-HNSF has launched a Guidelines International Network (G-I-N) Scholars Program
G-I-N Scholars, selected on their qualifications, experience, interest, and engagement in clinical practice guideline development, receive travel grants to attend training and educational sessions at an annual G-I-N meeting.
In exchange for receiving a G-I-N travel grant, recipients agree to serve on an upcoming AAO-HNS clinical practice guideline panel. Recipients will serve as either a panel member or as assistant chair if he or she has prior guideline experience. Recipients are also expected to submit a commentary to Otolaryngology–Head and Neck Surgery on any aspect of the guideline (e.g.,development, dissemination, adaptation,implementation).
Congratulations to the 2013 G-I-N Scholars
Awarded $2,500 travel grants to attend the 2013 G-I-N Conference in SanFrancisco, CA.
Apply to be a 2014 Guideline International Network Scholar
Meeting Location: Melbourne, Australia
Meeting Dates: August 20-23, 2014
(Two travel grants available)
To learn more about how to apply, visit http://www.entnet.org/Community/G-I-N_Scholars.cfm..
Residents are not eligible to apply and starting 2013 past/current Cochrane Scholars are not eligible to apply.