Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 11, pp 2633–2641 | Cite as

Narrow band imaging endoscopy improves visualization of vessels of the perforated tympanic membrane

  • Adela Cordero DevesaEmail author
  • Miguel Vaca González
  • Franklin Mariño-Sánchez
  • Cecilia Pérez Martínez
  • Rubén Polo López
  • María del Mar Medina González
  • Ignacio Cobeta Marco
Otology
  • 100 Downloads

Abstract

Purpose

Because successful healing of a tympanic membrane perforation (TMP) depends upon the maintenance of blood supply to the injured area, we assessed the usefulness of narrow band imaging (NBI) video endoscopy to evaluate its vascularization. To our knowledge, the use of NBI to assess tympanic membrane (TM) vascular patterns has never been attempted.

Methods

Prospective observational study. NBI and cold white light (CWL) flexible videoendoscopy was used to explore perforated TMs of 100 patients. Main outcome measures were visualization of vessels among abnormal TM findings: monomeric areas (MA) (n = 6), myringosclerosis plaques (MP) (n = 65) and perforation edges (n = 100). They were graded by a vascular otoendoscopic score (VOS) comparing both types of lights (Wilcoxon test). Location and vascularization patterns were analyzed (Fisher’s test).

Results

NBI was better to observe vascularization of 32% of perforation edges and 75.4% of MP (p < 0.001). NBI displayed higher (better) VOS when evaluating TMP edges (1.05 vs. 0.73) and MP (1.56 vs. 0.81, p < 0.001). The majority of TMP edges showed a ring pattern (66%), followed by irregular (19%), avascular (12%) and radial patterns (3%). The avascular pattern was more frequent in posterior perforations (p = 0.003). The radial pattern was most frequently found in MP, especially at posterior quadrants (p = 0.048). MA presented an irregular pattern in 83.3% of TMs.

Conclusions

NBI videoendoscopy is a promising non-invasive technique, superior to CWL for visualizing vessels among TMP edges and MP, based on further study, could become a supplementary diagnostic tool in the workup of TMP and the decision-making surgical field.

Keywords

Tympanic membrane Perforation Myringosclerosis Vascular pattern Narrow band imaging 

Notes

Acknowledgements

We thank Javier Zamora, head of the Statistics Unit of our Hospital, for helping us with the statistical analysis.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

405_2018_5119_MOESM1_ESM.jpg (519 kb)
Online Resource 1. Larger version of cold white light picture represented in Figure 3. Avascular pattern (JPG 519 KB)
405_2018_5119_MOESM2_ESM.jpg (595 kb)
Online Resource 2. Larger version of narrow band imaging picture represented in Figure 3. Avascular pattern (JPG 594 KB)
405_2018_5119_MOESM3_ESM.jpg (191 kb)
Online Resource 3. Larger version of cold white light picture represented in Figure 3. Ring vascular pattern (JPG 190 KB)
405_2018_5119_MOESM4_ESM.jpg (244 kb)
Online Resource 4. Larger version of narrow band imaging picture represented in Figure 3. Ring vascular pattern (black arrows) (JPG 243 KB)
405_2018_5119_MOESM5_ESM.jpg (387 kb)
Online Resource 5. Larger version of cold white light picture represented in Figure 3. Radial vascular pattern (JPG 387 KB)
405_2018_5119_MOESM6_ESM.jpg (437 kb)
Online Resource 6. Larger version of narrow band imaging picture represented in Figure 3. Radial vascular pattern (white arrow) (JPG 436 KB)
405_2018_5119_MOESM7_ESM.jpg (306 kb)
Online Resource 7. Larger version of cold white light picture represented in Figure 3. Irregular vascular pattern (JPG 305 KB)
405_2018_5119_MOESM8_ESM.jpg (347 kb)
Online Resource 8. Larger version of narrow band imaging picture represented in Figure 3. Irregular vascular pattern (arrowheads) (JPG 346 KB)
405_2018_5119_MOESM9_ESM.jpg (464 kb)
Online Resource 9. Larger version of cold white light picture represented in Figure 4. Avascular pattern (JPG 463 KB)
405_2018_5119_MOESM10_ESM.jpg (543 kb)
Online Resource 10. Larger version of narrow band imaging picture represented in Figure 4. Avascular pattern (JPG 543 KB)
405_2018_5119_MOESM11_ESM.jpg (480 kb)
Online Resource 11. Larger version of cold white light picture represented in Figure 4. Radial vascular pattern (JPG 480 KB)
405_2018_5119_MOESM12_ESM.jpg (556 kb)
Online Resource 12. Larger version of narrow band imaging picture represented in Figure 4. Radial vascular pattern (white arrows) (JPG 556 KB)
405_2018_5119_MOESM13_ESM.jpg (465 kb)
Online Resource 13. Larger version of cold white light picture represented in Figure 4. Irregular vascular pattern (JPG 464 KB)
405_2018_5119_MOESM14_ESM.jpg (550 kb)
Online Resource 14. Larger version of narrow band imaging picture represented in Figure 4. Irregular vascular pattern (arrowheads) (JPG 549 KB)
405_2018_5119_MOESM15_ESM.jpg (200 kb)
Online Resource 15. Larger version of cold white light picture represented in Figure 5. Radial vascular pattern (JPG 200 KB)
405_2018_5119_MOESM16_ESM.jpg (270 kb)
Online Resource 16. Larger version of narrow band imaging picture represented in Figure 5. Radial vascular pattern (white arrow) (JPG 269 KB)
405_2018_5119_MOESM17_ESM.jpg (494 kb)
Online Resource 17. Larger version of cold white light picture represented in Figure 5. Irregular vascular pattern (JPG 494 KB)
405_2018_5119_MOESM18_ESM.jpg (559 kb)
Online Resource 18. Larger version of narrow band imaging picture represented in Figure 5. Irregular vascular pattern (arrowheads) (JPG 559 KB)

References

  1. 1.
    Masutani H, Nakai Y, Sugita M, Ohashi K, Moriguchi M, Matsunaga K (1991) Microvasculature of the tympanic membrane. Acta Otolaryngol Suppl 486:99–104CrossRefGoogle Scholar
  2. 2.
    Hellstrom S, Spratley J, Eriksson PO, Pais-Clemente M (2003) Tympanic membrane vessel revisited: a study in an animal model. Otol Neurotol 24(3):494–499CrossRefGoogle Scholar
  3. 3.
    Applebaum EL, Deutsch EC (1986) An endoscopic method of tympanic membrane fluorescein angiography. Ann Otol Rhinol Laryngol 95(5 Pt 1):439–443CrossRefGoogle Scholar
  4. 4.
    Moller P (1981) Tympanosclerosis of the ear drum. A scanning electronmicroscopic study. Acta Otolaryngol 91(3–4):215–221CrossRefGoogle Scholar
  5. 5.
    Spandow O, Hellstrom S, Dahlstrom M (1996) Structural characterization of persistent tympanic membrane perforations in man. Laryngoscope 106(3 Pt 1):346–352CrossRefGoogle Scholar
  6. 6.
    Somers T, Houben V, Goovaerts G, Govaerts PJ, Offeciers FE (1997) Histology of the perforated tympanic membrane and its muco-epithelial junction. Clin Otolaryngol Allied Sci 22(2):162–166CrossRefGoogle Scholar
  7. 7.
    Arslan N, Tepe D, Tastan E, Demirci M, Caydere M, Ustun H, Oguz H (2012) Evaluation of the effectiveness of topical ciprofloxacin and prednisolone in the prevention of myringosclerosis. Eur Arch Otorhinolaryngol 269(11):2335–2341CrossRefGoogle Scholar
  8. 8.
    Triana RJ, Prazma J, Carrasco VN, Pillsbury HC (1990) Analysis of blood flow in the tympanic membrane: the use of intravital fluorescence microscopy. Am J Otol 11(4):266–271PubMedGoogle Scholar
  9. 9.
    Stenfors LE, Bloom GD, Hellstrom S (1984) The tympanic membrane. Acta Otolaryngol Suppl 414:28–30CrossRefGoogle Scholar
  10. 10.
    Hamberger CA, Wersaell J (1964) Vascular supply of the tympanic membrane and the ossicular chain. Acta Otolaryngol Suppl 57(sup188):308–318CrossRefGoogle Scholar
  11. 11.
    Ruah CB, Schachern PA, Zelterman D, Paparella MM, Yoon TH (1991) Age-related morphologic changes in the human tympanic membrane. A light and electron microscopic study. Arch Otolaryngol Head Neck Surg 117(6):627–634CrossRefGoogle Scholar
  12. 12.
    Applebaum EL, Deutsch EC (1985) Fluorescein angiography of the tympanic membrane. Laryngoscope 95(9 Pt 1):1054–1058PubMedGoogle Scholar
  13. 13.
    Lim DJ (1995) Structure and function of the tympanic membrane: a review. Acta Otorhinolaryngol Belg 49(2):101–115PubMedGoogle Scholar
  14. 14.
    Tseng CC, Lai MT, Wu CC, Yuan SP, Ding YF (2017) Comparison of the efficacy of endoscopic tympanoplasty and microscopic tympanoplasty: a systematic review and meta-analysis. Laryngoscope 127(8):1890–1896CrossRefGoogle Scholar
  15. 15.
    Zhang H, Wong PY, Magos T, Thaj J, Kumar G (2017) Use of narrow band imaging and 4K technology in otology and neuro-otology: preliminary experience and feasibility study. Eur Arch Otorhinolaryngol 275:301–305 (Epub ahead of print) CrossRefGoogle Scholar
  16. 16.
    Xiong Y, Li J, Ma S, Ge J, Zhou L, Li D, Chen Q (2017) A meta-analysis of narrow band imaging for the diagnosis and therapeutic outcome of non-muscle invasive bladder cancer. PLoS One 12(2):e0170819CrossRefGoogle Scholar
  17. 17.
    Zhu J, Li W, Zhou J, Chen Y, Zhao C, Zhang T, Peng W, Wang X (2017) The diagnostic value of narrow-band imaging for early and invasive lung cancer: a meta-analysis. Clinics (Sao Paulo) 72(7):438–448CrossRefGoogle Scholar
  18. 18.
    Vilaseca I, Valls-Mateus M, Nogués A, Lehrer E, López-Chacón M, Avilés-Jurado FX, Blanch JL, Bernal-Sprekelsen M (2017) Usefulness of office examination with narrow band imaging for the diagnosis of head and neck squamous cell carcinoma and follow-up of premalignant lesions. Head Neck 39(9):1854–1863CrossRefGoogle Scholar
  19. 19.
    Cohen J (2007) Advanced digestive endoscopy comprehensive atlas of high resolution endoscopy and narrowband imaging. Blackwell Publishing, New York, p 328CrossRefGoogle Scholar
  20. 20.
    Piazza C, Dessouky O, Peretti G, Cocco D, De Benedetto L, Nicolai P (2008) Narrow-band imaging: a new tool for evaluation of head and neck squamous cell carcinomas. Review of the literature. Acta Otorhinolaryngol Ital 28(2):49–54PubMedPubMedCentralGoogle Scholar
  21. 21.
    Vlantis AC, Woo JK, Tong MC, King AD, Goggins W, van Hasselt CA (2016) Narrow band imaging endoscopy of the nasopharynx is not more useful than white light endoscopy for suspected nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 273(10):3363–3369CrossRefGoogle Scholar
  22. 22.
    Saliba I (2008) Hyaluronic acid fat graft myringoplasty: how we do it. Clin Otolaryngol 33(6):610–614CrossRefGoogle Scholar
  23. 23.
    Shibuya K, Hoshino H, Chiyo M, Iyoda A, Yoshida S, Sekine Y, Iizasa T, Saitoh Y, Baba M, Hiroshima K, Ohwada H, Fujisawa T (2003) High magnification bronchovideoscopy combined with narrow band imaging could detect capillary loops of angiogenic squamous dysplasia in heavy smokers at high risk for lung cancer. Thorax 58(11):989–995CrossRefGoogle Scholar
  24. 24.
    Sun C, Han X, Li X, Zhang Y, Du X (2017) Diagnostic performance of narrow band imaging for laryngeal cancer: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 156(4):589–597CrossRefGoogle Scholar
  25. 25.
    Kumar N, Chilke D, Puttewar MP (2012) Clinical profile of tubotympanic CSOM and its management with special reference to site and size of tympanic membrane perforation, eustachian tube function and three flap tympanoplasty. Ind J Otolaryngol Head Neck Surg 64(1):5–12CrossRefGoogle Scholar
  26. 26.
    Gladstone HB, Jackler RK, Varav K (1995) Tympanic membrane wound healing. An overview. Otolaryngol Clin North Am 28(5):913–932PubMedGoogle Scholar
  27. 27.
    Kristensen S (1992) Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience. J Laryngol Otol 106(12):1037–1050CrossRefGoogle Scholar
  28. 28.
    Asiri S, Hasham A, al Anazy F, Zakzouk S, Banjar A (1999) Tympanosclerosis: review of literature and incidence among patients with middle-ear infection. J Laryngol Otol 113(12):1076–1080CrossRefGoogle Scholar
  29. 29.
    Bhaya MH, Schachern PA, Morizono T, Paparella MM (1993) Pathogenesis of tympanosclerosis. Otolaryngol Head Neck Surg 109(3 Pt 1):413–420CrossRefGoogle Scholar
  30. 30.
    Hinchcliffe R (1961) Prevalence of the commoner ear, nose, and throat conditions in the adult rural population of Great Britain. A study by direct examination of two random samples. Br J Prev Soc Med 15:128–140PubMedPubMedCentralGoogle Scholar
  31. 31.
    Reijnen CJ, Kuijpers W (1971) The healing pattern of the drum membrane. Acta Otolaryngol Suppl 287:1–74PubMedGoogle Scholar
  32. 32.
    Kuijpers W (1995) Persisting changes in the structure of the tympanic membrane. Acta Otorhinolaryngol Belg 49(2):181–185PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Adela Cordero Devesa
    • 1
    Email author
  • Miguel Vaca González
    • 1
  • Franklin Mariño-Sánchez
    • 1
  • Cecilia Pérez Martínez
    • 1
  • Rubén Polo López
    • 1
  • María del Mar Medina González
    • 1
  • Ignacio Cobeta Marco
    • 1
  1. 1.Otorhinolaryngology DepartmentHospital Universitario Ramón y CajalMadridSpain

Personalised recommendations