Comparison of outcomes of palisade cartilage with temporalis fascia following tympanoplasty at a tertiary care centre in Nepal
Keywords:Tympanoplasty, Palisade cartilage, Temporalis fascia
Background: Mucosal type of chronic otitis media is a common disease worldwide with 5.2% prevalence in Nepal. Cartilage material is criticized in terms of hearing results due to its thickness. The objective of this study was to compare graft uptake and post-operative hearing of palisade cartilage with temporalis fascia following tympanoplasty.
Methods: A prospective randomized study conducted over 12 months included subjects of chronic otitis media mucosal inactive having dry ear for at least 4 weeks. 76 subjects were enrolled and reviewed on 6th post-operative day, 6th and 12th post-operative week. The graft uptake and post-operative hearing were evaluated. The results were compared within and between the groups.
Results: The graft uptake on 42nd and 90th post-operative days were comparable with no statistical difference. The difference of mean pre-operative, 42nd and 90th post-operative air bone gaps in palisade cartilage and temporalis fascia were also comparable. The results were statistically significant, showing improvement in hearing after surgery. Closure of air-bone gap within 30 dB was achieved in 71.87% in temporalis fascia and 88.89% in palisade cartilage. The intergroup difference was not statistically significant.
Conclusions: The graft uptake rates and hearing results after palisade cartilage are similar to temporalis fascia.
Little P, Bridges A, Guragain RPS, Prasad R, Weir N, Freidman D. Hearing impairment and ear pathology in Nepal. J Laryngol Otol. 1993;107:395‐400.
Wullstein HL. Functional operations in middle ear with split‐thickness skin graft. Arch Otorhinolaryngol. 1952;161:422–35.
Zollner F. The principles of plastic surgery of the sound‐conducting apparatus. J Laryngol Otol. 1955;69:657–9.
Heermann J Jr, Heermann H, Kopstein E. Fascia and cartilage palisade tympanoplasty: Nine years’ experience. Arch Otolaryngol. 1970;91(3):228–41.
Couloigner V, Baculard F, El Bakkouri W, Viala P, Francois M, Narcy P. Inlay butterfly cartilage tympanoplasty in children. OtolNeurotol. 2005;26:247–51.
Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000;110:1994–9.
Jansen C. The use of cartilage in hearing restorative operations [in German]. In: 7th international congress of otology, rhinology and laryngology 1961. Paris: 1961.
Murbe D, Zahnert T, Bornitz M, Huttenbrink KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002;112:1769–76.
Neumann A, Henning A, Schultz-Coulon HJ Morphological and functional results of palisade cartilage tympanoplasty. HNO. 2002;50(10):935–9.
Amadee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol. 1989;10:447–50.
Neumann A, Schultz-Coulon HJ, Jahnke K. Type III tympanoplasty applying the palisade cartilage technique: a study of 61 cases. OtolNeurotol. 2003;24(1):33–7.
Uzun C, Caye-Thomasen P, Andersen J, Tos M. A tympanometric comparison of tympanoplasty with cartilage palisades or fascia after surgery for tensacholesteatoma in children. Laryngoscope. 2003;113(10):1751–7.
Shishegar M, Faramarzi A, Taraghi A. A short-term comparison between results of palisade cartilage
tympanoplasty and temporalis fascia technique. Iran J Otorhinolaryngol. 2012;24(68):105-111.
Uzun C, Yagiz R, Tas A, Adali MK, Koten M, Karasalihoglu AR. Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results. Laryngoscope. 2005;113(10):1771–7.
Khan MM, Parab SR. Primary cartilage tympanoplasty: our technique and results, Am J Otolaryngol. 2011;32:381–7.
Dornhoffer JL. Cartilage tympanoplasty. OtolaryngolClin North Am. 2006;39:1161–76.
Prasad R, Amatya R, Sinha B, Bhattarai H, Guragain RPS, Bhusal CL. Graft uptake rate and audiological evaluation after myringoplasty: 4 years experience at TUTH. J Nep Med Assoc. 1993;31:29.
Khan MM, Parab SR. Comparative study of sliced tragal cartilage and temporalis fascia in type 1 tympanoplasty. J LaryngolOtol. 2015;129(1):16-22.
Ben Gamra O, Mbarek C, Khammassi K. Cartilage graft in type I tympanoplasty: audiological and otological outcome. Eur Arch Otorhinolaryngol. 2008;265:739–42.