DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20192557

Minimally invasive cartilage myringoplasty: our technique and experience

Venkatesh C. Ballal, Lohith Shivappa, Subramanya B. Tmmappaiah, Sphoorthi Basavannaiah, Chandralekha T. V. Rangaswamy

Abstract


Background: Chronic suppurative otitis media is an inflammatory process in the middle ear and is an important health problem in India. Myringoplasty is the most common procedure performed that aims to close the tympanic membrane perforation which is traditionally done with temporalis fascia graft under microscope. Recent studies using the transcanal cartilage “push-through” technique of myringoplasty have demonstrated that it to be very feasible and effective. The aims and objectives of the study was to analyze the results of endoscopic transcanal ‘push-through’ myringoplasty in dry small central perforations in cases of inactive mucosal type of chronic ottitis media.

Methods: This retrospective study was conducted in 16 patients who underwent transcanal endoscopic cartilage ‘push through’ myringoplasty and patients were called for regular follow up for 12 weeks and results were statistically analysed.  

Results: A total of 16 cases were included in the present study. The graft uptake rate in the present study was found to be 93.75%. The mean preoperative air bone gap was 21.76 dB and the mean postoperative air bone gap was reduced to 12.6 dB. The air bone gap was 10 dB or less in 37.5% ears.

Conclusions: Endoscopic push-through technique of cartilage myringoplasty is an effective, minimally invasive and feasible method and has good success rate in terms of graft uptake as well as hearing gain. It may also represent a first choice approach for small and medium sized tympanic membrane perforations.


Keywords


Chronic suppurative otitis media, Carilage, Endoscopic ‘push through’ myringoplasty, Air bone gap, Graft uptake

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References


Singh M, Rai A, Bandyopadhyay S. Middle ear microsurgery in India: A retrospective audit study. Indian J Otolaryngol Head Neck Surg. 2006;58:133-6.

Jain S, Gupta N, Gupta R, Roy A. Interlay Type I tympanoplasty in large central perforations: Analysis of 500 cases. Indian J Otol. 2017;23:32-5.

Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope. 1987;97:1069-74.

Eviatar A. Tragal perichondrium and cartilage in reconstructive ear surgery. Laryngoscope 1978;88(11):1-23.

Duckert LG, Mueller J, Makielski KH, Helms J. Composite autograft ‘‘shield’’ reconstruction of remnant tympanic membranes. Am J Otol. 1995;16:21-6.

Eavey RD. Inlay tympanoplasty: Cartilage butterfly technique. Laryngoscope. 1998;108:657 61.

Harugop AS, Mudhol RS, Godhi RA. A comparative study of endoscope assisted myringoplasty and micrsoscope assisted myringoplasty. Indian J Otolaryngol Head Neck Surg. 2008;60:298-302.

Loh TL, Ranguis S, Patel H, Crossland G. Permeatal ‘push through’ myringoplasty in the Northern Territory: a prospective cohort. Aust J Otolaryngol. 2018;1:22.

Yung M. Cartilage tympanoplasty: Literature review. J Laryngol Otol. 2008;122:663-72.

Murbe D, Zahnert T, Bornitz M, Huttenbrink KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002;112:1769-76.

Lin YC, Wang WH, Weng HH, Lin YC. Predictors of surgical and hearing long term results for inlay cartilage tympanoplasty. Arch Otolaryngol Head Neck Surg. 2011;137:215-9.

Kim HJ, Kim MJ, Jeon JH, Kim JM, Moon IS, Lee WS. Functional and practical outcomes of inlay butterfly cartilage tympanoplasty. Otol Neurotol. 2014;35:1458-62.

Ayache S. Cartilaginous myringoplasty: The endoscopic transcanal procedure. Eur Arch Otorhinolaryngol. 2013;270:853-60.

Maurya AK, Jadia S, Qureshi S, Jain L. Butterfly cartilage tympanoplasty: An alternative approach for management of small- and medium-sized perforations. Indian J Otol. 2016;22:81-4.

Celik H, Samim E, Oztuna D. Endoscopic “Push-Trough” Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations. Clin Experimental Otorhinolaryngol. 2015;8(3):224-9.

El-Hennawi DEM, Ahmed MR, Abou-Halawa AS, Al-Hamtary MA. Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations. J Laryngol Otol. 2018;132(6):509-13.