Results of cartilage shield tympanoplasty in revision cases of myringoplasty
Keywords:Cartilage shield tympanoplasty, Revision tympanoplasty, Failure of myringoplasty
Background: Cartilage shield tympanoplasty (CST) is seen as a good option for revision surgery in cases of myringoplasty failure. Cartilage serves as rigid material which resists retraction. However, there have been concerns regarding hearing outcome and surveillance in follow up period.
Methods: A prospective study was conducted at our tertiary institute. 25 patients of either sex in age group of 18-50 years with one or more failed tympanoplasties underwent CST. Pre-operative and post-operative audiograms were obtained, and patients were regularly followed up to calculate graft uptake and hearing outcome. Quantitative data was analyzed by using Student t-test and for qualitative data chi square test was used.
Results: The mean pre-operative pure tone air-bone gap was 25.09±8.10 dB while the mean postoperative pure tone air-bone gap was 13.47±5.18 dB, one case (4%) presented with failure as there was a residual perforation antero-inferiorly. Since it was a small residual perforation, it was planned for closure by fat myringoplasty. No complications were recorded. We obtained graft take rate of 96% and mean postoperative gain of 11.62±7.11 dB in PTA-ABG.
Conclusions: We recommend CST for revision cases of tympanoplasty.
Sismanis AA. Tympanoplasty : tympanic membrane repair. In: Gulya AJ, Minor LB, Poe DS, editors. Glasscock-Shambaugh Surgery of the Ear. 6th ed. Shelton: Peoples Medical Publishing House; 2010: 465-488.
Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope. 2003;113:1844-56.
Singh I. Textbook of human histology. New Delhi, India: Jaypee Brothers Medical Publishers; 2004: 89-93.
Murbe D, Zahnert T, Bornitz M, Huttenbrink KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002;112:1769-76.
Sheehy JL, Crabtree JA. Tympanoplasty: staging the operation. Laryngoscope. 1973;83:1594-621.
Yung M, Vivekanandan S, Smith P. Randomized study comparing fascia and cartilage grafts in myringoplasty. Ann Otol Rhinol Laryngol 2011;120:535-41.
Cabra J, Montoux A. Efficacy of cartilage palisade tympanoplasty: randomized controlled trial. Otol Neurotol. 2010;31:589-95.
Yetiser S, Hidir Y. Temporalis fascia and cartilage-perichondrium composite shield grafts for reconstruction of the tympanic membrane. Ann Otol Rhinol Laryngol. 2009;118:570-4.
Aidonis I, Robertson TC, Sismanis A. Cartilage Shield Tympanoplasty: A Reliable Technique. Otol Neurotol. 2005;26:838-41.
Kulkarni S, Kulkarni V, Burse K, Sancheti V, Roy G. Cartilage support for fascia graft in type I tympanoplasty. Indian J Otolaryngol Head and Neck Surg. 2014;66(3):291-96.
Khan MM, Parab SR. Primary cartilage tympanoplasty: our technique and results. Am J Otolarygol. 2011;32:381-7.
Kyrodimos E, Stamatiou G, Margaritis E, Kikidis D, Sismanis A. Cartilage tympanoplasty: a reliable technique for smokers. Eur Arch Otorhinolaryngol. 2014;271:255-60.
Boone RT, Gardner EK, Dornhoffer JL. Success of cartilage grafting in revision tympanoplasty without mastoidectomy. Otolneurotol. 2004;25:678-81.
Elwany S. Histochemical study of cartilage autografts in tympanoplasty. J Laryngol Otol.1985;99:637-42.
Smyth GDL. Tympanic reconstruction. Fifteen year report on tympanoplasty. Part II. J Laryngol Otol 1976;90(8):713-4.
Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope 1997;107:1094-9.
Ahmad A, Elasfour, Hesham S, Zaghloul: Cartilage tympanoplasty: Audiological and otological outcome. Int Cong Series. 2003;1240:73-9.
Simsek E, Ozkan O, Kucur C, Carlioglu. Evaluation of the anatomical and auditory outcomes of minimally invasive cartilage myringoplasty: our technique and experience. Am J Otolaryngol Head Neck Medicine Surg. 2016;37(6):517-22.
Yamamoto E, Iwanaga M, Fukumoto M. Histologic study of homograft cartilages implanted in the middle ear. Otolaryngol Head Neck Surg. 1988;98:546-50.
Hamed M, Samir M, El Bigermy M. Fate of cartilage material used in middle ear surgery: light and electron microscopy study. Auris Nasus Larynx. 1999;26:257-62.
Zahnert T, Hottenbrink KB, Morbe D. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322-8.
Moore GF. Candidate’s thesis: revision tympanoplasty utilizing fossa triangularis cartilage. Laryngoscope 2002;112:1543-54.
Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993;103:1352-6.
Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and retraction pockets. Laryngoscope. 1987;107:1094-9.
Borkowski G, Sudhoff H, Luckhaupt H. Autologous perichondrium- cartilage graft in the treatment of total and subtotal perforations of the tympanic membrane. Laryngorhinootologie. 1999;78:68-72.
Sismanis A, Dodson K, Kyrodimos E. Cartilage shield grafts in revision tympanoplasty. Otol Neurotol. 2008;29:330-3.
Kyrodimos E, Sismanis A, Santos D. Type III cartilage “shield” tympanoplasty: an effective procedure for hearing improvement. Otolaryngol Head and Neck Surg. 2007;136:982-5.