DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201676

A comparative study of post-operative outcomes in type 1 tympanoplasty using tragal chondroperichondrial shield graft and temporalis fascia graft

Pradeep Kumar Muniasamy, Dharanya Gopalakrishnan Srinivasan, Prabu Velayutham, Nishanth Savery, Balasubramanian Krishnaswami, Ramkumar Vellikannu

Abstract


Background: Type 1 tympanoplasty is the reconstruction of perforated tympanic membrane with an intact and mobile ossicular chain. Among various autologous graft materials, temporalis fascia and tragal chondroperichondrium are commonly used, having their own merits and demerits. In our study, we have compared the results and postoperative outcomes of tympanoplasty using temporalis fascia and tragal chondroperichondrium.

Methods: This prospective comparative study included 60 cases of chronic suppurative otitis media - tubotympanic disease (CSOM-TTD) in a tertiary care centre. They were randomised into two groups of 30 patients each and were subjected to tympanoplasty using either tragal cartilage-perichondrium (group 1) or temporalis fascia graft (group 2) from November 2017 to May 2019. Objective hearing improvement at 1st, 3rd and 6th month postoperative follow-up and graft uptake rate at 3rd month were compared.  

Results: Incidence of cases was more in the age group between 31-45 years age group (53.3%). Graft uptake rate was 96.6% for temporalis fascia group and 83.33% for tragal group (p value - 0.194). Preoperative air-bone (AB) gap in group 1 was found to be 25±4.09 dB which improved to 11.73±2.21 dB at 6 months and in group 2, it was 25.7±3.94 dB which improved to 14.06±3.68 dB at 6 months. Mean improvement in hearing for tragal group (13.27 dB) was better than temporalis fascia group (11.64 dB) (p value <0.001).

Conclusions: Both temporalis fascia and tragal chondroperichondrium are suitable graft materials for tympanoplasty, although graft uptake was clinically better with the use of temporalis fascia.

 


Keywords


Air-bone gap, Graft uptake, Tympanic membrane, Ossicular chain, CSOM-TTD

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References


Herman MK. Tang: The perforated ear drum: To repair or not. Hong Kong J Online. 1989;11:124-5.

Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope. 1993;103:1352-6.

Dornhoffer JL. Cartilagetympanoplasty. Otolaryngol Clin North Am. 2006; 39:1161-76.

Najeeb T. Temporal Fascia Versus Tragal Perichondrial Graft in Myringoplasty and Tympanoplasty. Int J Otorhinolaryngology. 2019;5(1):15.

Nemade SV, Shinde KJ, Naik CS, Qadri H. Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique. Braz J Otorhinolaryngol. 2018;84(3):318-23.

Basak B, Gayen GC, Das M, Dhar G, Ray R, Das AK. Demographic profile of CSOM in a rural tertiary care hospital. IOSR J Pharm. 2014;4(6):43-6.

Kiran RB. Tragal Perichondrium vs. Temporalisfascia in Myringoplasty: A Comparative Study. Sch J App Med Sci. 2017;5:2752-5.

Sood AS, Pal P, Singla A. Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material. Int J Otorhinolaryngol Head Neck Surg. 2018;4(3):789.

Sharma N, Sharma P, Sharma P, Gourav K, Goyal VP. Comparison of otological and audiological outcome of type-I tympanoplasty using composite tragal perichondrium and temporalis fascia as graft. Int J Otorhinolaryngol Head Neck Surg. 2018;4(5):1182.

Hameed GS, Prasad BD, Babu PR. A Comparative Study of Temporalis Fascia versus Tragal Peri-chondrium as Graft in Repair of Tympanic Membrane Perforation. Indian J Medn Alli Sci. 2015;3(3):150.

PatilK, Baisakhiya N, Deshmukh PT. Evaluation of different graft material in Type I tympanoplasty. Indian J Otol. 2014;20:106-14.

Rakesh K, Rajesh KS, Yogesh AGE. Comparative study of Underlay Tympanoplasty with Temporalis Fascia and Tragal Chondroperichondrium. IOSR-JDMS. 2014;(13):89-98.

Hameed GS, Prasad BD, Babu PR. A Comparative Study of Temporalis Fascia versus Tragal Peri-chondrium as Graft in Repair of Tympanic Membrane Perforation. Indian J Medn Alli Sci. 2015;3(3):150.

Dabholkar JP, Vora K, Sikdar A. Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian J Otolaryngol Head Neck Surg. 2007;59:116-9.

Kumar A, Narayan P, Narain P, Singh J, Porwal PK, Sharma S, et al. Comparative study between result of temporalis muscle fascia and tragal cartilage perichondrium as a graft material in type 1 tympanoplasty. Int J Otorhinolaryngol Head Neck Surg. 2018;4:565-8.

Aidonis I, Robertson TC, Sismanis A. Cartilage shield tympanoplasty: a reliable technique. Otol Neurotol. 2005;26:838-41.

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

Witt RL, Weinstein GS, Rejto LK. Tympanomastoid suture and digastric muscle incadaver and live parotidectomy. Laryngoscope. 2005;115:574-7.

Williamson PA, Thomas DM, Beasley P. Posterior tragal perichondrium harvesting for myringoplasty. Clin Otolaryngol Allied Sci. 1999;24:252-4.

Zahnert T, Huttenbrink KB, Murbe D, Bornitz M. Experimental investigations of theuse of cartilage in tympanic membrane reconstruction. Am J Otol. 2000;21(3):322-8.

Dornhoffer J. Cartilage tympanoplasty: Indications, Techniques and Outcomes in a 1,000-Patient Series. Laryngoscope. 2003;113:1844-56.