Comparative study of outcomes of type-1 tympanoplasty with temporalis fascia only and with cartilage slice reinforcement
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20202053Keywords:
Tympanoplasty, Temporalis fascia, Cartilage slice reinforcementAbstract
Background: Tympanoplasty is a surgical procedure performed to eradicate infection and restore the function of middle ear. Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. The purpose of this study was to evaluate the graft uptake and auditory outcomes of type I tympanoplasty using temporalis muscle fascia only and with cartilage slice reinforcement.
Methods: This prospective study was conducted at the Department of Otorhinolaryngology, Government Medical College, Jalaun, Uttar Pradesh, India from November 2016 to November 2019. There were total of 100 patients, divided in two groups, 50 patients in each group, tympanoplasty type-1 using only temporalis fascia (group-A) and tympanoplasty type-1 using temporalis fascia with cartilage slice reinforcement (group-B). The result was measured on graft uptake and hearing outcome at 6 months postoperatively.
Results: Overall graft uptake rate in group-A was 94%, whereas that in group-B was 100%. The age and sex had no significant effect on the success rate of surgery (p>0.05) in group-A. The average air bone gap (ABG) decreased from 28.3 dB to 10 dB, in group-B, the average ABG was 28.3 dB preoperatively and reached 16.6 dB after surgery. The difference between the rates of ABG improvement in the two groups was significant (p<0.01).
Conclusions: Hearing improvements is better in tympanoplasty type-1 with a temporalis graft only then with cartilage slice reinforcement. However, the graft uptake rate is higher in cartilage reinforcement compare with temporalis muscle fascia only.
Metrics
References
Flint PW, Haughey B, Lund V, Niparko JK, Robbins J, Thomas R, et al. Cummings Otolaryngology E-Book: Head and Neck Surgery, 6th ed., Saunders; 2014.
Wullstein H. Theory and practice of tympanoplasty. Laryngoscope. 1956;66:1076-93.
Storrs L. Myringplasty with use of fascia graft. Arch Otolaryngol Head Neck Surg. 1961;74:45-9.
Shea JJ. Vein graft closure of eardrum perforations. Arch Otolaryngol. 1960;74:358-62.
Utech H. Tympanotomy in disorders of sound conduction; its diagnostic and therapeutic possibilities. Laryngol Rhinol Otol 1959;38:212-21.
Shea JJ. Vein graft closure of eardrum perforations. Arch Otolaryngol. 1960;74:358-62.
Karlan MS. Gelatin film sandwich in tympanoplasty. Otolaryngol Head Neck Surg. 1979;87(1):84-6.
Hartwein J, Leuwer RM, Kehrl W. The total reconstruction of the tympanic membrane by the - crown cork‖ technique. Am J Otolaryngol. 1992;13(3):172-5.
Schwaber MK. Post auricular undersurface tympanic membrane grafting: some modifications of the swinging door‖ technique. Otolaryngol Head Neck Surg. 1986;95(2):182-7.
Escudero LH, Castro AO, Drumond M, Porto SP, Bozinis DG, Penna AF, Gallego Lluesma E. Argon laser in human tympanoplasty. Arch Otolaryngol. 1979;105(5):252-3.
Williams JD. Microclip application in tympanoplasty. Ann Otol Rhinol Laryngol. 1977;86(2):223-6.
Cabra J, Monux A. Efficacy of cartilage palisade tympanoplasty: randomized controlled trial. Otol Neurotol. 2010;31:589-95.
Tek A, Karaman M, Uslu C, Habesoglu T, Kilicarslan Y, Durmus R, et al. Audiological and graft take results of cartilage reinforcement tympanoplasty (a new technique) versus fascia. Eur Arch Otorhinolaryngol. 2012;669:1117-26.
Khan MK, Parab SR. Reinforcement of Sliced Tragal Cartilage Perichondrium Composite Graft with Temporalis Fascia in Type I Tympanoplasty: Our Techniques and Results. J Rhinolaryngo Otolog. 2013;1:1–6.
Prasad S, Ahlawat B, Kumar A, Agrawal A, Nalksulaha M, Chaudhury N. Cartilage island tympanoplasty: the prespective study of anatomical and audiological results. Indian J Sci Res. 2010;7:103-7.
Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope. 2003;113:1844-56.
Vashishth A, Mathur NM, Verma D. Cartilage palisades in type 3 tympanoplasty: functional and hearing results. Indian J Otolaryngol Head Neck Surg. 2014;66:309-13.
Demirpehlivan IA, Onal K, Arslanogulu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Otorhinolaryngol. 2011;268:471-4.
Shrestha BL, Amatya RC, Shrestha I, Pokharel M. Comparison of pre and post-operative hearing results in patients undergone modified inlay butterfly cartilage perichondrium myringoplasty. J Rhinol-Otologies. 2013;1:82-6.
Mendes Neto JA, Neiva FC, Brodskyn F, Palumbo MD, Bittar CV, et al. Plug cartilage tympanoplasty in children. Braz J Otorhinolaryngol. 2008;74:890-5.
Kiran Gangadar S, Priyadarshini G. Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking, Int J Otorhinolaryngol Head Neck Surg. 2020;6(4):657-60.
Mundra RK, Sinha R, Agrawal R. Tympanoplasty in subtotal perforation with graft supported by a slice of cartilage: A study with near 100% results. Indian J Otolaryngol Head Neck Surg. 2013;65:631-9.
Uslu C, Tek A, Tatlipinar A, Kiliçarslan Y, Durmuş R, Ayöğredik E, et al. Cartilage reinforcement tympanoplasty: otological and audiological results. Acta Otolaryngol. 2010;130:375-83.
Kouhi A, Ashthiani MTK, Jalali MM. Results of Type I Tympanoplasty Using Fascia with or without Cartilage Reinforcement: 10 Years’ Experience, Iranian J Otorhinolaryngol. 2018;30(2):103-6.
Singh SP, Nagi RS, Singh J. To study the effect of site and size of tympanic membrane perforation on graft uptake rates and hearing improvement in type I tympanoplasty using sliced conchal cartilage reinforced with temporalis muscle fascia and temporalis muscle fascia alone. Indian J Otol. 2019;25:121-6.
Gerber MJ, Mason JC, Lampert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000;110:1994-9.
Sheikh S, Bajaj A, Vaze V. Is cartilage shield tympanoplasty better than fascia tympanoplasty. Int J Otorhinolaryngol Head Neck Surg. 2020;6(1):70-3.