DOI: https://dx.doi.org/10.18203/issn.2454-5929.ijohns20222439
Published: 2022-09-26

Role of cartilage graft in type 1 tympanoplasty: audiological and otologic outcomes

Jasmeet Kaur, Sanjeev Bhagat, Dimple Sahni, Dinesh K. Sharma, Vishav Yadav

Abstract


Background: Temporalis fascia is the most commonly used graft material for the tympanic membrane perforations. Due to high failure rate of temporalis fascia in adhesive otitis media, large perforations and advanced middle ear pathology alternate graft materials which are more rigid and resistant to infection are being used. Cartilage graft has shown to be a promising graft material in such cases. The purpose of this study was to evaluate the functional and anatomic results with cartilage graft in type 1 tympanoplasty.

Methods: The present prospective study was conducted among 40 patients of chronic otitis media between 11-60 years of age requiring tympanoplasty in department of ear, nose and throat (ENT) in Government Medical College and Rajindra Hospital, Patiala.  

Results: The overall success rate of type 1 cartilage tympanoplasty was 85% in terms of perforation closure and post operative pure tone audiometry (PTA) at 6 weeks was 37.24 and at 12 weeks PTA was 34.27 The p value was <0.001 which was found to be significant. The AB gap closure at 6 weeks post op was 6.79 and at 12 weeks 9.76±2.12 dB.

Conclusions: Based on the results of this study, it can be concluded that cartilage is more effective graft material in high-risk perforations, chronic ET dysfunction than fascia and audiological improvement with cartilage is found to be comparable with temporalis fascia.


Keywords


Cartilage, Graft uptake, ABG

Full Text:

PDF

References


Muftah S, Mackenzie I, Faragher B, Brabin B. Prevalence of Chronic Suppurative Otitis Media (CSOM) and Associated Hearing Impairment Among School-aged Children in Yemen. Oman Med J. 2015;30(5):358-65.

World Health Organization. Chronic suppurative otitis media: Burden of illness and management options. World Health Organization. Geneva, 2004. Available at: https://apps.who.int/iris/handle/ 10665/42941. Accessed on 12 April 2022.

Ramalingam V, Kamindan K, Murugan RK, Rajeswari V. A comparative study on outcome of type 1 Tympanoplasty using sliced 1mm conchal cartilage and full thickness conchal cartilage for grafting. Egyptian J Otolaryngol. 2020;36:5.

Anderson J, Caye-Thomasen P, Tos M. A comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction cholesteatoma in children. Otol Neurotol. 2004;25:856-63.

Gierek T, Kaspera A, Majzel K, Gotqbml K. Results of myringoplasty and type 1 tympanoplasty with the use of fascia, cartilage and perichondrium grafts. Otolaryngologica Polska. 2004;3:529-33.

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

Glasscock ME, Shambaugh GE. Surgery of the ear 6th edition. Chapter 28. Elsevier publishers. 2007; 463-85.

Toss M. Cartilage Tympanoplasty Methods: Proposal of a classification. Otolaryngol Head Neck Surg. 2008;139:747-58.

Lee CF, Chen JH, Chou YF, Hsu LP, Chen PR, Liu TC. Optimal graft thickness for different sizes of tympanic membrane perforation in cartilage myringoplasty: a finite element analysis. Laryngoscope. 2007;117(4):725-30.

Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD. Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope. 2006;116(10):1813-6.

Kerr AG, Bryne JET, Symth GDL. Cartilage homografts in the middle ear: a long term histologic study. J Laryngol Otol. 1973;87:1193-9.

Sahan M, Derin S, Deveer M, Cullu N. Factors affecting success and results of cartilage perichondrium island graft in revision tympanoplasty. Int Adv Otol. 2014;10:64-7.

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

Strahan RW, Acquarelli M, Ward PH, Jafek B. Tympanic membrane grafting. Analysis of materials and techniques. Ann Otol Rhinol Laryngol. 1971;80(6):854-60.

Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of otological, surgical and patient related factors in determining success in myringoplasty. Clin Otolaryngol. 2005;30(2):115-20.

Kumar A, Sangavi B. Assessment of hearing improvement by myringoplasty. J Scientific Innovative Res. 2015;4(2):67-70.

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

Ruhl CM, Pensak ML. Role of aerating mastoidectomy in noncholesteatomatous chronic otitis media. Laryngoscope. 1999;109:1924-7.

Khan MM, Parab SR. Primary cartilage tympanoplasty: our technique and results. Am J Otolaryngol. 2011;32(5):381-7.

Guler I, Baklaci D, Kuzucu I, Kum RO, Ozcan M. Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients. Auris Nasus Larynx. 2019;46(3):319-23.

Ozbek C, Ciftçi O, Tuna EE, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in Type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol. 2008;29:679-83.

El-Sheikh MM. Evaluation of hearing outcome of tympanoplasty using cartilage graft versus temporalis fascia graft. Egypt J Otolaryngol. 2019;35(1):1.

Sharma N, Sharma P, Sharma P, Kumar G, Goyal VP. Comparison of otological and audiological outcome of type 1 tympanoplasty using composite tragal perichondrium and temporalis fascia as graft. Int J Otolaryngol Head Neck Surg. 2018;4(5):1182-7.

Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997;107:1094-9.

Boone RT, Gardner EK, Dornhoffer JL. Success of cartilage grafting in revision tympanoplasty without mastoidectomy. Otol Neurotol. 2004;25(5):678-81.

Ozbek C, Ciftçi O, Tuna EE, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in Type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol. 2008;29:679-83.

Albirmaway OA. Comparison between cartilage perichondrium composite 'ring' graft and temporalis fascia in type 1 tympanoplasty in children. J Laryngol Otol. 2010;124:967-74.

Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E. Comparison of different tympanic membrane reconstruction techniques in type 1 Tympanoplasty. Eur Arch Otorhinolayngol. 2011;268:471-4.

Yurttas V, Yakut F, Kutluhan A, Bozdemir K, et al. Preparation and placement of cartilage island graft in tympanoplasty. Braz J Otorhinolaryngol. 2014;80(6):522-6.

Couloigner V, Baculard F, El Bakkouri W, Viala P, François M, Narcy P, Van Den Abbeele T. Inlay butterfly cartilage tympanoplasty in children. Otol Neurotol. 2005;26(2):247-51.