Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material

Authors

  • Arvinder Singh Sood Department of Otorhinolaryngology, SGRD Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India
  • Pooja Pal Department of Otorhinolaryngology, SGRD Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India
  • Anshul Singla Department of Otorhinolaryngology, SGRD Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20181873

Keywords:

Tympanoplasty, Graft acceptance, Hearing improvement, Tragal cartilage, Temporalis fascia

Abstract

Background: Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.

Methods: This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared.  

Results: The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.

Conclusions: Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.

 

Author Biographies

Arvinder Singh Sood, Department of Otorhinolaryngology, SGRD Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India

Professor and Head, Department of Otolaryngology and Head Neck Surgery

Pooja Pal, Department of Otorhinolaryngology, SGRD Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India

Associate Professor, Department of Otolaryngology and Head Neck Surgery

Anshul Singla, Department of Otorhinolaryngology, SGRD Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab, India

Post graduate Resident

References

Lau T, Tos M. Tympanoplasty in children. An analysis of late results. Am J Otol. 1986;7:55-9.

Sapci T, Almac S, Usta C, Karavus A, Mercangoz E, Evcimik F. Comparison between tympanoplasties with cartilage-perichondrium composite graft and temporal fascia graft in terms of hearing levels and healing. Kulak Burun Bogaz Ihtis Derg. 2006;16:255-60.

Aggarwal R, Saeed SR, Green KJ. Myringoplasty. J Laryngol Otol. 2006;120:429-32.

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

Zoellner F. The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol. 1955;69:657–9.

Wullstein HL. Functional operations in the middle ear with split-thickness skin graft. Arch Otorhinolaryngol. 1952;161:422–35.

Cavaliere M, Mottola G, Rondinelli M, Iemma M. Tragal cartilage in tympanoplasty: anatomic and functional results in 306 cases. Acta Otorhinolaryngol Ital. 2009;29(1):27-32.

Dornhoffer J. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997;07:1094–99.

Zulkifal Awan, Habib Bashir, Altaf Hussain. Myringoplasty. A comparative study of different graft materials and various surgical techniques. Ann Pak Inst Med Sci. 2008;4(4):209-11.

Kalcioglu MT, Firat Y, Selimoglu E. Cartilage tympanoplasty with island technique: A comparison with the temporalis muscle fascia technique. Int Adv Otol. 2009;5(1):45-50.

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

Goodhill V. Tragal perichondrium and cartilage in tympanoplasty. Arch Otolaryngol 1967;85:480-91.

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

Matthew JG, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000;110:1994-9.

Kirazli T, Bilgen C, Midilli R, Ogut F. Hearing results after primary cartilage tympanoplasty with island technique. Otolaryngol Head Neck Surg. 2005;132:933-7.

Chen XW, Yang H, Gao RZ, Yu R, Gao ZQ. Perichondrium/cartilage composite graft for repairing large tympanic membrane perforations and hearing improvement. Chin Med J(Engl). 2010;123(3):301-4.

Zhi Gang Zhang, Qiu Hong Huang, Yi Qing Zheng, Wei Sun, Yu Bin Chen, Yu Si. Three autologous substitutes for myringoplasty: A comparative study. Otol Neurotol. 2011;32:1234-8.

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Published

2018-04-26

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Original Research Articles