DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20182715

Outcomes of circumferential tympanomeatal flap tympanoplasty in large central perforation

Venkatesha B. K., Yogeesha B. S., Shibu khan

Abstract


Background: Tympanoplasty is the commonest procedure performed in patients with chronic otitis media. Circumferential elevation of tympanomeatal flap and underlay graft placement is thought to be a good surgical technique as it ensures elevation of canal skin over the Eustachian tube area to form a good assemble between the temporalis graft and the flap to increase the success rate. In our study we intend to study the surgical and hearing outcome in patients undergoing tympanoplasty with circumferential tympanomeatal flap in large central perforations.

Methods: A prospective study with 25 patients in a tertiary care hospital for a period of 2 years, who underwent circumferential tympanomeatal flap tympanoplasty. Patients were followed up on one month and two months. Graft outcomes and hearing outcomes were studied.  

Results: Graft uptake was 92%. Blunting was noticed in 4% and medialisation in 4% of patients in circumferential group. Average air-bone gap closure achieved was 17.468 dB.

Conclusions: Circumferential flap elevation in tympanoplasty is an effective surgical technique in patients with anterior and large central perforations with satisfactory outcomes. 


Keywords


Tympanic membrane perforations, Tympanoplasty, Circumferential tympanomeatal flap, Air bone gap

Full Text:

PDF

References


Telain SA, Schmalbach CE. Chronic otitis media. In: Snow JB, ed. Ballenger’s Otorhinolaryngology. BC Decker; 2003: 46-57.

Jones RO. Myringoplasty. In: Haberman RS, Middle Ear and Mastoid Surgery. New York, NY: Thieme; 2004: 5-11.

Pradeep P, Abhimanyu A, Priti L. Circumferential Elevation of Tympanomeatal Flap: A Novel Technique for subtotal and Anterior Perforation Closure. Ann Otolaryngol Rhinol. 2015;2(7):1052.

Gersdorff M, Gerard J, Thill M. Overlay versus underlay tympanoplasty: comparative study of 122 cases. Rev Laryngol Otol Rhinol. 2003;24:15-22.

Vadiya SI, Shah SK, Chaudhary M. Comparison of canal wall incisions for tympanoplasty for large central perforations. Indian J Otol. 2015;21:186-9.

Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ.Over-under tympanoplasty. Laryngoscope. 2002;112:802–7.

Schraff S, Dash N, Strasnick B. ‘Window shade’ tympanoplasty for anterior marginal perforations. Laryngoscope. 2005;115:1655–9.

Jung TT, Park SK. Mediolateral graft tympanoplasty for anterior or subtotal tympanic membrane perforation. Otolaryngol Head Neck Surg. 2005;132:532–6.

D’Eredità R, Lens MB. Anterior tab flap versus standard underlay myringoplasty in children. Otol Neurotol. 2009;30:777–81.

Lee HY, Auo HJ, Kang JM. Loop overlay tympanoplasty for anterior or subtotal perforations. AurisNasus Larynx. 2010;37:162–6.

Hosamani P, Ananth L, Medikeri SB. Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal-type chronic otitis media. J Laryngol Otol. 2012;126:125–30.

Faramarzi A, Hashemi SB, Rajaee A. ‘Mucosal pocket’ myringoplasty: a modification of underlay technique for anterior or subtotal perforations. Am J Otolaryngol. 2012;33:708–13.

Roychaudhuri BK. 3-flap tympanoplasty: a simple and sure success technique. Indian J Otolaryngol Head Neck Surg. 2004;56:196–200.

Gavriel H, Eviatar E. Inferior flap tympanoplasty: a novel technique for anterior perforation closure. Biomed Res. Int 2013; 26-30.

Mokhtarinejad F, Okhovat S, Barzegar F. Surgical and hearing results of the circumferential subannular grafting technique in tympanoplasty: a randomized clinical study. Am J Otolaryngol. 2012;33(1):75-9.

Mishra P, Sonkhya N, Mathur N. Prospective study of 100 cases of underlay tympanoplasty with superiorly based circumferential flap for subtotal perforations. Indian J Otolaryngol Head Neck S. 2007;59(3):225-8.

Güneri A, Ecevit MC, Erdag˘ TK. Circumferential subannular grafting technique in tympanoplasty: preliminary results. Kulak Burun BogazIhtis Derg 2006;16:7–10.

Singh G, Ranjan S, Arora R, Kumar S. Role of circumferential subannular tympanoplasty in anterior and subtotal perforations. J Laryngol Otol. 2017;131(02):123-7.

Potsic WP, Winawer MR, Marsh RR. Tympanoplasty for the anterior-superior perforation in children. Am J Otol. 1996;17:115–8.

Ganguly S, Reddy N, Shrestha A, Acharya A. Underlay tympanoplasty with tunneling and placement of graft in anterior canal wall. J Coll Med Sci-Nepal. 2012;7(4):44-7.

Robinson J. Surgery of chronic suppurative otitis media. In: Ludman H, Wright W, eds. Diseases of the ear, 6th edn. London: Hodder Arnold; 1997: 423.

Kulkarni V, Mittal M. Single Flap Otoendoscopic Myringoplasty for Large Central Perforation—A Pilot Study. International Journal of Otolaryngology and Head & Neck Surg. 2014;03(04):161-5.

Doyle JP, Schleuning AJ, Echevarria J. Tympanoplasty: should grafts be placed medial or lateral to the tympanic membrane? Laryngoscope 1972; 82:1425–30.

Rizer FM. Overlay versus underlay tympanoplasty. Part 1: Historical review of the literature; part II: the study. Laryngoscope. 1997;107:26–36.

Stage J, Bak-Pedersen K. Underlay tympanoplasty with the graft lateral to the malleus handle. Clin Otolaryngol. 1992;17:6–9.

Rogha M, Berjis N, Taherinia A, Eshaghian A. Comparison of tympanic membrane grafting medial or lateral to malleus handle. Adv Biomed Res. 2014;3:56.

Sweeney AD, Hunter JB, Haynes DS, Driscoll. Iatrogenic cholesteatoma arising from the vascular strip. The Laryngoscope. 2017;127:698–701.

Moras K, Lasarado S, Shivaraj R, Aramani A. 360 Degree Subannular Tympanoplasty: A Retrospective Study. J Evol Med Dental Sci. 2015;4(32);5455-61.

Takahashi H, Sato H, Nakamura H, Naito Y. Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty. AurisNasus Larynx. 2007(2):173–6.