Comparison between cartilage–perichondrium composite ‘ring’ graft and temporalis fascia in type one tympanoplasty in children

AbstractObjective:This study aimed to evaluate the anatomical and audiological outcomes of primary type one tympanoplasty performed with a modified cartilage–perichondrium composite ‘ring’ graft, and to compare them with results for primary type one tympanoplasty performed with temporalis fascia, in children.Study design:Retrospective clinical study.Setting:Otolaryngology department, Tanta University Hospital, Egypt.Patients and methods:Records were evaluated for 82 children with dry tympanic membrane perforation (any size) and intact ossicular chain, and with no history of previous ear surgery except for tympanostomy. Patients of similar age and middle-ear pathology were selected to make the two groups as homogeneous as possible. An underlay type one tympanoplasty, using either a ring graft or temporalis fascia, was performed: 40 children were included in the ring graft group and 42 in the temporalis fascia group. All procedures were performed by the same surgeon. A successful anatomical outcome was considered to comprise full, intact healing of the graft without perforation, retraction, lateralisation or blunting, for at least one year post-operatively. Patients' post-operative pure tone average air–bone gap and speech reception threshold were compared with pre-operative levels, within and between the two groups.Results:Type one tympanoplasty using a ring graft technique resulted in a significantly greater graft acceptance rate (95 per cent) compared with the temporalis fascia technique (76.2 per cent;p < 0.01). Pure tone average air–bone gap and speech reception threshold levels improved significantly in both the ring graft and fascia groups (p < 0.001). There was no significant difference in audiometric results between the two groups (p > 0.05), although there was a trend towards better post-operative results in the ring group.Conclusion:In our paediatric patients, type one tympanoplasty with a modified cartilage–perichondrium composite ring graft yielded good anatomical and functional results. The anatomical results obtained using this graft (with its unique appearance and stability during and after surgery) were superior to those for temporalis fascia. The ring graft group had equivalent, if not better, post-operative audiometric results, compared with the temporalis fascia group. Thus, the ring graft is believed to be effective in enabling both tympanic membrane closure and rapid hearing improvement, in the paediatric population.

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Association of age-related macular degeneration with age-related hearing loss

The Journal of Laryngology & Otology ◽

10.1017/s0022215110002604 ◽

2010 ◽

Vol 125 (3) ◽

pp. 231-235 ◽

Cited By ~ 5

Author(s):

M K Bozkurt ◽

B T Ozturk ◽

H Kerimoglu ◽

I Ersan ◽

H Arbag ◽

...

Keyword(s):

Hearing Loss ◽

Macular Degeneration ◽

Pure Tone ◽

Group Versus ◽

Age Related Macular Degeneration ◽

University Hospital ◽

Pure Tone Average ◽

Age Related ◽

Significant Difference ◽

Age Related Hearing Loss

AbstractObjective:To assess the association between age-related macular degeneration and age-related hearing loss in Turkish subjects aged 50 years or older.Study design and setting:Prospective, case–control study within a tertiary university hospital.Subjects and methods:Fifty subjects with age-related macular degeneration and 43 healthy subjects underwent ophthalmological and otolaryngological examination. Statistical analyses were conducted for the poorer eye and ear, comparing age-related hearing loss and pure tone average in the macular degeneration group versus controls.Results:Median pure tone average was significantly poorer in the macular degeneration group (35 dBHL) compared with controls (23 dBHL). In the macular degeneration group, hearing loss was significantly greater in dry type (43 dBHL) than wet type (32 dBHL) cases. There was a significant difference between the prevalence of varying degrees of hearing loss in the macular degeneration versus control groups, being respectively: mild, 50 and 35 per cent; moderate, 20 and 5 per cent; and severe, 6 and 0 per cent. There was a weak, but significant correlation between each patient's visual acuity and pure tone average results (rs = −0.37, p < 0.001).Conclusion:Age-related hearing loss is more common in patients with age-related macular degeneration. Such patients should be questioned regarding hearing difficulty, and referred to an otolaryngologist if appropriate.

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The Effect of Monaurally Fitted Hearing Aid Use on the Evolution of Presbycusis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421995279 ◽

2021 ◽

pp. 000348942199527

Author(s):

Gabriel Dunya ◽

Fadi Najem ◽

Aurelie Mailhac ◽

Samer Abou Rizk ◽

Marc Bassim

Keyword(s):

Word Recognition ◽

Pure Tone ◽

Hearing Aid ◽

Residual Hearing ◽

Inclusion Criteria ◽

Pure Tone Average ◽

Hearing Aid Use ◽

Deprivation Effect ◽

Significant Difference

Objective: The effect of hearing aid use on the evolution of presbycusis has not been well described in the literature, with only a handful of publications addressing this topic. This paper aims to evaluate the long-term use of amplification and its effect on pure-tone thresholds and word recognition scores. Method: Monaurally fitted patients were followed with serial audiograms. Data was collected from hearing aid centers. Seventy-seven patients with presbycusis met the inclusion criteria and participated in the present study. The progression of hearing loss in both pure tone thresholds and word recognition scores were compared between the hearing aid ears (HA), and the non-hearing aid ears (NHA). Pure tone thresholds were analyzed by comparing the pure tone average at the initial and last audiograms. Word Recognition Scores (WRS) were analyzed using the model of Thornton and Raffin (1978), and by comparing the change in the absolute values of WRS from the initial to the last audiogram between the HA ear and the NHA ear. Results: No significant difference in pure-tone thresholds between the HA ear and NHA ear was found at the last audiogram ( P = .696), even after dividing the patients into groups based on the duration of amplification. Both methods of analysis of patients’ WRS showed a statistically significant worsening in NHA ( P < .05). Conclusion: The present study supports the previously defined auditory deprivation effect on non-fitted ears, which showed worsening of word recognition over time and no effect on pure tone average. It provides an additional argument for the counseling of patients with presbycusis considering amplification, and highlights the importance of bilateral amplification in preserving the residual hearing of hearing impaired patients.

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Outcome of Myringoplasty with Temporalis Fascia and Perichondrial-Cartilage Composite Graft in High Risk Perforations

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24855 ◽

2019 ◽

Vol 21 (1) ◽

pp. 60-64

Author(s):

Anup Dhungana ◽

RR Joshi ◽

AS Rijal ◽

KK Shrestha ◽

S Maharjan

Keyword(s):

High Risk ◽

Tympanic Membrane ◽

Uptake Rate ◽

Pure Tone Audiometry ◽

Composite Graft ◽

Temporalis Fascia ◽

Fascia Graft ◽

Significant Difference ◽

The Mean ◽

And Cartilage

The objective of this study was to compare the graft uptake results and postoperative hearing of myringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high risk perforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/ eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement cases were included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80 cases were included for myringoplasty which were randomly allocated by lottery method with 40 cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptake results were assessed after 6 weeks and postoperative hearing was evaluated and compared within and between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrial composite graft group was 90% and 92.5%, respectively with no significance difference in the graft uptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalis fascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and 33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001) showing improvement in the hearing after surgery in both groups. The mean air bone gain were 14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectively with no significant difference between the groups (p=0.469). The graft uptake rate and hearing results after cartilage perichondrial composite graft are comparable to those of temporalis fascia graft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it is more resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend the use of cartilage perichondrial composite graft for tympanic membrane reconstruction in high risk perforation without concern about affecting audiometric results.

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Temporalis Fascia and Cartilage-Perichondrium Composite Shield Grafts for Reconstruction of the Tympanic Membrane

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940911800807 ◽

2009 ◽

Vol 118 (8) ◽

pp. 570-574 ◽

Cited By ~ 22

Author(s):

Sertac Yetiser ◽

Yusuf Hidir

Keyword(s):

Tympanic Membrane ◽

Bone Conduction ◽

Hearing Threshold ◽

Functional Results ◽

Mean Value ◽

Acoustic Energy ◽

Type I ◽

Temporalis Fascia ◽

Significant Difference ◽

And Cartilage

Objectives We sought to compare the long-term functional results of tympanic membrane reconstruction with temporalis fascia and cartilage shield grafting. Methods This study includes 113 patients who had tympanoplasty type I tympanic membrane reconstruction between 1997 and 2007, 47 with tragal cartilage and 66 with temporalis fascia. Fourteen patients in the cartilage group and 9 patients in the temporalis fascia group also had mastoidectomy. The average follow-up was 3.2 years. The hearing threshold was calculated as the mean value of the thresholds for 500, 1,000, 2,000, and 3,000 Hz. A paired-samples t-est was used for comparison of the preoperative and postoperative air and bone conduction hearing thresholds and air-bone gaps. Results Significant recovery was found in the postoperative air conduction threshold and air-bone gap in both the temporalis fascia and cartilage groups as compared to those before surgery (p < 0.001). However, the average air and bone conduction thresholds and air-bone gap were found to be statistically different after surgery in the cartilage group as compared to those in the temporalis fascia group. There was no significant difference in hearing parameters before and after surgery in patients with or without mastoidectomy in either the cartilage group or the temporalis fascia group. Conclusions The hearing gain in patients with cartilage shield grafting was better than that in those who had temporalis fascia tympanoplasty, although experimental analysis shows loss of acoustic energy for thick and large shield cartilage grafts.

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Correlation between the characteristics of resonance and aging of the external ear

CoDAS ◽

10.1590/2317-1782/2014211in ◽

2014 ◽

Vol 26 (2) ◽

pp. 112-116 ◽

Cited By ~ 2

Author(s):

Aline Papin Roedas da Silva ◽

Wanderléia Quinhoneiro Blasca ◽

José Roberto Pereira Lauris ◽

Jerusa Roberta Massola de Oliveira

Keyword(s):

Tympanic Membrane ◽

Hearing Aids ◽

External Auditory Canal ◽

The Elderly ◽

Peak Frequency ◽

External Ear ◽

Primary Peak ◽

Retrospective Clinical Study ◽

Significant Difference ◽

Group B

PURPOSE: Aging causes changes in the external ear as a collapse of the external auditory canal and tympanic membrane senile. Knowing them is appropriate for the diagnosis of hearing loss and selection of hearing aids. For this reason, the study aimed to verify the influence of the anatomical changes of the external ear resonance in the auditory canal in the elderly. METHODS: The sample consisted of objective measures of the external ear of elderly with collapse (group A), senile tympanic membrane (group B) and without changing the external auditory canal or tympanic membrane (group C) and adults without changing the external ear (group D). In the retrospective/clinical study were performed comparisons of measures of individuals with and without alteration of the external ear through the gain and response external ear resonant frequency and the primary peak to the right ear. RESULTS: In groups A, B and C was no statistically significant difference between Real Ear Unaided Response (REUR) and Real Ear Unaided Gain (REUG), but not for the peak frequency. For groups A and B were shown significant differences in REUR and REUG. Between the C and D groups were significant statistics to the REUR and REUG, but not for the frequency of the primary peak. CONCLUSION: Changes influence the external ear resonance, decreasing its amplitude. However, the frequency of the primary peak is not affected

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Correlation between degree of hearing loss and intraoperative findings in tubotympanic type of chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180717 ◽

2018 ◽

Vol 4 (2) ◽

pp. 537 ◽

Cited By ~ 1

Author(s):

Ravi Dudda ◽

Sowmya Tumkur Rangaiah ◽

M. Hanumantha Prasad ◽

Nagavara Kalegowda Balaji

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Significant Difference

Background: The aim of tympanoplasty done for tubotympanic type of chronic suppurative otitis media (CSOM) should not only be to achieve a dry ear, but also to give hearing improvement to the patient. Aim of this study was to determine the correlation between size and site of tympanic membrane perforation with degree of hearing loss and correlation between ossicular chain status and degree of hearing loss on pure tone audiometry.Methods: Patients with tubotympanic CSOM with hearing loss upto 60 dBHL undergoing tympanoplasty were examined to know the site and size of tympanic membrane(TM) perforation. Intraoperative findings pertaining to middle ear and ossicles were noted. Results: Out of 52 patients of tubotympanic type of CSOM, hearing loss was least (31.18±7.46 dBHL) in small perforations of the TM and highest in subtotal perforations (48.74±7.83 dBHL) which was statistically significant. Hearing loss was significantly more in posterior perforation (46.61±7.02 dBHL) than in anterior perforation of TM (32.65±8.77 dBHL). There was a statistically significant difference in pure tone average hearing loss between intact ossicle group (32.87±9.77 dBHL) and eroded ossicle group (43.39±9.60dBHL). Difference in air bone gap was also significant between intact ossicle group (24.09±9.56 dB) and eroded ossicle group (31.02±9.83 dB). Multiple ossicles were eroded in nineteen patients with incus being the most commonly eroded ossicle.Conclusions: In this study, hearing loss increased with increased size of TM perforation and also with posterior perforation. Incus was found to be the most commonly eroded ossicle. Multiple ossicles were seen eroded most commonly when hearing loss was moderate. The surgeon will be better equipped to do ossiculoplasty in view of these preoperative findings and also to counsel the patient better about their expectation of hearing improvement following surgery.

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Evaluation of Clinical Parameters in FMT-Application of a Vibrant Soundbridge® at the Short Incus Process Compared to Conventional FMT-Application

Surgical Case Reports ◽

10.31487/j.scr.2020.05.04 ◽

2020 ◽

pp. 1-4

Author(s):

Markus Pirlich ◽

Andreas Dietz ◽

Markus Pirlich ◽

Viktor Kunz

Keyword(s):

Pure Tone ◽

Revision Rate ◽

University Hospital ◽

Complication Rates ◽

Vibrant Soundbridge ◽

Surgical Time ◽

Pure Tone Audiogram ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: The application of the Floating Mass Transducer (FMT) of a Vibrant Soundbridge (VSB) to the short incus process is intended to reduce both the surgery time and the complication and revision rate compared to other forms of application. In addition to collecting these parameters, the aim of this study is to investigate the primary audiological outcome of patients with an FMT application to the short process compared to the conventional methods. Methods: The present study retrospectively examined a total of n=36 patients who received a VSB between 01/2015 and 08/2018 at the ENT University Hospital Leipzig. In n=12 patients (group 1) the FMT was coupled to the short process, in n=24 patients (group 2) to other ear structures. The audiological results were evaluated pre- and postoperatively in the pure tone audiogram according to the recommendations of the AAO-HNS (1995) and the intelligibility (Freiburger, monosyllabic) was measured at 65 dB in the speech audiogram. In addition, the revision and complication rates as well as the surgical time were evaluated. Results: The audiological outcome of group 2 was significantly better postoperatively in both the pure tone (p<.001) and speech audiogram (p=.012). The surgery time of group 1 was significantly shorter (p=.002), but with a slightly increased revision rate (p=.519). The complication rate of group 2 was slightly higher, with no statistically significant difference to group 1 (p=.185). Conclusions: The FMT application on the short ambos process does not seem to offer any advantage in terms of audiological outcome, but at the same time is associated with a significantly shorter surgery time. There are no statistically significant differences in revision and complication rates.

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Impact of type of graft material on outcome of tympanoplasty: a comparison between temporalis fascia and cartilage with perichondrium

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183706 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1301

Author(s):

Kanchan Tadke ◽

Randhir Ghorpade ◽

Vaibhav Lahane ◽

P. S. Mundada

Keyword(s):

Tympanic Membrane ◽

Controlled Trial ◽

Tertiary Care ◽

Type I ◽

Graft Material ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Graft Take ◽

Significant Difference ◽

And Cartilage

Background: Various graft materials have been used to repair tympanic membrane perforations. Temporalis fascia and cartilage with or without perichondrium are the most commonly used materials. The objective of the study was to compare the anatomical and functional success in type I tympanoplasty by using cartilage- perichondrium graft with that of temporalis fascia in a homogenous group of population.Methods: 64 patients with chronic otitis media - mucosal type were included in the study. This prospective, randomized controlled trial was conducted at a tertiary care centre between December 2012 to October 2014. Patients were grouped randomly between temporalis fascia (34/64) and cartilage group (30/64). In the fascia group, the graft was placed by underlay technique. In the cartilage group, tragal cartilage was thinned by cartilage thinner keeping the perichondrium attached on one side. The graft was placed by underlay or over-underlay technique. Postoperative results i.e. graft take up (anatomical success) and hearing improvement (functional success) were evaluated at 6 months. Results: Graft take up rate was 94.11% for fascia group and 96.66% for cartilage group. The mean pure tone air bone gaps pre and postoperatively in the fascia group were 26.4±6.55 dB and 11.47±6.5 dB respectively, whereas for cartilage-perichondrium group, the values were 28.3±5.86 dB and 13.2±6.48 dB respectively. There was no statistically significant difference in the graft take up rate and postoperative hearing improvement between the two groups (p≥0.05).Conclusions: Cartilage with perichondrium can be considered as an alternative to more traditional grafting material for tympanic membrane reconstruction.

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Prediction of the Pure-Tone Average from the Speech Reception and Auditory Brainstem Response Thresholds in a Geriatric Population

ORL ◽

10.1159/000163032 ◽

2008 ◽

Vol 70 (6) ◽

pp. 366-372 ◽

Cited By ~ 5

Author(s):

Chih-Hung Chien ◽

Tzong-Yang Tu ◽

An-Suey Shiao ◽

Shu-Feng Chien ◽

Yi-Fen Wang ◽

...

Keyword(s):

Auditory Brainstem Response ◽

Pure Tone ◽

Auditory Brainstem ◽

Geriatric Population ◽

Pure Tone Average ◽

Speech Reception ◽

Brainstem Response ◽

Response Thresholds

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A prospective study of the hearing gain achieved in relation to the site and size of tympanic membrane perforation after type 1 tympanoplasty with temporalis fascia graft

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195198 ◽

2019 ◽

Vol 6 (1) ◽

pp. 20

Author(s):

Gopinathan N. Pillai ◽

Anjana Mary Reynolds ◽

Nazneen Parammal Ayyappankandi ◽

Cyril C. Ninan

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone ◽

Tympanic Membrane Perforation ◽

Temporalis Fascia ◽

Hearing Gain ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Membrane Perforation

Background: Chronic otitis media (COM) mucosal type is characterised by recurrent ear discharge and hearing loss secondary to tympanic membrane perforation. Type 1 tympanoplasty is the surgical option for its closure. The objective of this study is to record the site and size of tympanic membrane perforation, quantify the hearing loss with pure tone audiogram and to assess the hearing gain achieved following type 1 tympanoplasty with temporalis fascia graft.Methods: This prospective study comprises 120 patients of the age group of 15 to 60 years with COM who attended the otorhinolaryngology department, from June 2015 to May 2018. Site and size of perforation were assessed by the number of quadrants involved. Hearing loss was quantified by pure tone audiometry (PTA) pre-op and 3, 6 and 12 months post-op. The pure tone average with the air-bone gap (ABG) at 12 months is used for the assessment. Results: In this study, mean pure tone average pre-operatively for small, medium, large and subtotal perforations were 26 dB, 32 dB,35 dB, 42 dB respectively and 14.37 dB, 23 dB, 23.66 dB, and 32.5 dB post operatively after one year. On statistical analysis by ANOVA test, postoperative hearing gain was statistically significant.Conclusions: The study shows that hearing loss was proportional to the size of perforation. Air-bone closure following type 1 tympanoplasty was more for subtotal perforation and for perforations involving both anterior and posterior quadrants.

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