Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty

2018 ◽  
Vol 132 (06) ◽  
pp. 497-504 ◽  
Author(s):  
A A Kolethekkat ◽  
R Al Abri ◽  
K Al Zaabi ◽  
N Al Marhoobi ◽  
S Jose ◽  
...  
Keyword(s):  
Comparative Study ◽  
Ossicular Chain ◽  
Composite Graft ◽  
Temporalis Fascia ◽  
Definite Advantage ◽  
Hearing Gain ◽  
Graft Healing ◽  
Graft Take ◽  
Significant Difference ◽  
Retrospective Comparative Study

AbstractObjectiveTo validate a newly introduced cartilage rim augmented temporalis fascia tympanoplasty technique by statistically comparing it with the morphological and audiological outcomes of traditional temporalis fascia tympanoplasty.MethodsA retrospective comparative study was conducted on 115 patients who underwent tympanoplasty during 2013 and 2015. Fifty-eight patients underwent temporalis fascia tympanoplasty and 57 underwent cartilage rim augmented fascia tympanoplasty.ResultsIn the cartilage fascia group, graft healing was achieved in 94.7 per cent of cases; in the temporalis fascia group, the graft take-up rate was 70 per cent. In those with a normal ossicular chain, the post-operative air–bone gap was within 20 dB in 92.6 per cent of cartilage fascia group cases and in 69.7 per cent of the temporalis fascia group cases, which was a statistically significant difference. Among the defective ossicular chain cases, the post-operative air–bone gap was within 20 dB in 76.9 per cent in the cartilage fascia group, as against 57.1 per cent in the temporalis fascia group.ConclusionCartilage rim augmented temporalis fascia tympanoplasty has a definite advantage over the temporalis fascia technique in terms of superior graft take up and statistically significant hearing gain in those with normal ossicular mobility.

Comparative study of the underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane

2003 ◽  
Vol 117 (6) ◽  
pp. 444-448 ◽  
Author(s):  
Mangal Singh ◽  
Ashutosh Rai ◽  
Sarmishtha Bandyopadhyay ◽  
S. C. Gupta
Keyword(s):  
Comparative Study ◽  
Prospective Study ◽  
Tympanic Membrane ◽  
Influencing Factors ◽  
Ossicular Chain ◽  
Time Consumption ◽  
Hearing Gain ◽  
Established Procedure ◽  
Graft Take ◽  
Overlay Technique

Myringoplasty is an established procedure. However, the quest is on to improve the results further by studying the different influencing factors, that could possibly affect the outcome. In the present randomized prospective study of one year’s duration, 60 patients having dry, large and subtotal perforations of the tympanic membrane were subjected to myringoplasty, 30 by the overlay technique and 30 by the underlay technique keeping all other influencing factors constant. The graft take-up rate was found to be the same (93.3 per cent) in both techniques but the underlay technique was judged to be better because of its technical ease, better assessment of ossicular chain integrity and mobility, less time consumption (55 minutes vs 90 minutes), earlier healing of graft (four to six weeks vs six to eight weeks), hearing gain in more patients (92.8 per cent vs 57.1 per cent) and fewer minor complications (6.6 per cent vs 33.3 per cent).

scholarly journals Factors affecting surgical outcome of myringoplasty

1970 ◽  
Vol 17 (2) ◽  
pp. 82-87 ◽  
Author(s):  
Md Zakaria Sarker ◽  
Mesbauddin Ahmed ◽  
Khabiruddin Patwary ◽  
Rabiul Islam ◽  
Abul Hasnat Joarder
Keyword(s):  
Middle Ear ◽  
Surgical Outcome ◽  
Tympanic Membrane Perforation ◽  
Hearing Improvement ◽  
Factors Affecting ◽  
Hearing Gain ◽  
Graft Take ◽  
Significant Difference ◽  
Large Perforation ◽  
Small Perforation

Introduction: This prospective study was carried out to evaluate the factors that affect the graft take rate as well as hearing improvement after myringoplasty. Method: In this study 60 patients were divided into several groups based on 4 factors like size of perforation (small, medium and large), site of perforation (anterior central, posterior central and central malleolar), Condition of the middle ear (dry & wet) and surgical approach (post auricular and transcanal). Surgical outcome of myringoplasty was measured on the basis of graft take rate and post operative hearing improvement. Results: Size of the perforation affects the graft take rate and post operative hearing gain. Post operative closure of air-bone gap was 10.45 dB, 19.21 dB and 18.86 dB in small, medium and large perforation respectively. Hearing gain was greater after closure of large perforation than the smaller one. Graft take rate was 100%, 82% and 72.73% in small, medium and large perforation respectively. Graft take rate was greater in small perforation than other. Site of perforation also affects surgical outcome after myringoplasty. Graft take rate in anterior central, posterior central and central malleolar perforation was 66.67%, 82.25% and 83.79% respectively. Graft take rate was higher in central malleolar perforation than anterior central perforation. Post operative air-bone gap closure after myringoplasty was 15.31 dB, 12.38 dB and 20.89 dB in anterior central, posterior central and central malleolar perforation respectively. Post operative improvement of hearing was greater in central malleolar perforation. Condition of middle ear at the time of operation also affects the surgical outcome. Graft take rate was 89.36% in dry perforation and 53.85% in wet perforation. Graft take rate was greater in dry perforation. Closure of air-bone gap was 18.23 dB and 7.8 dB in dry and wet perforation respectively. Hearing improvement was greater in dry perforation. No significant difference was found in post-aural and transcanal approach. Conclusion: From this study we concluded that site and size of tympanic membrane perforation and condition of middle ear effects surgical outcome after myringoplasty. Key words: Myringoplasty; hearing improvement; graft take rate. DOI: http://dx.doi.org/10.3329/bjo.v17i2.8846 BJO 2011; 17(2): 82-87

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

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.

scholarly journals A Comparative Study of Graft-Take Between Tie-Over Dressing and Dressing with Multiple Quilting in Full Thickness Skin Graft

2014 ◽  
Vol 3 (2) ◽  
pp. 38-44
Author(s):  
Md Maruful Islam ◽  
Imran Choudhury ◽  
Md Nashir Uddin ◽  
Lutfar Kader Lenin ◽  
Rayhana Awwal ◽  
...  
Keyword(s):  
Comparative Study ◽  
Plastic Surgery ◽  
Skin Graft ◽  
Full Thickness ◽  
Full Thickness Skin Graft ◽  
Recipient Site ◽  
Full Thickness Skin ◽  
Graft Take ◽  
Thickness Skin ◽  
Significant Difference

A skin graft is the simplest way of reconstructing an area of skin loss. The graft must acquire blood supply from the wound bed and ‘taken’ by the recipient site. The aim of the present study was to compare the outcome of graft-take of full thickness skin graft by tie-over dressing versus multiple quilting and simple dressing in face and neck region. This prospective, interventional, comparative study was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital from January 2009 to December 2010 (2 years). A total number of 60 cases from 56 patients of any age of both sexes requiring full thickness skin graft and fulfilling the pre-set inclusion and exclusion criteria, were selected for the study. Of whom 30 cases were tagged as Group A (Quilting) while the rest 30 as Group B, which was managed with tie-over dressing. Variable outcomes like epidermal loss, partial dermal loss and full thickness loss were observed in both groups. In quilting group excellent result was achieved in 22(73.3%), good 2(6.7%), satisfactory 3(10%) and poor in 3(10%) patient. In tie-over group, it was 19(63.3%), 3(10%), 3(10%) and 5(16.7%) accordingly. So, the good take were 27(90%) in quilting group and 25(83.3%) in tie-over group. Haematoma recorded in 3 (10%) of quilted group and 5 (16.7%) of tie-over group. No infection occurred in any cases of any group. There were no other recorded complications or adverse outcomes directly related to the technique for securing the grafts in either group. The results demonstrate no significant difference in ‘graft-take’ comparing grafts secured with a tie-over dressing or by quilting. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18249 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 38-44

scholarly journals A Prospective Comparative Study between Dry and Wet Tympanoplasty

2018 ◽  
Vol 01 (02) ◽  
pp. 083-088 ◽  
Author(s):  
Hepsiba Pothala ◽  
Sunita Shukla ◽  
Wasim Khan ◽  
Ravi Ramalingam ◽  
Kombupalayam Ramalingam
Keyword(s):  
Comparative Study ◽  
Otitis Media ◽  
Uptake Rate ◽  
Chronic Otitis Media ◽  
Hearing Improvement ◽  
Temporalis Fascia ◽  
Suppurative Otitis Media ◽  
Significant Difference ◽  
Prospective Comparative Study ◽  
Contralateral Ear

Abstract Background Tympanoplasty is the well-established procedure for closure of perforations of tympanic membrane. Study Design This study was a prospective comparative study. Objective The objective of this study was to compare the hearing improvement and graft uptake rate between dry and wet tympanoplasty performed on tubotympanic type of chronic suppurative otitis media. Materials and Methods One hundred forty patients with tubotympanic type of chronic otitis media were selected and categorized into dry and wet ears. Tympanoplasty was performed using temporalis fascia by underlay technique in all cases. Postoperatively, graft uptake rate and hearing improvement were analyzed. Results The graft uptake rate was equal in both dry and wet ears, which was statistically insignificant. There was no statistically significant difference in the hearing improvement between the dry ears and wet ears (χ – 2.39, p = 0.122). Conclusion Factors such as age, sex, and status of the contralateral ear and wet ear did not have any impact on the postoperative graft uptake of tympanoplasty. There was no difference in the graft uptake between the dry and wet ears and there was no statistically significant difference between hearing improvement in both and wet ears.

Success rate of type 1 tympanoplasty: a comparative study

2021 ◽  
pp. 1-5
Author(s):  
H Odat ◽  
M Alali ◽  
Y Kanaan ◽  
M Al-Qudah
Keyword(s):  
Comparative Study ◽  
Success Rate ◽  
Outcome Measures ◽  
Temporalis Fascia ◽  
Type 1 Tympanoplasty ◽  
Paediatric Patients ◽  
Graft Take ◽  
The Difference

Abstract Objectives This study aimed to compare graft take rate after tympanoplasty between adults and paediatric patients, cartilage and fascia grafts, and overlay and underlay techniques. Methods Data were analysed in groups according to the technique (underlay vs overlay), age (paediatric patients vs adults) and graft (cartilage vs temporalis fascia). The main outcome measures were full graft take and the incidence of complications. Results A total of 198 patients (208 ears) were included. Overall, full graft take was achieved in 200 ears (96 per cent). The success rate was higher in adults compared with paediatric patients (97.5 per cent vs 92.25, respectively) but the difference was insignificant. Similarly, higher but insignificant graft take rate was found in the cartilage group compared with fascia group (98.6 per cent vs 94.9 per cent, respectively). Conclusion All cases of overlay tympanoplasty had full graft take (success rate 100 per cent). In the underlay group, successful graft take was achieved in 154 cases (95 per cent). This difference was statistically insignificant.

scholarly journals Hearing Evaluation after Myringoplasty in Underlay Technique

2020 ◽  
Vol 22 (2) ◽  
pp. 84-89
Author(s):  
Md Khorshed Alam ◽  
Mohammad Wakilur Rahman ◽  
Md Abdur Razzak ◽  
ABM Khorshed Alam ◽  
Abu Yusuf Fakir ◽  
...  
Keyword(s):  
Success Rate ◽  
Medical College Hospital ◽  
Hearing Improvement ◽  
College Hospital ◽  
Mean Values ◽  
Hearing Gain ◽  
Medical College ◽  
Graft Take ◽  
Significant Difference ◽  
The Mean

Objective: to determine the success rate of underlay technique of myringoplasty regarding rate of graft take, complications and hearing improvement. Methods: This Cross sectional study was done in the department of ENT & Head-Neck Surgery, Dhaka Medical College Hospital & Shaheed Suhrawardy Medical college Hospital, Dhaka from July 2012 to December 2012. Sixty(60) patients who underwent myringoplasties were included in the study. All myringoplasty were performed by a postaural approach using autologous temporalis fascia and underlay technique. Results: The total success rate (graft uptake) was 88.3% and of the successful cases an overall hearing improvement was achieved in 73.58% of cases. The mean audiological improvement in air conduction threshold was 13.24 dB & mean closure of the air bone gap was 11.64 dB. The mean values of hearing gain of small perforations and subtotal perforations have shown significant difference.The mean values of hearing gain between posterior perforation and subtotal perforation have shown significant difference. Conclusion: Underlay myringoplasty is an effective technique of repairing the tympanic membrane perforation due to high rate of graft take and marked hearing improvement. Bangladesh J Otorhinolaryngol; October 2016; 22(2): 84-89

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.  </p><p class="abstract"><strong>Results:</strong> 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).</p><p class="abstract"><strong>Conclusions:</strong> Cartilage with perichondrium can be considered as an alternative to more traditional grafting material for tympanic membrane reconstruction.</p>

scholarly journals Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method

2020 ◽  
Vol 3 (2) ◽  
pp. 33-37
Author(s):  
Avinash Das ◽  
Surendra V Pimparkar ◽  
Ashwani Sethi ◽  
Himanshu Joshi
Keyword(s):  
Comparative Study ◽  
Conventional Method ◽  
Study Design ◽  
Complication Rate ◽  
Hearing Improvement ◽  
Tissue Glue ◽  
Graft Take ◽  
Significant Difference ◽  
Overlay Method

ABSTRACT Purpose The purpose of this research is to study the role of tissue glue (TISSEL) in overlay tympanoplasty when compared with the conventional overlay method. Study design A prospective randomized comparative study was carried out at the ENT department of Base Hospital, Delhi, in which 60 patients with dry central perforation underwent overlay tympanoplasty. Out of these, 30 underwent conventional overlay tympanoplasty (control) and in the rest of the 30, overlay tympanoplasty was done with the use of tissue glue (cases). Results Graft take-up rate in control is 90% and in cases 96.7% (p > 0.05). Hearing improvement within 20 dB of A–B gap (at 03 months) in control is 86.70 and 96.70% in cases (p > 0.05). Early hearing improvement (at 6 weeks) in cases was better when compared with the control (p < 0.05). The complication rate in cases is 10% with residual perforation in 01 patient, while that in control is 16.66% with residual perforation in 03 patients (p > 0.05). Conclusion Graft take-up rate in hearing improvement was found to be better in overlay tympanoplasty with the use of tissue glue when compared with the conventional method with no statistically significant difference. The only significant advantage with the TISSEL group was found to be an early hearing improvement at 6 weeks. Tissue glue (TISSEL) was found to be safe and effective. How to cite this article Pimparkar SV, Sethi A, Das A, et al. Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method. J Med Acad 2020;3(2):33–37.

scholarly journals A comparative study of the outcomes of temporalis fascia graft versus tragal perichondrium graft in type 1 tympanoplasty in our experience

2017 ◽  
Vol 4 (1) ◽  
pp. 60
Author(s):  
Santhanakrishnan K. ◽  
Poornima S. Bhat
Keyword(s):  
Hearing Loss ◽  
Conductive Hearing Loss ◽  
Temporalis Fascia ◽  
Hearing Gain ◽  
Type 1 Tympanoplasty ◽  
Fascia Graft ◽  
Significant Difference ◽  
Considerable Morbidity ◽  
Conductive Hearing

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Type 1 tympanoplasty is a surgical procedure which intends improves the hearing and quality of the life. Comparison of the outcomes will help to determine the merits or demerits of a particular graft. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted in the department of ENT, SMVMCH, Pondicherry from April 2015 to April 2017. A detailed history taking, thorough clinical examination done for these patients. PTA was done before the procedure, post operatively at 3<sup>rd</sup> month. Hearing improvement analysed using different parameters like type of graft used, hearing gain, graft uptake; the data collected was tabulated and subjected to statistical analysis.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">All the patients had COM, mucosal type, with conductive hearing loss of &lt;40 dB. 23 patients underwent type 1 tympanoplasty by underlay technique using temporalis fascia, 19 patients using tragal perichondrium. There was no significant difference in total hearing gain at 3<sup>rd</sup> month and graft uptake between temporalis fascia and tragal perichondrium. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This study compared the outcomes of temporalis fascia and tragal perichondrium graft with respect to hearing gain and graft uptake. Tragal perichondrium graft equally effective as temporalis fascia graft in terms of hearing gain and graft uptake.</span></p>

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