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

2009 ◽  
Vol 118 (8) ◽  
pp. 570-574 ◽  
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.

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 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.

Functional results of temporalis fascia versus cartilage tympanoplasty in patients with bilateral chronic otitis media

2011 ◽  
Vol 126 (1) ◽  
pp. 22-25 ◽  
Author(s):  
K Onal ◽  
S Arslanoglu ◽  
M Songu ◽  
U Demiray ◽  
I A Demirpehlivan
Keyword(s):  
Standard Deviation ◽  
Otitis Media ◽  
Chronic Otitis Media ◽  
Functional Results ◽  
Type I ◽  
Temporalis Fascia ◽  
Cartilage Tympanoplasty ◽  
The Mean ◽  
Graft Success ◽  
And Cartilage

AbstractObjectives:To compare the functional results of type I tympanoplasty performed with either temporalis fascia or a perichondrium and cartilage island flap, in patients with bilateral chronic otitis media.Method:The study included primary tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least one month and normal middle-ear mucosa, together with contralateral tympanic membrane perforation. Temporalis fascia tympanoplasty was undertaken in 41 patients, and cartilage tympanoplasty in 39 patients.Results:The graft success rate was 65.9 per cent for the fascia group and 92.3 per cent for the cartilage group. Post-operatively, the mean ± standard deviation air conduction threshold was 28.54 ± 14.20 dB for the fascia group and 22.97 ± 8.37 dB for the cartilage group, while the mean ± standard deviation bone conduction threshold was 11.71 ± 8.50 dB for the fascia group and 7.15 ± 5.56 dB for the cartilage group.Conclusion:In patients with bilateral chronic otitis media, cartilage tympanoplasty seems to provide better hearing results and graft success rates.

scholarly journals Application of fascia of the temporal muscle and cartilage of the auricular tragus in myringoplasty in children

2012 ◽  
Vol 140 (7-8) ◽  
pp. 408-411 ◽  
Author(s):  
Ivan Baljosevic ◽  
Jovica Milovanovic ◽  
Vladan Subarevic ◽  
Mladen Novkovic ◽  
Katarina Stankovic
Keyword(s):  
Surgical Technique ◽  
Tympanic Membrane ◽  
Statistical Significance ◽  
Functional Results ◽  
Young Age ◽  
Temporal Muscle ◽  
Temporal Fascia ◽  
Middle Ear Infection ◽  
Number Of Patients ◽  
And Cartilage

Introduction. Perforation of the tympanic membrane in children may be the cause of recurrent middle ear infection and loss of hearing. Objective. The aim of this study was to analyze the application of different reconstructive materials in surgical technique myringoplasty. Methods. We performed 88 myringoplasties due to auricular tragus perforation in 76 children (aged 4 to 16 years, mean 11.9 years) from July 2001 to July 2009. Age, gender, size and the site of perforation, status of the contra lateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels and postoperative complications were recorded and analyzed. In performing myringoplasty we used fascia of the temporal muscle and cartilage of the auricular tragus. Results. In 43 (48%) patients we used fascia of the temporal muscle and in 45 (52%) cartilage of the auricular tragus. Graft success was defined as an intact eardrum at 12 months postoperatively and improvement in the perception of air-bone gap of 10 dB, which we recorded in 73 (83%) cases. Re-perforations were recorded in 12 (13%) patients, of whom in 8 (18.6%) cases we used the temporal fascia and in 4 (9.3%) cases a tragal cartilage. Retraction of the tympanic membrane was recorded in 3 (4%) cases with the temporal fascia. Conclusion. Myringoplasty is a reasonably successful method with good functional results in pediatric patients. Risk factors of surgical failure are young age, the size of auricular tragus perforation and pathological conditions of the contra lateral ear. The tragal cartilage gives better results in cases with bilateral perforations because the possibility of retractions and re-perforations is lower. Relatively small number of patients is probably the reason that, except for young age, differences between the two groups did not reach the level of statistical significance.

Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study

2015 ◽  
Vol 129 (10) ◽  
pp. 945-949 ◽  
Author(s):  
R Shankar ◽  
R S Virk ◽  
K Gupta ◽  
A K Gupta ◽  
A Bal ◽  
...  
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Histopathological Examination ◽  
Chronic Otitis Media ◽  
Type I ◽  
Significant Difference ◽  
Type I Tympanoplasty ◽  
One Year ◽  
A Prospective Study

AbstractObjective:This study aimed to compare the success rate of type I tympanoplasty in active (wet) and inactive (dry) mucosal chronic otitis media.Methods:A prospective study was performed of 35 patients each with dry ear and wet ear undergoing type I tympanoplasty in the Otolaryngology Department, Postgraduate Institute of Medical Education and Research, India. All patients underwent type I tympanoplasty between January 2010 and June 2011 by the post-auricular approach. Samples of the remnant tympanic membrane were sent for histopathological examination.Results:After a minimum follow up of one year, the success rate was 88.6 per cent for dry ears and 80 per cent for wet ears. Neither the type (p = 0.526) nor the presence (p = 0.324) of discharge influenced the success rate. Histopathological examination of the tympanic membrane margins was performed for 46 patients: of these, 19 showed evidence of vascularity and 27 did not. There was no significant difference in success rate between groups (p = 0.115).Conclusion:The success rate was not influenced by the presence of ear discharge at the time of surgery, and tympanic membrane vascularity did not influence graft uptake.

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

2010 ◽  
Vol 124 (9) ◽  
pp. 967-974 ◽  
Author(s):  
O A Albirmawy
Keyword(s):  
Tympanic Membrane ◽  
Pure Tone ◽  
University Hospital ◽  
Temporalis Fascia ◽  
Composite Ring ◽  
Pure Tone Average ◽  
Speech Reception ◽  
Retrospective Clinical Study ◽  
Significant Difference ◽  
Primary Type

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.

Type I tympanoplasty with island chondro-perichondral tragal graft: the preferred technique?

2013 ◽  
Vol 127 (4) ◽  
pp. 354-358 ◽  
Author(s):  
E De Seta ◽  
D De Seta ◽  
E Covelli ◽  
M Viccaro ◽  
R Filipo
Keyword(s):  
Chronic Otitis Media ◽  
Functional Results ◽  
Tympanic Membrane Perforation ◽  
Type I ◽  
Temporalis Fascia ◽  
Cartilage Tympanoplasty ◽  
Membrane Perforation ◽  
Type I Tympanoplasty ◽  
One Year ◽  
Retrospective Comparative Study

AbstractObjective:This retrospective, comparative study aimed to assess anatomical and functional results in a group of adults undergoing type I tympanoplasty for subtotal tympanic membrane perforation, using two different types of graft.Subjects and methods:The study included 106 patients affected by chronic otitis media, who underwent underlay type I tympanoplasty, 53 using an autologous chondro-perichondral tragal graft and 53 using temporalis fascia. Anatomical and functional outcomes were evaluated over time.Results:Audiometric results comparing the cartilage and fascia groups at six months and one year after surgery showed no statistically significant differences. Assessment of anatomical outcomes indicated a greater number of complications in the fascia group.Conclusion:Functional results indicate the validity of the cartilage tympanoplasty, while anatomical results indicate a slightly better outcome in terms of graft re-perforation and retraction, compared with temporalis fascia at one-year follow up. These results suggest that the cartilage technique is preferable for type I tympanoplasty.

scholarly journals Comparison of results between cartilage tympanoplasty and temporalis fascia tympanoplasty.

2020 ◽  
Vol 27 (09) ◽  
pp. 1915-1921
Author(s):  
Tahir Hussain Khan ◽  
Humaira Tahir ◽  
Ashfaq Hussain Rana ◽  
Sohail Malik ◽  
Shahid Akhtar
Keyword(s):  
Tympanic Membrane ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
P Value ◽  
Temporalis Fascia ◽  
System Integrity ◽  
Group I ◽  
Duration Of Surgery ◽  
Cartilage Tympanoplasty ◽  
Group Ii

Objectives: To compare the results after performing cartilage tympanoplasty and temporalis fascia tympanoplasty. Study Design: Analytical/Observational study. Setting: Two different hospitals. Social Security Landhi Hospital Karachi and Al-Tibri Medical College & Hospital Malir Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations after taking antibiotics. Age ranges between 18 to 40 years. Patients were divided into two groups, group-I and group-II. In group-I, temporalis fascia tympanoplasty performed under microscope with post aural approach and in group-II, tragal cartilage tympanoplasty performed with the oto-endoscope via permeatal approach. Observed and compare the results of both procedure after 1 day, after 1 week, after 1 month and after 2 months. Variables were bleeding, pain, hearing assessment with pure tone audiometry (PTA) in which air conduction, bone conduction and air-bone gap (AB-gap) measured, Vomiting, vertigo and duration of surgery. Weber test done in all patients on very next day after surgeries in both groups to exclude the damage of vestibulo-cochlear system. Integrity of grafted tympanic membrane examined with oto-endoscope. Results: Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Vomiting and vertigo not found after tympanoplasty in both groups which indicate the safety of vestibular system. There was no blood soaked guaze seen after tympanoplasty in group-II (cartilage tympanoplasty). Bleeding was less in group-II as compare to group-I. 37 patients out of 38 had intact grafted tympanic membrane in group-I while all (38) patients had intact grafted tympanic membrane in group-II. Mean duration of surgery was 65.1 +3.7 minutes in group-II (cartilage tympanoplasty) and mean duration of surgery was 82.0 + 5.6 minutes in group-I (temporalis fascia tympanoplasty). P value was <0.001 is significant. Duration of surgery was less in group-II. Hearing was also improved in both groups after tympanoplasty. Post-operated AB-gap reduction seen in all patients of both groups. Conclusion: Results of both temporalis fascia and cartilage tympanoplasty were almost same but cartilage tympanoplasty is better because it consumed less time, less post-operated bleeding and perception of pain were also less.

scholarly journals The effect of serous inflammation in the mucous membrane of the middle ear on the morphological and functional results of tympanoplasty

2020 ◽  
Vol 19 (2) ◽  
pp. 64-68
Author(s):  
F. V. Semenov ◽  
◽  
Yu. V. Misyurina ◽  
Keyword(s):  
Tympanic Membrane ◽  
Mucous Membrane ◽  
Chronic Otitis Media ◽  
Functional Results ◽  
Type I ◽  
Tympanic Cavity ◽  
Frequency Range ◽  
Hearing Improvement ◽  
Average Value ◽  
Mucous Discharge

A comparative analysis of the results of a separate atticoantrotomy with tympanoplasty of type I in patients with serous mucositis (moderately thickened and edematous mucous membrane of the tympanic cavity with serous-mucous discharge, n = 59) and patients with intact mucous membrane (n = 48) was performed. The functional outcome of surgical treatment was evaluated using tonal threshold audiometry by calculating the average value of the air-bone gap (ABG) in the speech frequency range after 3 and 12 months. The condition of the graft (the presence or absence of perforation of the neo tympanic membrane) was determined by otomicroscopy 12 months after surgery. Hearing improvement was observed in patients in both groups: the air-bone gap after 12 months in the speech frequency zone was 13.5 ± 5.1 dB in the patients of the main group and 15 ± 5.0 dB in the control patients. The absence of perforation of the neo tympanic membrane 12 months after surgery was observed in all patients. The results obtained in this study suggest that the phenomena of serous mucositis in the form of edema of the mucous membrane of the tympanic cavity and serous-mucous discharge do not significantly affect the morphological and functional results of tympanoplasty in patients with a tubo-tympanic form of chronic otitis media.

scholarly journals Staining in Tympanoplasty: Is Methylene Blue Rational?

2015 ◽  
Vol 7 (3) ◽  
pp. 125-131
Author(s):  
SPS Yadav ◽  
Bhushan Kathuria ◽  
Himani Dhingra ◽  
Joginder Gulia ◽  
Sharad Hernot
Keyword(s):  
Methylene Blue ◽  
Hearing Threshold ◽  
Antimicrobial Properties ◽  
Hearing Improvement ◽  
Temporalis Fascia ◽  
Suppurative Otitis Media ◽  
Fascia Graft ◽  
Significant Difference ◽  
The Difference

ABSTRACT Objective Is there any advantages of using methylene blue in myringoplasty? To compare the results of methylene blue stained temporalis fascia graft with unstained temporalis fascia graft in underlay myringoplasty. Materials and methods In this prospective study, 120 patients of either sex in age group of 15 to 50 years with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited. Patients were initially managed medically to make the ear dry and after that they were operated upon. Sixty patients underwent underlay myringoplasty using methylene blue stained temporalis fascia graft and 60 patients underwent underlay myringoplasty using unstained temporalis fascia graft. Follow-up period was at least 6 months. Results Graft uptake and hearing improvement was comparable in both groups. Although there was 10% higher graft uptake using methylene blue stained temporalis fascia (95%) as compared to unstained temporalis fascia graft (85%), however the difference was not statistically significant (p = 0.5). But there was statistically significant difference in gain in hearing threshold (gain in air-bone gap) in the myringoplasty using methylene blue stained temporalis fascia graft (18 dB ± 7.156) as compared to myringoplasty using unstained temporalis fascia graft (13.7 dB ± 5.70814) (p = 0.04). Conclusion Methylene blue use in myringoplasty allows improved identification of the graft, can be very helpful for trainee residents and reduce the time of a graft placement. Also, methylene blue as an antioxidant and antimicrobial properties, prevents degradation and lysis of fascia graft, improves the overall success rate of graft uptake with no adverse effects. How to cite this article Kathuria B, Dhingra H, Gulia J, Kakkar V, Yadav SPS, Hernot S, Bishnoi S. Staining in Tympanoplasty: Is Methylene Blue Rational? Int J Otorhinolaryngol Clin 2015;7(3):125-131.

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