Audiometric evaluation of type 1 tympanoplasty for hearing results

Background: To evaluate the graft uptake rate of the type1 tympanoplasty performed by underlay technique using autologous temporalis fascia graft for the last two years and to assess the hearing improvement in the successfully operated cases with respect to age, sex, size and location of perforation. Methods: This prospective Study included 50 patients, who underwent type1tympanoplasty.All operations are performed using an underlay technique and by postural approach. In all the cases, temporalis fascia is used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and location, surgical approach, graft material, pre and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results are analyzed. Results: Successful closure rate of the TM perforation is 88% and the graft failure rate is 12%. In this study, lowest and highest age of patients at presentation is 13 and 55 years respectively with a mean age of 26.6 years. Most common approaches is post aural. The mean pre and post-operative air conduction threshold in the successful cases are 33.34 dB and 20.20 dB respectively with a mean audiological improvement of around 13 dB. The improvement in the hearing is achieved in only 88% (44 out of 50) among the successful operated type 1 tympanoplasty. Conclusions: Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach is postural. The graft uptake rate is better at three months. The improvement in hearing is noted irrespective of age, sex, size and location of perforation.

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Hearing Evaluation After Myringoplasty At Nepal Medical College And Teaching Hospital

Journal of Nobel Medical College ◽

10.3126/jonmc.v2i1.7671 ◽

2013 ◽

Vol 2 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

Rupesh Raj Joshi ◽

Anil Kumar Jha ◽

Anupama Shah Rijal ◽

Anup Dhungana ◽

Kundan Kumar Shrestha

Keyword(s):

Medium Size ◽

Graft Material ◽

Temporalis Fascia ◽

Closure Rate ◽

Medical College ◽

Fascia Graft ◽

One Year ◽

Air Conduction ◽

Hearing Evaluation

Objective: To evaluate the graft takes rate of the myringoplasties performed by underlay technique using temporalis fascia graft for the last one year and to assess the hearing improvement in the successfully operated cases. Methods: This prospective Study included 52 ears of 50 patients, who underwent myringoplasty. All operations were performed using an underlay technique and mostly by postaural approach. In all the cases, temporalis fascia was used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and localization, surgical approach, graft material, pre- and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results were analyzed. Results: Successful closure rate of the TM perforation was 82.69% and the graft failure rate was 17.30%. In this study, lowest and highest age of patients at presentation was 12 and 42 years respectively with a mean age of 25.5 years. The success rate was better with the advancing age. The most common approach was postaural. Medium size and posterior perforations were common and the graft take rate was 80.95%, and 88.89% respectively. The mean pre and post-operative air conduction threshold in the successful cases were 38.69dB and 30.35 dB respectively with a mean audiological improvement of around 8 dB. The improvement in the hearing was achieved in only 67.44% (29 out of 43) among the successful operated myringoplasties. Conclusion: Myringoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach was postaural. The graft takes rate was better with the advancing ages and with the medium size and posterior perforations. The improvement in hearing was also achieved. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 36-42 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7671

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Comparative study between result of temporalis muscle fascia and tragal cartilage perichondrium as a graft material in type 1 tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180726 ◽

2018 ◽

Vol 4 (2) ◽

pp. 565

Author(s):

Abhay Kumar ◽

Prabhu Narayan ◽

Prem Narain ◽

Jaypal Singh ◽

Prateek Kumar Porwal ◽

...

Keyword(s):

Otitis Media ◽

Pure Tone Audiometry ◽

Chronic Suppurative Otitis Media ◽

Graft Material ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Hearing Results ◽

Group Type ◽

Type 1 Tympanoplasty

Background: Leading cause of deafness in India is chronic suppurative otitis media. Most common cause of TM perforation is chronic suppurative otitis media. With this background this study was to compare hearing results, as well as graft takes for commonly preferred reconstruction techniques of the TM (i.e., temporalis fascia vs. cartilage) in tympanoplasty.Methods: The present study consists of 60 cases of C.S.O.M (TTD) which was divided into two groups with 30 cases in each group. In first group type1 tympanoplasty was done by Temporalis fascia technique. In second group type 1 tympanoplasty done by tragal cartilage with perichondrium technique. History and otoscopic examination along with pure tone audiometry was performed preoperatively. Postoperative hearing results and graft uptake were compared between two groups, all surgeries were performed through the post aural approach. Results: Graft uptake results are better with tragal cartilage with perichondrium technique. Hearing improved significantly in both groups. Though this was slightly better in TFT, but not significant statistically.Conclusions: Graft uptake rates are better with the tragal cartilage with perichondrium technique in comparison of TFT and hearing results are almost equivalent with both techniques.

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Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i2.56355 ◽

2021 ◽

Vol 27 (2) ◽

pp. 104-110

Author(s):

Md Mainul Islam ◽

Kanu Lal Saha ◽

Harun Ar Rashid Talukder ◽

Md Khalid Mahmud ◽

Riashat Azim Majumder ◽

...

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Uptake Rate ◽

Cartilage Graft ◽

Temporalis Fascia ◽

Hearing Gain ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Cartilage Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge and perforation. It is the commonest ear problem in adult and children. Most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. Inactive mucosal variety of COM presents with the perforation in tympanic membrane with non-inflamed middle ear mucosa. The treatment of inactive mucosal variety of COM is Type 1tympanoplasty. It can be done by conventional temporalis fascia or cartilage graft. Both have some merits and demerits. Objective: To compare the the outcomes between reinforcement cartilage graft and temporalis fascia graft in type -1 tympanoplasty. Methods: 86 (43 patients in each group) patients with COM (inactive mucosal) who were admitted in the department of Otolaryngology – Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2018 to June 2019, and had fulfilled the inclusion and exclusion criteria were selected for the study. History, examinations, investigations were done. All patients underwent type 1 tympanoplasty. Prior to surgery relevant investigations were done and informed written consent was taken from all patients. In Group-A reinforcement cartilage tympanoplasty cases and in Group-B temporalis fascia tympanoplasty cases were placed. Post-operative graft uptake rate and hearing gain were compared in two groups Results: The surgical outcomes between reinforcement cartilage tympanoplasty in comparison with temporalis fascia tympanoplasty showed no significant difference of graft uptake rate and hearing gain. Conclusion: Cartilage tympanoplasty has been practised for reconstruction of perforated tympanic membrane in COM since long with variable results. Graft uptake rate in cartilage reinforcement is comparatively better than temporalis fascia graft. So, reinforcement cartilage graft can be adopted as an alternative to temporalis fascia graft in type- I tympanoplasty. Bangladesh J Otorhinolaryngol 2021; 27(2): 104-110

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Pre-operative and post-operative audiological evaluation of type 1 tympanoplasty and comparison between temporalis fascia graft and tragal perichondrium graft

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212128 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1031

Author(s):

Satguru Saran Singh ◽

Sandip M. Parmar ◽

Abhey Sood ◽

Nilank Saroha ◽

Meenu Chaudhary

Keyword(s):

Pure Tone Audiometry ◽

Major Effect ◽

Medium Size ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Large Size ◽

Fascia Graft

Background: Aim of the study was to evaluate the hearing improvement of type 1 tympanoplasty performed by using autologous temporalis fascia and autologous tragal perichondrium graft in successfully operated and graft uptake cases, with respect to age, sex, size of perforation and type of graft.Methods: This prospective study consists of total 100 patients with chronic suppurative otitis media (CSOM) tubotympanic disease who have undergone type 1 tympanoplasty. Randomization of patients was done. Every alternate patient was divided accordingly in to two groups-one in temporalis fascia graft group and another in tragal perichondrium graft group. Pure tone audiometry (PTA) was performed preoperatively and 3 months after surgery. Cases with successful graft uptake were included in the study. Statistical comparisons were performed using the t test, and ANOVA test.Results: In this study maximum numbers of patients were found in the age group of 15-30 years. Study showed that audiological benefits were more in males in comparison to females. Large size of perforation showed more improvement due to more air bone gap in comparison to medium size and small size perforation of ears. Audiological improvement occurred in 94% of cases, 3% cases worsened and 3% cases showed no change. More improvement was found in temporalis fascia graft in comparison to tragal perichondrium graft.Conclusions: Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. Size of perforation, type of graft was found to have a major effect on the final outcome of surgery.

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Perichondrium - An Autologous Substitute for Temporalis Fascia in Type I Tympanoplasty: A Comparative Study

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i2.241 ◽

2019 ◽

Vol 27 (2) ◽

pp. 140-148

Author(s):

Bahnisikha Kayet ◽

Aryabrata Dubey

Keyword(s):

Type I ◽

Graft Material ◽

Inclusion Criteria ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Hearing Results ◽

Fascia Graft ◽

Free Grafts ◽

Better Than

Introduction Temporalis fascia is the commonly used graft material for tympanic membrane reconstruction. Tragal perichondrium share with the fascia the quality of being mesenchymal tissue. In our study we compared perichondrium and temporalis fascia in terms of graft uptake and hearing improvement. Materials and Methods All patients presenting with discharge from ear and decreased hearing were subjected to clinical examination and investigation. Patients satisfying inclusion criteria were included in study with total of 40 patients. Twenty underwent type1 tympanoplasty with temporalis fascia (TF) and another 20 patients with tragal perichondrium (TP). To evaluate success patients are evaluated at end of 6 months for graft uptake and 3 months for hearing results in audiological gain of 10 dB in two consecutive frequencies. Results Mean Pre-op AC Threshold in TF group was 30.75 dB±5.16 and Post-op AC Threshold was 14.15 dB±8.05. Mean Pre-op AC Threshold in TP group was 32.2 dB±4.81 and Post-op AC Threshold was 20.95 dB±7.14. Mean post-op AC Threshold, Mean Post-Op AB Gap and Mean Audiological Gain was statistically significant among 2 groups p=0.0075, p=0.0013, p=0.0294 respectively. Temporalis fascia was better than Tragal Perichondrium. Graft uptake in 2 groups was not significant (p=0.6325). Conclusion From the present study we may conclude that temporalis fascia, tragal perichondrium free grafts provide viable autograft material for tympanoplasty. Both achieve good hearing restoration but the improvement in hearing or audiological gain is better in temporalis fascia graft than in tragal perichondrium graft.

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A comparative study of post-operative outcomes in type 1 tympanoplasty using tragal chondroperichondrial shield graft and temporalis fascia graft

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201676 ◽

2020 ◽

Vol 6 (5) ◽

pp. 867

Author(s):

Pradeep Kumar Muniasamy ◽

Dharanya Gopalakrishnan Srinivasan ◽

Prabu Velayutham ◽

Nishanth Savery ◽

Balasubramanian Krishnaswami ◽

...

Keyword(s):

Comparative Study ◽

Uptake Rate ◽

P Value ◽

Age Group ◽

Temporalis Fascia ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Group 2 ◽

Group 1

Background: Type 1 tympanoplasty is the reconstruction of perforated tympanic membrane with an intact and mobile ossicular chain. Among various autologous graft materials, temporalis fascia and tragal chondroperichondrium are commonly used, having their own merits and demerits. In our study, we have compared the results and postoperative outcomes of tympanoplasty using temporalis fascia and tragal chondroperichondrium.Methods: This prospective comparative study included 60 cases of chronic suppurative otitis media - tubotympanic disease (CSOM-TTD) in a tertiary care centre. They were randomised into two groups of 30 patients each and were subjected to tympanoplasty using either tragal cartilage-perichondrium (group 1) or temporalis fascia graft (group 2) from November 2017 to May 2019. Objective hearing improvement at 1st, 3rd and 6th month postoperative follow-up and graft uptake rate at 3rd month were compared. Results: Incidence of cases was more in the age group between 31-45 years age group (53.3%). Graft uptake rate was 96.6% for temporalis fascia group and 83.33% for tragal group (p value - 0.194). Preoperative air-bone (AB) gap in group 1 was found to be 25±4.09 dB which improved to 11.73±2.21 dB at 6 months and in group 2, it was 25.7±3.94 dB which improved to 14.06±3.68 dB at 6 months. Mean improvement in hearing for tragal group (13.27 dB) was better than temporalis fascia group (11.64 dB) (p value <0.001).Conclusions: Both temporalis fascia and tragal chondroperichondrium are suitable graft materials for tympanoplasty, although graft uptake was clinically better with the use of temporalis fascia.

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A comparative study of preoperative and postoperative hearing after type I tympanoplasty using temporalis fascia graft at Dr. B. R. Ambedkar Medical College, Bengaluru

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202777 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1258

Author(s):

Muniraju M. ◽

Smita Hegde

Keyword(s):

Disease Duration ◽

Type I ◽

Temporalis Fascia ◽

Hearing Gain ◽

Medical College ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Cortical Mastoidectomy ◽

A Prospective Study

Background: The objective of the study was to identify the factors which significantly influence type 1 tympanoplasty success.Methods: A prospective study was performed on 30 patients who underwent type 1 tympanoplasty via underlay technique using temporalis fascia graft from December 2017 to September 2019 in a teaching hospital. Outcome measures were graft uptake rate and hearing gain. The factors assessed were the age and sex, preoperative condition of the ipsilateral and contralateral ears, perforation size, presence of tympanosclerosis, and whether simultaneous cortical mastoidectomy was performed. Results: None of the factors proved to have a significant influence on tympanic membrane closure or hearing gain.Conclusions: The success rate of a type 1 tympanoplasty is dependent on the skills of the surgeon and the type of graft used. Age, sex, laterality of the disease, duration of dry ear, size of the perforation, presence of tympanosclerosis and simultaneous cortical mastoidectomy have no bearing on hearing gain.

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Does cartilage thickness affect hearing results in real life? Long‐term results of cartilage and fascia graft in type 1 tympanoplasty

Clinical Otolaryngology ◽

10.1111/coa.13383 ◽

2019 ◽

Vol 44 (5) ◽

pp. 842-846 ◽

Cited By ~ 1

Author(s):

Mahmut Tayyar Kalcioglu ◽

Ozan Tuysuz ◽

Muhammed Zeki Yalcin ◽

Erkan Karatas

Keyword(s):

Real Life ◽

Cartilage Thickness ◽

Long Term Results ◽

Hearing Results ◽

Type 1 Tympanoplasty ◽

Fascia Graft

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A Comparative Study of Temporalis Fascia Graft and Full Thickness Tragal Island Cartilage Graft in Type 1 Tympanoplasty

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-021-02459-2 ◽

2021 ◽

Author(s):

Deepakraj Venkatesan ◽

Preethi Umamaheswaran ◽

Ramkumar Vellikkannu ◽

Senthil Kannan ◽

Alagammai Sivaraman ◽

...

Keyword(s):

Comparative Study ◽

Cartilage Graft ◽

Full Thickness ◽

Temporalis Fascia ◽

Type 1 Tympanoplasty ◽

Fascia Graft

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Reinforced temporalis fascia with conchal cartilage versus exclusive temporalis fascia grafting in type 1 tympanoplasty: a comparative study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202779 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1268

Author(s):

Rahul S. Gosavi ◽

Shishir D. Gosavi ◽

Digwijay A. Bandgar ◽

Akash D. Gupta ◽

Pradny S. Naik ◽

...

Keyword(s):

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Temporalis Fascia ◽

Conchal Cartilage ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Membrane Perforation ◽

A Prospective Study ◽

Grafting Materials

Background: Various grafting materials have been used for the repair of a tympanic membrane perforation over the years, with temporalis fascia and conchal cartilage being the most widely used. Our study is an attempt to compare and analyse the use of exclusive temporalis fascia as grafting material against a reinforced graft consisting of temporalis fascia and conchal cartilage.Methods: This is a prospective study of 100 patients having inactive mucosal chronic otitis media with a dry central perforation with moderate conductive hearing loss, undergoing type 1 tympanoplasty using underlay technique. 50% of the subjects were grafted with temporalis fascia alone while a reinforced temporalis fascia graft along with conchal cartilage was used in the remaining 50% of the cases. The results were evaluated at an interval of 24 weeks after surgery on the basis of graft uptake and hearing restoration (closure of air-bone gap <10 dB). Results: Graft uptake in exclusive temporalis fascia grafting was 86% while it was 94% when a reinforced graft was used; the hearing restoration rates in both the groups were 82% and 80% respectively. Conclusions: Reinforced temporalis fascia grafting along with conchal cartilage gives better results than grafting with temporalis fascia alone as regards to graft uptake, while the audiometric results are comparable in both the groups.

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