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

Author(s):  
Santhanakrishnan K. ◽  
Poornima S. Bhat

<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>

Author(s):  
Gopinathan N. Pillai ◽  
Anjana Mary Reynolds ◽  
Nazneen Parammal Ayyappankandi ◽  
Cyril C. Ninan

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.  </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p><p> </p>


Author(s):  
Muniraju M. ◽  
Smita Hegde

<p class="abstract"><strong>Background:</strong> The objective of the study was to identify the factors which significantly influence type 1 tympanoplasty success.</p><p class="abstract"><strong>Methods:</strong> 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.  </p><p class="abstract"><strong>Results:</strong> None of the factors proved to have a significant influence on tympanic membrane closure or hearing gain.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>


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 ◽  
...  

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


Author(s):  
Kiran A. Deshmukh ◽  
Vinayak Kurle

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media attributes to 71.6% of hearing impairment in which most of them only have central perforations without any ossicular erosion or middle ear pathology. There are insufficient explanations to conclude which technique is better for type 1 tympanoplasty. Hence the study was conducted to compare and analyze the endoscopic technique with conventional microscopic technique for performing type 1 tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> This prospective study was done at Basaweshwara teaching and general hospital attached to MR medical college, Kalaburagi from December 2015 to June 2017 after obtaining institutional ethical clearance. Patients were selected according to inclusion and exclusion criteria and randomly posted for surgery by either endoscopic or microscopic technique and results were analyzed.  </p><p class="abstract"><strong>Results:</strong> There were 60 patients in the study between 11-65 years with mean age of 28.85±10.87 years in which were 28 females and 32 were males. All patients were divided into 2 groups in which 30 underwent endoscopic and 30 underwent microscopic type 1 tympanoplasty. In this 46.7% of the patients had left ear conductive hearing loss whereas 31.7% of patients had right ear conductive hearing loss and 21.7% of the patients had bilateral conductive hearing loss which included 22 small perforations, 33 medium size perforations and 5 large perforations of pars tensa.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that endoscope can be a better alternative for microscope in type 1 tympanoplasty as it provides a wide panoramic view, less operating time and hospital stay with negligible scar post operatively.</p>


Author(s):  
K. Santhanakrishnan ◽  
G. Gandhi ◽  
K. Pradheep

<p class="abstract"><strong>Background:</strong> COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Myringostapediopexy and myringoplationpexyis a surgical procedure which intends improve the hearing and quality of the life.</p><p class="abstract"><strong>Methods:</strong> The  study was conducted in the department of ENT, SMVMCH, Puducherry from April 2017 to April 2018. 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 and graft uptake. The data collected was tabulated and subjected to statistical analysis.  </p><p class="abstract"><strong>Results:</strong> Myringostapediopexy better hearing gain than myingoplatinopexy. Myringostapediopexy mean hearing gain 19.53 dB, myringoplatinopexy 12.59 dB.</p><p class="abstract"><strong>Conclusions:</strong> This study compared the hearing outcomes of Myringostapediopexy and myringoplatinopexy with respect to hearing gain. Myringostapediopexy better hearing gain than myringoplatinopexy due to presence of stapes supra-structure.</p>


2006 ◽  
Vol 120 (12) ◽  
pp. 1067-1071 ◽  
Author(s):  
G Thiel ◽  
R Mills

We describe two patients with stapes fixation, in both of whom Rosen mobilization seemed to be the most prudent surgical choice. In both cases, a useful hearing gain was achieved initially. In the patient with otosclerosis, the conductive hearing loss recurred and a stapedectomy was subsequently carried out. In the patient with congenital stapes fixation, the hearing gain was maintained for two years eight months. We believe that this technique still has a place in stapes surgery in rare instances.


1984 ◽  
Vol 98 (11) ◽  
pp. 1097-1101 ◽  
Author(s):  
J. A. Doig ◽  
S. Gatehouse

AbstractFifty-six individuals with acromegaly referred for pituitary surgery were studied to determine any relationship between acromegaly and sensorineural or conductive hearing loss. Compared to a matched population control sample, no significant difference between the acromegalics and controls has been found, either for air conduction or for bone conduction. The differences between these findings and those published previously are discussed, and reasons proposed to explain the discrepancies.


2008 ◽  
Vol 78 (3) ◽  
pp. 409-414 ◽  
Author(s):  
Nihat Kilic ◽  
Ali Kiki ◽  
Hüsamettin Oktay ◽  
Erol Selimoglu

Abstract Objective: To test the null hypothesis that rapid maxillary expansion (RME) with a rigid bonded appliance has no effect on conductive hearing loss (CHL) in growing children. Materials and Methods: Fifteen growing subjects (mean age 13.43 ± 0.86 years) who had narrow maxillary arches and CHL participated in this study. Three pure-tone audiometric and tympanometric records were taken from each subject. The first records were taken before RME (T1), the second after maxillary expansion (T2) (mean = 0.83 months), and the third after retention (mean = 6 months) and fixed appliance treatment (approximately 2 years) periods (T3). The data were analyzed by means of analysis of variance (ANOVA) and least significant difference (LSD) tests. Results: Hearing levels of the patients were improved and air-bone gaps decreased at a statistically significant level (P &lt; .001) during active expansion (T2–T1) and the retention and fixed appliance treatment (T2–T3) periods. Middle ear volume increased in all observation periods. However, a statistically significant increase was observed only in the T2–T3 period. No significant change was observed in the static compliance value. Conclusions: The hypothesis is rejected. RME treatment has a positive and statistically significant effect on both improvements in hearing and normal function of the eustachian tube in patients having transverse maxillary deficiency and CHL.


Author(s):  
Mallikarjun S. Tegnoor ◽  
Kazim Ali ◽  
Sutrave Mithun

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">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. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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.<strong> </strong>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.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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.</span></p>


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