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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20171188 ◽

2017 ◽

Vol 3 (2) ◽

pp. 332

Author(s):

Mallikarjun S. Tegnoor ◽

Kazim Ali ◽

Sutrave Mithun

Keyword(s):

Uptake Rate ◽

Graft Material ◽

Temporalis Fascia ◽

Closure Rate ◽

Hearing Results ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Air Conduction

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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ROLE OF MASTOIDECTOMY IN TYPE 1 TYMPANOPLASTY OF SAFE TYPE CHRONIC SUPPURATIVE OTITIS MEDIA- A PROSPECTIVE STUDY

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2016/1167 ◽

2016 ◽

Vol 3 (102) ◽

pp. 5645-5649

Author(s):

Sami Ullah ◽

Faiz S. M ◽

Mohd Shakeel ◽

Saurabh Srivastav ◽

Satveer Singh Jassal ◽

...

Keyword(s):

Prospective Study ◽

Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

A Prospective Study

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Endoscopic versus microscopic type 1 tympanoplasty in chronic suppurative otitis media- tubotympanic type

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201289 ◽

2020 ◽

Vol 6 (4) ◽

pp. 720 ◽

Cited By ~ 1

Author(s):

Kiran A. Deshmukh ◽

Vinayak Kurle

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Conductive Hearing Loss ◽

Chronic Suppurative Otitis Media ◽

Medium Size ◽

Microscopic Technique ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Conductive Hearing

Background: 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.Methods: 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. Results: 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.Conclusions: 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.

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A study on endoscopic type 1 tympanoplasty in tubotympanic chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194930 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1580

Author(s):

Kiran A. Deshmukh ◽

Vinayak Kurle

Keyword(s):

Hospital Stay ◽

Otitis Media ◽

Middle Ear ◽

Operating Time ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Duration Of Surgery ◽

The Mean

Background: Chronic suppurative otitis media (CSOM) attributes to 71.6% of hearing impairment in which most of them only have central perforation without any ossicular erosion or middle ear pathology. Tympanoplasty has evolved to provide and reconstruct better hearing mechanism, avoid complications as well as recurrence. Traditionally over the decades, tympanoplasty has been done using an operating microscope. Middle ear endoscopy was first introduced by Mer and colleagues in 1967, since then middle ear surgeries which were traditionally done using the microscope can be done using the endoscope also.Methods: This prospective study was conducted at Basaweshwar Teaching and General Hospital, Kalaburagi between March 2016 to November 2017. Endoscopic type 1 tympanoplasty was performed in all the cases using temporalis fascia.Results: There were 30 patients between 15-65 years with average being 29.6 years in which 17 were females and 13 were males. Pre and post-operative PTA at 1, 3 and 6 months were analyzed. The mean duration of surgery was 50.13 mins. The mean duration of hospital stay was 2.23 days. The mean duration of wound healing was 12.23 days. The average pre-operative PTA was 32.47±4.79 dBHL and postoperative PTA at 1, 3 and 6 months was18.3±3.22 dbHL, 16.5±2.2 dbHL and 16.35±2.22 dBHL. The graft uptake at end of 6 months was 100%.Conclusions: We here by 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 minimal visible scar post operatively.

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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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Outcome of Type 1 Tympanoplasty with and without the use of Topical Nasal Steroid: A Comparative Study from Eastern Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i1.19765 ◽

2018 ◽

Vol 3 (1) ◽

pp. 377-380

Author(s):

Rajeev Kumar Shah ◽

Karuna Shrestha ◽

Shrijana Sapkota ◽

Sandarva Giri

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Post Surgery ◽

Hearing Assessment ◽

Nasal Steroid ◽

Intact Tympanic Membrane

Introduction: Chronic suppurative otitis media (CSOM) is the infection of the middle ear cleft. It is an important cause of preventable hearing loss.Objectives: The primary objective of this study is to compare the surgery outcome in terms of graft uptake described as intact tympanic membrane or residual perforation of tympanic membrane in patients with use of levocetirizine tablet 5 milligram only and levocetirizine tablet 5 milligram with topical fluticasone 100 microgram nasal steroid spray. This study is also aimed to determine the hearing status before and after the surgery and to find out its association with graft intake.Methodology: This prospective cross sectional study was conducted on patients diagnosed with chronic suppurative otitis media with medium to large central perforation of tympanic membrane in Birat Medical College Teaching Hospital during the period from 14 April 2015 to 13 April 2017. All the patients underwent type 1 tympanoplasty with placement of temporalis fascia under general anesthesia. After surgery, two equal groups were created with 40 patients in each group. One group received antibiotics, levocetirizine tablet and another group received antibiotics, levocetirizine tablets along with topical intranasal steroid spray from 1 post operative day till 6 wks. All the patients were followed up on the 5th day, 7th day and 42nd day. On 42nd day, status of tympanic membrane graft, post operative hearing assessment was done and compared between the two groups. Data were entered and analysed using Statistical Package For Social Sciences (SPSS) v21.Result: There were 40 patients who received levocetirizine only starting from the first post operative day and 39 patients received levocetirizine and topical nasal steroid spray. Patients with intact tympanic membrane following surgery were 88.6% and remaining had residual perforation of tympanic membrane. Of the study participants 87.3 % had improvement during post operative hearing assessment. 92.3% of the patients receiving levocetirizine and topical nasal steroid post surgery had intact tympanic membrane on otoscopic examination and there was a significant association with p value of 0.04Conclusion: Combination therapy with topical intranasal steroid spray, antihistaminics and antibiotics is beneficial compared to antibiotics and antihistaminics in type 1 tympanoplasty in terms of graft intake and improvement in hearing. BJHS 2018;3(1)5 : 377-380

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Role of Cortical Mastoidectomy in the Management of Mucosal Chronic Suppurative Otitis Media

International Journal of Research and Review ◽

10.52403/ijrr.20210718 ◽

2021 ◽

Vol 8 (7) ◽

pp. 136-141

Author(s):

Sumit Sharma ◽

Chhavi Gupta ◽

Richa Singh

Keyword(s):

Otitis Media ◽

Chronic Suppurative Otitis Media ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Cortical Mastoidectomy ◽

Significant Difference ◽

Group A ◽

Group B

This is a comparative study done to evaluate outcome of type 1 Tympanoplasty with and without mastoidectomy in terms of hearing improvement and graft uptake. This is a prospective study done in 100 patients at a tertiary care referral centre during November 2018 to march 2020. Patients were divided in two groups, Group A consists of 50 patients in whom type 1 Tympanoplasty was done and in Group B 50 patients were there who had undergone Type 1 Tympanoplasty with cortical mastoidectomy. Patients were evaluated postoperatively at 2nd wk, 4th wk, 2nd month and 3rd month for graft uptake, disease clearance, and hearing improvement. PTA was done at 3rd month postoperatively. In our study we observed graft uptake in 94% of patients in Group A as compared to 98% of patients in Group B and in terms of hearing improvement there is not much difference in both the groups i.e. in Group A it is 13.996 ± 4.235 while in Group B it is 14.172 ± 5.381 P value is 1 which means there is no statistically significant difference in two groups. Though better results were observed for cortical mastoidectomy with Type 1 Tympanoplasty than Type 1 Tympanoplasty alone but the difference was insignificant. Keywords: Cortical Mastoidectomy; Mucosal Chronic Suppurative Otitis Media; CSOM.

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To assess the hearing improvement in patients of Chronic Otitis Media Tubotympanic type post tympanoplasty

The Journal of Medical Research ◽

10.31254/jmr.2020.6611 ◽

2020 ◽

Vol 6 (6) ◽

pp. 305-308

Author(s):

Harsh Lokhna ◽

◽

Sanjay Kumar ◽

Anshul Bansal ◽

◽

...

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Hearing Improvement ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Significant Difference

Aim: To determine hearing improvement in type- 1 tympanoplasty by comparing mean preoperative air bone gap with mean postoperative AB gap. Material and method: Patients clinically diagnosed as 75 cases of Chronic Suppurative Otitis Media Tubotympanic Type Disease presenting to the ENT OPD of Chhatrapati Shivaji Hospital attached to Subharti Medical College, Meerut were taken up for study. Detailed clinical examination and history was taken. Pure tone audiometry was conducted, hearing loss and mean AB Gap was noted pre-operatively. X-Ray mastoid B/L Schuller’s view was done and findings were noted. Tympanoplasty type 1 with or without mastoidectomy was performed. Cortical mastoidectomy with type 1 Tympanoplasty was performed in patients having granulations & polypoidal middle ear mucosa along with sclerotic mastoid. All these patients were followed up post-operatively at 6 weeks. The status of graft uptake was noted. Pure tone audiometry was performed. Hearing loss and mean AB Gap results were compared with pre-operative findings. Results: In our study out of 75 patients, 33 (44%) patients were affected with Right ear and 42 (56%) patients were affected with Left ear. Hearing loss was the chief complaint in all 75 patients (100%) followed by blocking sensation. Post operatively 58 (77.33%) patients had normal hearing followed by 16 (21.33) patients who had mild hearing loss. Only 1 (1.33%) patient had moderately severe hearing loss. Pre-operatively, mean AB Gap was 46.62+/-7.89dB while post-operatively mean AB Gap was 23.43+/-5.52dB with statistically significant difference as p<0.05. Conclusion: In our study, the post-operative Mean AB Gap was improved significantly as compared to preoperative mean AB Gap.

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Retrospective Study of Clinical Profile of Patients with Chronic Suppurative Otitis Media at a Tertiary Health Centre

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2014/v1/i1/829 ◽

2014 ◽

Vol 1 (1) ◽

pp. 7 ◽

Cited By ~ 1

Author(s):

Shreeya Kulkarni ◽

Kiran S. Burse ◽

Devashri Patil ◽

Chaitanya Bharadwaj ◽

Vandana Sancheti ◽

...

Keyword(s):

Retrospective Study ◽

Otitis Media ◽

Health Centre ◽

Chronic Suppurative Otitis Media ◽

Graft Material ◽

Age Group ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Nerve Paralysis ◽

Mastoid Surgery

Introduction: Chronic Suppurative Otitis Media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. Tubotympanic type of chronic suppurative otitis media is characterized by a perforation of pars tensa, while marginal & attic perforations are pathognomonic of attico-antral variety. The latter category is usually associated with the presence of cholesteatoma. In cases of cholesteatoma, complications like facial nerve paralysis, meningitis, cerebellar abscess, sigmoid sinus thrombosis may develop and potentially threaten the patient's life. The aim of this study was to retrospectively perform analysis of patients suffering from Chronic Suppurative Otitis Media, visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 528 patients in and around Nashik District and were subjected to Tympanoplasty or Mastoid surgery. Results: Complete data records from 528 patients were available for statistical analysis. Maximum numbers of patients were in age group 21-40. High prevalence of CSOM was found in females. 408 patients had CSOM of Safe type. 97 patients had CSOM of unsafe type, whereas 23 patients had unsafe CSOM with complications. 381 patients underwent Type 1 Tympanoplasty, while 31 patients underwent Modified Radical Mastoid Surgery. 61 patients were operated for MRM with Tympanoplasty and 28 patients were operated for MRM with Myringostapediopexy. 27 patients were operated for revision tympanoplasty. Different methods of tympanoplasty were performed. Simple underlay was done in 123 patients. Maximum patients about 245 were operated by cartilage support method of tympanoplasty. Anterior tucking was done in 40 patients. Myringostapediopexy was done in 28 patients. Ossiculoplasty with tragal or conchal cartilage was done in 61 patients. Graft was not placed in 31 patients. Temporalis fascia was used in maximum patients. In 90.9% of patients temporalis fascia was used. Fascia Lata was used in 3.2% of patients. Conclusion: Retrospective study of patients with CSOM shows: females were affected more than males. Majority of patients were in age group of 21 to 40 years. The reason could be that this age group is socially active and health conscious. 77.3% of patients had safe CSOM while 22.7% of patients had unsafe CSOM. 2.27% of patients had extra-cranial complication, and 2.08% of patients had intracranial complications. 5.1% of patients underwent revision tympanoplasty surgery. Temporal is fascia as a graft material was used for tympanoplasty in maximum patients, and cartilage support method of tympanoplasty was used in majority of patients. Maximum patients were operated in year 2012. This was due to conduction of camps in peripheral areas around Nashik City which shows that CSOM is more common in patients of lower socioeconomic group, overcrowding, sub-standard hygiene and under resourced health care.

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Role of pre-operative air-bone gap in outcome in tinnitus after undergoing type-1 tympanoplasty in patients with chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212116 ◽

2021 ◽

Vol 7 (6) ◽

pp. 963

Author(s):

Manit M. Mandal ◽

Ajay K. Panchal ◽

Rakesh Kumar ◽

Parth B. Kapadia

Keyword(s):

Otitis Media ◽

Statistical Significance ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Chronic Suppurative Otitis Media ◽

Middle Ear Surgery ◽

Type I ◽

Suppurative Otitis Media

Background: Researches suggest middle ear surgery might improve tinnitus after tympanoplasty. Purpose of this study was to investigate association between pre-operative air-bone gap (ABG) and tinnitus-outcome after tympanoplasty type I.Methods: 100 patients with tinnitus having more than 6 months of symptoms of chronic suppurative otitis media (CSOM) that were refractory to medical treatment were included in study. All patients were evaluated through otoendoscopy, pure-tone audiometry, questionnaire-based survey using the visual analogue scale (VAS) and tinnitus handicap inventory (THI) for tinnitus symptoms before and 4 months after tympanoplasty. Inﬂuence of preoperative bone conduction (BC), preoperative air-bone-gap and postoperative air-bone-gap on tinnitus outcome post-operatively was calculated.Results: Patients were divided into two groups based on preoperative BC of <25 dB or >25 dB. Postoperative improvement of tinnitus in both groups showed statistical signiﬁcance. Patients whose preoperative air-bone-gap was <15 dB showed no improvement in postoperative tinnitus using VAS (p=0.887) and THI (p=0.801). Patients whose preoperative air-bone-gap was >15 dB showed signiﬁcant improvement in postoperative tinnitus using VAS (p<0.01) and THI (p=0.015). Postoperative change in tinnitus showed signiﬁcance compared with preoperative tinnitus using VAS (p=0.006). Correlation between reduction in VAS score and air-bone-gap (p=0.201) or between reduction in THI score and air-bone-gap (p=0.270) was not signiﬁcant.Conclusions: Preoperative ABG can be a predictor of tinnitus outcome after tympanoplasty in CSOM with tinnitus.

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