Comparative study of temporalis fascia graft versus cartilage shield tympanoplasty

Background: The objective of the study was to demonstrate the comparative study in terms of graft uptake rate & hearing gain between cartilage shield tympanoplasty and temporalis fascia tympanoplasty in patients with moderate/ large/subtotal perforation.Methods: Cartilage shield tympanoplasty and temporalis fascia tympanoplasty were conducted in Group A and Group B, respectively, each containing 30 patients with moderate/large/subtotal perforations. Pure tone audiogram (PTA) was performed preoperatively and at postoperative visit i.e. at 12th month, a greater than 10-dB closure of air bone gap (ABG) was considered significant. Results: The graft uptake rates were 93.33% and 86.67% in Group A and Group B, respectively, at the end of 10th week. In total, 90% in Group A and 88% in Group B had significant improvement in hearing (ABG ≥10 dB) at 12th week of surgery.Conclusions: Conchal cartilage is a possible graft material for cartilage shield tympanoplasty, especially in moderate, large & subtotal perforation, as it is showed superior autograft as compared to temporalis fascia, not only because of better graft uptake rate and less partial failure but also due to the comparable hearing improvement in terms of mean AB gap in both types of graft materials.

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Is cartilage shield tympanoplasty better than fascia tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195691 ◽

2019 ◽

Vol 6 (1) ◽

pp. 70

Author(s):

Shahnaz Sheikh ◽

Anushree Bajaj ◽

Vikrant Vaze

Keyword(s):

Uptake Rate ◽

Pure Tone Audiometry ◽

Cartilage Graft ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Fascia Graft ◽

Cartilage Tympanoplasty ◽

Group A ◽

Group B ◽

And Cartilage

Background: Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy in tympanoplasty. The aim of the study was to compare the graft uptake rates and hearing results in case of temporalis fascia and cartilage in type 1 tympanoplasty.Methods: A total of 400 cases with large, subtotal and total perforation were considered in the study. All the selected patients were divided into two groups. Group A in which temporalis fascia graft was used and including 200 cases and cartilage graft was used in Group B patients including 200 cases. Pure tone audiometry was performed preoperatively and postoperatively at 6 months.Results: The graft uptake rate was more than 90 percent and more than 80 percent in Group B respectively at the end of 14 week. There was no statistical difference in hearing improvement in both the groups.Conclusions: Tragal cartilage graft can be used in cartilage tympanoplasty especially in moderate, large and subtotal perforations. The graft has better uptake rate, less graft failure and hearing improvement results were comparable to temporalis fascia graft.

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Comparative study between fascia lata and temporalis fascia in myringoplasty

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-020-00052-y ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Ayman Ali Abdel Fattah ◽

Abdel Hay Rashad Elasy ◽

Ahmed Helmy Hoseini ◽

Tarek Abdel Rahman Abdel Hafez

Keyword(s):

Tympanic Membrane ◽

Good Alternative ◽

Fascia Lata ◽

The Body ◽

Temporalis Fascia ◽

Fascia Graft ◽

Fascia Lata Graft ◽

Group A ◽

The Mean ◽

Group B

Abstract Background Repair of a perforated tympanic membrane (myringoplasty) can facilitate normal middle ear function, resist infection, and help re-establish normal hearing. Autogenous graft materials are the most popular graft materials used in myringoplasty because of their easy acceptability by the body. This study is conducted to compare between temporalis fascia graft and fascia lata graft in myringoplasty for patients with tubo-tympanic dry perforation. Results A total of 60 patients with persistent dry tympanic membrane perforation were included in our study during the period from January 2018 to May 2020. Patients underwent myringoplasty with temporalis fascia (30 patients as group A) or fascia lata (30 patients as group B). Patients were scheduled for follow-up visits concerning graft status, ear discharge, and audiograms. The mean postoperative air-bone gap in group A was 17.5 ± 4 after 1 month and 8.6 ± 6.9 after 3 months, while in group B, the mean postoperative air-bone gap was 17.6 ± 4.9 after 1 month and 9.4 ± 7.5 after 3 months. There was 90% success in graft uptake in group A, while there was 80% success in group B. Conclusion Using temporalis fascia is still the best and most trustworthy technique of myringoplasty compared to fascia lata graft. However, fascia lata can be a good alternative to temporalis fascia especially in cases of revision myringoplasty, ears having large perforation, or near-total perforation where the chances of residual perforation are high because of the limited margin of remnant tympanic membrane overlapping the graft.

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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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Comparative study of type I tympanoplasty using temporalis fascia and tragal cartilage with perichondrium as graft material

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181873 ◽

2018 ◽

Vol 4 (3) ◽

pp. 789

Author(s):

Arvinder Singh Sood ◽

Pooja Pal ◽

Anshul Singla

Keyword(s):

Tertiary Care ◽

Chronic Otitis Media ◽

Type I ◽

Graft Material ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Tertiary Care Centre ◽

Fascia Graft ◽

Uptake Rates

Background: Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.Methods: This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared. Results: The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.Conclusions: Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.

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A comparative study of using temporalis fascia autograft and dehydrated temporal fascia homograft in tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194947 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1669

Author(s):

Hemendra Bamaniya ◽

Padam Chand Ajmera

Keyword(s):

Graft Material ◽

Age Group ◽

Temporalis Fascia ◽

Suppurative Otitis Media ◽

Medical College ◽

Temporal Fascia ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Background: The objective of the present study was to compare the results of tympanoplasty operations performed using autograft temporalis fascia with those of dehydrated temporalis fascia homograft.Methods: This prospective study was conducted in the department of ENT of Pacific Medical College and Hospital, Udaipur in duration from February 2014 to January 2015. The study included 90 patients of chronic suppurative otitis media with dry, central perforation of tympanic membrane. The patients were divided into two groups with 45 members in each group. In group A, temporalis fascia autograft was used and in group B, dehydrated temporalis fascia homograft was used for tympanoplasty. Results were evaluated in terms of graft uptake rate and hearing improvement. Results: There were 50 male and 40 female patients in the study. Most of the patients (43.33%) were of the age group 21-30 years, followed by age group 31-40 years (24.44%). Post-operatively, 95.55% patients in group A and 91.11% patients in group B showed successful graft uptake. Mean preoperative AB gap in group A patients was 31.46±6.78 dB which was reduced to 13.01±5.61 dB postoperatively. Similarly, in group B patients, AB gap was reduced from 29.81±5.99 to 12.92±6.01 dB postoperatively. No statistically significant difference was observed between groups while comparing pre and postoperative AB gap.Conclusions: The results of tympanoplasty done by using either homograft or autograft were the same so dehydrated temporalis fascia homograft can be used as an alternative graft material with the same success rate wherever possible with the advantage of reduction in duration of surgery.

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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 Outcomes of Type I Tympanoplasty with or without Fibrin Glue

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i1.220 ◽

2019 ◽

Vol 27 (1) ◽

pp. 15-18

Author(s):

Somu Lakshmanan ◽

Preethi Umamaheswaran

Keyword(s):

Comparative Study ◽

Fibrin Glue ◽

Tertiary Care ◽

Type I ◽

Hearing Improvement ◽

Uptake Rates ◽

Significant Difference ◽

Group A ◽

Type I Tympanoplasty ◽

Group B

Introduction: Various materials have been used in tympanoplasty to ensure the adherence of the graft with the remnant tympanic membrane. This study aims to compare the clinical outcomes of type I tympanoplasty done with and without fibrin glue. Materials and Methods: This is a prospective comparative study conducted in a tertiary care centre between August 2014 and July 2016. A sample size of 70 patients was used. The patients were randomly divided into two groups – Group A and Group B. Patients in group A underwent tympanoplasty with fibrin glue and patients in group B underwent tympanoplasty without fibrin glue. The patients were followed up for 6 months and the postoperative hearing improvement and graft uptake rates were compared. Results: The pre-operative mean pure tone average for group A was 34.33±7.3dB; it improved to 22.14±6.5 at the end of 6 months. In group B, it improved from 34.25±8dB to 22.64±7.4dB at the end of 6 months. There was no statistical significance in hearing improvement between both the groups. Though there was no statistically significant difference in the graft uptake rates between group A (94.3%) and group B (91.4%), fibrin glue had better outcomes with larger perforations. Conclusion: The use of fibrin glue in tympanoplasty is safe and it has a particular advantage in the graft uptake in subtotal perforations.

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Comparitive study between button-hole tympanoplasty and tympanoplasty with placement of graft lateral to handle of malleus with or without cortical mastoidectomy in mucosal type of chronic otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201689 ◽

2020 ◽

Vol 6 (5) ◽

pp. 929

Author(s):

J. Mansoor Ahmed ◽

Panchami .

Keyword(s):

Conductive Hearing Loss ◽

Chronic Otitis Media ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Graft Placement ◽

Normal Limits ◽

Fascia Graft ◽

Group A ◽

Group B ◽

Conductive Hearing

Background: Various techniques of underlay graft placement have been described in literature. In this study we compare two simple underlay techniques of temporalis fascia graft placement that is Buttonhole tympanoplasty and tympanoplasty with placement of graft lateral to handle of malleus in mucosal type of chronic otitis media patients undergoing tympanoplasty to find out which among the two is a better technique based on the audiological improvement post-operatively.Methods: This is a case series study which included 30 patients undergoing type-1 tympanoplasty. Group A with 15 patients underwent Buttonhole tympanoplasty and Group B with 15 patients underwent tympanoplasty with placement of graft lateral to handle of malleus. Results: Post-operative hearing improvement was assessed after duration of three months. In Group A, 13 (87%) patients showed hearing within normal limits and 2 (13%) patients showed mild conductive hearing loss. In Group B, 9 (60%) patients showed hearing within normal limits and 6 (40%) of patients showed mild conductive hearing loss. Both the techniques were statistically significant.Conclusions: Both the techniques mentioned are simple and effective procedures. Buttonhole tympanoplasty was considered as superior technique among the two as the handle of malleus provides better anchoring for the temporalis fascia graft, intra-operative manoeuvring of the graft is easier without causing displacement of the graft, there is no reduction in the middle ear space and post-operative hearing improvement is excellent. When the handle of malleus is eroded surgeon can perform tympanoplasty with placement of graft lateral to handle of malleus.

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COMPARISON BETWEEN TRAGAL CARTILAGE WITH PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT BY UNDERLAY ENDOSCOPIC TYMPANOPLASTY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.5819 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S622-25

Author(s):

Muhammad Tahir ◽

Asim Abbass ◽

Faiz Ul Hassan Nawaz ◽

Syed Asad Shabir ◽

Atif Rafique

Keyword(s):

Success Rate ◽

Tertiary Care ◽

Care Hospital ◽

Temporalis Fascia ◽

Tympanic Membrane Perforations ◽

Fascia Graft ◽

Group A ◽

The Difference ◽

Group B ◽

Endoscopic Tympanoplasty

Objective: To compare the results of tragal cartilage with perichondrium versus temporalis fascia graft in endoscopic tympanoplasty using underlay technique. Study Design: Comparative prospective study. Place and Duration of Study: Study conducted in Tertiary Care Hospital, Karachi, from Jul 2018 to Feb 2020. Methodology: Overall, 34 patients having permanent unilateral tympanic membrane perforations were included in this study, in whom underlay endoscopic tympanoplasty was performed. Group A patients underwent temporalis fascia graft while group B received a tragal cartilage with perichondrium graft. The success rate between groups was compared in respect of reduction in postoperative air-bone gap and healing of perforation. Results: The success rate of graft was 88% (30/34) in group A and 94% (32/34) in group B after 6 months follow-up, the difference was not found to be statistically significant (p=0.368). Hearing improvement in the form of closure of air bone gap in group A was from 24.52 ± 1.73 dB (decibel) to 13.56 ± 5.67s dB and in group B it was from 19.76 ± 3.47dB to 11.94 ± 3.9dB, the difference was not significant statistically (p=0.333). Conclusion: Keeping in view the results of our study, we conclude that both tragal cartilage with perichondrium and temporalis fascia graft are considered equally successful in endoscopic tympanoplasty.

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OUTCOME OF TYPE 1 TYMPANOPLASTY WITH CARTILAGE-PERICHONDRIUM GRAFT IN COMPARISON WITH TEMPORALIS FASCIA

10.36106/ijsr/7933348 ◽

2021 ◽

pp. 1-3

Author(s):

Shambhu Sharan Gupta ◽

Satish Kumar ◽

Debarshi Jana

Keyword(s):

Pure Tone Audiometry ◽

Temporalis Fascia ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Middle Ear Pressure ◽

Group A ◽

Group B ◽

Sound Conduction ◽

Rate Of Failure

Objective: To compared the outcome of Type 1 tympanoplasty with cartilage-perichondrium graft in comparison with temporalis fascia graft in terms of post-operative graft take-up and hearing results. Materials and Methods: A prospective observational study among 80 patients between 15 and 60 years of age satisfying the inclusion criteria with complaints of ear discharge and hearing loss due to COM - mucosal type was conducted. Patients were grouped in two groups of 40 patients each. Group A patients underwent Type 1 tympanoplasty with temporalis fascia and Group B with cartilage-perichondrium graft. Patients were followed up for graft uptake, hearing improvement and rate of failure are compared for both the grafts. Graft uptake was assessed at the end of the 1st month, 3rd month, and 6th month, and hearing was assessed at the end of the 6th month with pure tone audiometry. Results: Patients with temporalis fascia graft showed a take-up rate of 80% and cartilage-perichondrium graft of 92.5% by 6 months. Among the fascia group, graft failure was seen in 20% (8). One patient had failed take-up of graft and four patients showed reperforation. In cartilage group, three patients showed failure of take-up of graft during the 1st month. No patient had reperforation or retraction. Air-bone gap in fascia group showed a closure to 10 dB in 17.5% (7). In the cartilage group, 10 dB in 25% (10 patients). In our short-term follow-up of 6 months, we found that cartilage-perichondrial graft reduces the chance of reperforation and retraction even with variation in middle ear pressure due to eustachian tube catarrh. It gives good take-up rate and comparable hearing result as that of the fascia graft. It does not affect the sound conduction when thinned out to appropriate thickness. It is available from the same surgical field and in sufficient quantity for the closure of the TM defect. Cartilage-perichondrium graft for Type 1 tympanoplasty could be a successful replacement for temporalis fascia giving good result with neotympanum.

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