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 Inlay butterfly versus underlay cartilage tympanoplasty

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Osama Hassan ◽  
Mena Esmat ◽  
Mohamed Salah ◽  
Mohamed El Shazly
Keyword(s):  
Tympanic Membrane ◽  
Patient Comfort ◽  
Middle Ear Surgery ◽  
Graft Material ◽  
Hearing Improvement ◽  
Gap Closure ◽  
Graft Take ◽  
Significant Difference ◽  
Cartilage Tympanoplasty ◽  
Group A

Abstract Background Tympanic membrane grafting is one of the most common otological procedures. Underlay technique of tympanoplasty was described by Shea in 1960. Utech in 1959 introduce the cartilage in middle ear surgery. The search for an ideal graft material and technique for tympanoplasty was adopted by numerous contributions from surgeons all over the world. Professor Roland Eavey in 1998 introduced a transcanal inlay technique which offers advantages of surgical ease and speed as well as patient comfort. Results This study included 46 patients; 23 patients had inlay butterfly myringoplasty (group A), and 23 patients had underlay cartilage tympanoplasty. In group A, 65 % of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 3.94 db. In underlay group B, 82.6% of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 4.7 db. These outcomes show no statistically significant difference between both groups in terms of graft take and hearing improvement (p > 0.1). Conclusions Inlay butterfly myringoplasty is an easy, reliable, and time saving procedure that should be possible as a choice to underlay procedure. Results are comparable with underlay technique in terms of graft take rate and hearing improvement. Procedure is better regarding diminishing operative time, postoperative pain, and duration before resuming usual activities.

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

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

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

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

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.

scholarly journals A Comparative Study of Outcomes of Type I Tympanoplasty with or without Fibrin Glue

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.

scholarly journals Tympanoplasty Type I using Tragal Cartilage as graft: Our experience.

2019 ◽  
Vol 26 (12) ◽  
pp. 2135-2140
Author(s):  
Fazal-I- Wahid ◽  
Sajid Rashid Nagra
Keyword(s):  
Pure Tone Audiometry ◽  
Neck Surgery ◽  
Acoustic Properties ◽  
P Value ◽  
Type I ◽  
Graft Material ◽  
Cartilage Graft ◽  
Hearing Improvement ◽  
Female Ratio ◽  
Significant Difference

Objectives: To determine the efficacy of tragal cartilage graft in tympanoplasty type I. Study Design: Quasi-experimental study. Setting: Department of ENT, Head and Neck Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, Pakistan. Period: From Jan. 2017 to Dec. 2017 (One Year). Material & Methods: A total of forty four patient fulfilling inclusion criteria were included in this study. All the patients were assessed in terms of detail history, thorough examination focusing on ENT findings. Pure Tone Audiometry (PTA) was performed pre-operative and post-operative at 3 and 6 months interval for the frequencies of 0.5, 1, 2,4 Hz. Data were analyzed using SPSS (version 16). Paired sample t-test of significance was used. The confidence interval was set to 95% and P-value <0.05 was considered significant. Results: Out of 44 patients males were 24 (54.54%), female 20 (45.45%) with Male: Female ratio of 1.2:1. Mean age of the patients was 28. 47 + SD 7.26 Years. There was statistically significant difference between the pre and post-op air conduction (p<.001), and pre-op and post-op air bone gap (p<.001).There was subjectively significant hearing improvement in 31 patients (70.5%). Cartilage graft was taken in 43 patients with success rate of 97.7%. Conclusion: Tragal cartilage is an effective graft material, which yields good results in terms of graft take up, hearing improvement and minimum complication, postoperative healing and acoustic properties.

scholarly journals A comparative study of temporalis fascia grafting techniques in cortical mastoidectomy with type 1 tympanoplasty patients in tertiary care hospital

2020 ◽  
Vol 6 (9) ◽  
pp. 1612
Author(s):  
Gowrishankar M. ◽  
Athiyaman K. ◽  
Suresh V. ◽  
Gayathiri R. ◽  
Natarajan S.
Keyword(s):  
Comparative Study ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Graft Material ◽  
Care Hospital ◽  
Temporalis Fascia ◽  
Surgical Methods

<p class="abstract"><strong>Background: </strong>Chronic otitis media is a highly prevalent middle ear disease in the developing countries which causes various pathological changes in the tympanic membrane and middle ear. Treatment of chronic otitis media involve medical and surgical methods. There are many surgical techniques followed regarding the grafts used, temporalis fascia remains the most commonly used. There are some studies debating the usefulness of dry grafts and wet grafts. Our study is aimed at comparing the both and evaluating the outcome.</p><p class="abstract"><strong>Methods: </strong>A prospective comparative study conducted in the department of Otorhinolaryngology and Head and Neck surgery, Government Stanley Medical College, Chennai, with 64 patients for the period of 1 year from July 2017 to June 2018.</p><p class="abstract"><strong>Results: </strong>Graft uptake of temporalis fascia in dry group is 93.8% and wet group has graft uptake of 87.5%, failure rate is low in dry group when compared with wet group. And also, this study showed higher graft uptake in small and medium sized perforation (95%) than the larger perforation (87.5%) and also there is no relationship between the duration of inactive stage and the graft uptake has been observed in our study.</p><p class="abstract"><strong>Conclusion: </strong>Temporalis fascia is a reliable graft material for reconstruction of tympanic membrane perforations. In our study dry graft has shown more success rate than the wet graft. Hearing improvement was the same in dry and wet group in which the grafts have been up taken well.</p>

Double-Layer Tympanic Membrane Graft in Type I Tympanoplasty

2019 ◽  
Vol 128 (9) ◽  
pp. 795-801 ◽  
Author(s):  
Es-hak Bedri ◽  
Bilen Korra ◽  
Miriam Redleaf ◽  
Alemayehu Worku
Keyword(s):  
Tympanic Membrane ◽  
Double Layer ◽  
Medical Records ◽  
Single Layer ◽  
Layer Versus ◽  
Type I ◽  
Hearing Improvement ◽  
Significant Difference ◽  
The Difference ◽  
Hearing Outcomes

Background: Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques. Materials and Methods: A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement. Results: A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( P = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( P < .0001). Preoperative hearing levels ( P = .179), postoperative hearing ( P = .857), and decibels of hearing improvement ( P = .356) were the same for all 3 groups. Conclusion: Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.

scholarly journals Comparison of conventional temporalis fascia myringoplasty with fascia lata myringoplasty among patients with hearing loss

2019 ◽  
Vol 5 (4) ◽  
pp. 926
Author(s):  
Sumeer Verma ◽  
Anshu Arora ◽  
Ved Prakash Narvey
Keyword(s):  
Postoperative Complications ◽  
Biological Properties ◽  
Fascia Lata ◽  
Graft Material ◽  
Hearing Improvement ◽  
Temporalis Fascia ◽  
Probability Of Survival ◽  
Temporal Fascia ◽  
Tissue Factors ◽  
Tube Function

<p class="abstract"><strong>Background:</strong> In selection of a graft tissue factors considered include its biological properties, probability of survival, its adequacy in size and ease of procurement<strong> </strong>The present study aims to preoperatively predict hearing improvement by paper patch test and compare with postoperative hearing improvement i.e. pre and post operatively hearing assessment.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on 25 cases undergoing myringoplasty with Fascia lata and Temporalis fascia as a graft material among the patients fulfilling the standard criteria for myringoplasty i.e. pars tensa perforation, good cochlear reserve, dry ear and normal eustachian tube function were considered for surgery. Myringoplasty was done from post aural route for harvesting fascia temporalis graft &amp; from upper 1/3rd of thigh laterally to harvest fascia lata. Each case was followed up post operatively monthly for 3 months.  </p><p class="abstract"><strong>Results:</strong> Factors which influence graft take up are the size of perforation and lack of infection at the time of surgery and postoperative. Large perforations were difficult to repair as it took more time to heal. Surgery performed postaurally underlay technique using temporal fascia was associated with less morbidity, better uptake and lesser postoperative complications but permeatal route also serve similar purpose and does not affect the result of study significantly.</p><p class="abstract"><strong>Conclusions:</strong> This study compared both temporal fascia and fascia lata as graft materials for myringoplasty and proved that myringoplasty done by postaural underlay technique using temporal fascia holds best as per graft uptake, hearing improvement and postoperative complications when compared to fascia lata myringoplasty.</p>

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