Is cartilage shield tympanoplasty better than fascia tympanoplasty

Background: Evaluation of success of tympanoplasty depends on various host and surgical factors has been subject of interest for many years and still continues to be challenge. Methods: Present study was undertaken to observe results of type I tympanoplasty using tragal cartilage and perichondrium with temporalis fascia grafts using endomeatal and postauricular approach. Results: Study group comprises of 30 patients in Group A and B operated by tympanoplasty type I by endomeatal and postauricular techniques. Success was 96.3% in Group A and 94.7% in Group B for closure of membrane perforation. During postoperative period average time taken for wound healing was 23 days in Group A and 35 days in Group B. Preoperative and postoperative assessment of hearing performed with pure tone audiometry revealed an average hearing loss of 36.50 dB in Group A before surgery and postoperative assessment at end of 1 year revealed hearing improvement of 14.23 dB. In Group B preoperative assessment revealed hearing loss of 38.23 dB lowered to 15.12 dB after surgery. When hearing improvement in both groups were compared preoperatively and postoperatively, in Group A there was improvement of 22.27 dB while in Group B was 23.11 dB. The hearing improvements in both the groups appear to be similar when the results were compared. In present study overall success rate was 89.7% which is comparable to outcome of surgery performed with post auricular approach with temporalis fascia graft which is 91.3%. When postoperative complications were studied it was observed that Group A had fewer numbers of complications as over Group B which was documented in Table 2. Conclusions: Success of tympanoplasty depends on several host and surgical factors. Tragal perichondrium appears as proven alternate for closure of perforation of tympanic membrane. Cosmetically endomeatal approach appears promising over post auricular approach.

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Outcome of Myringoplasty with Temporalis Fascia and Perichondrial-Cartilage Composite Graft in High Risk Perforations

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24855 ◽

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.

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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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Comparative study of temporalis fascia graft versus cartilage shield tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182019 ◽

2018 ◽

Vol 4 (4) ◽

pp. 951

Author(s):

Gaurav Chhabra ◽

Amresh K. Saxena ◽

Sanjay Kumar

Keyword(s):

Comparative Study ◽

Uptake Rate ◽

Graft Material ◽

Temporalis Fascia ◽

Fascia Graft ◽

Uptake Rates ◽

Group A ◽

Subtotal Perforation ◽

Group B ◽

The Comparative Study

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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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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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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Audiological evaluation in between patients with type 1 tympanoplasty alone and type 1 tympanoplasty with cortical mastoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175495 ◽

2017 ◽

Vol 4 (1) ◽

pp. 45

Author(s):

K. Mallikarjuna Swamy ◽

Arati Ganiger

Keyword(s):

Hearing Loss ◽

Pure Tone Audiometry ◽

Type I ◽

Hearing Improvement ◽

Temporalis Fascia ◽

Type 1 Tympanoplasty ◽

Postoperative Assessment ◽

Group A ◽

Group B

Background: Evaluation of success of tympanoplasty depends on various host and surgical factors has been subject of interest for many years and still continues to be challenge. Methods: Present study was undertaken to observe results of type I tympanoplasty using tragal cartilage and perichondrium with temporalis fascia grafts using endomeatal and postauricular approach. Results: Study group comprises of 30 patients in Group A and B operated by tympanoplasty type I by endomeatal and postauricular techniques. Success was 96.3% in Group A and 94.7% in Group B for closure of membrane perforation. During postoperative period average time taken for wound healing was 23 days in Group A and 35 days in Group B. Preoperative and postoperative assessment of hearing performed with pure tone audiometry revealed an average hearing loss of 36.50 dB in Group A before surgery and postoperative assessment at end of 1 year revealed hearing improvement of 14.23 dB. In Group B preoperative assessment revealed hearing loss of 38.23 dB lowered to 15.12 dB after surgery. When hearing improvement in both groups were compared preoperatively and postoperatively, in Group A there was improvement of 22.27 dB while in Group B was 23.11 dB. The hearing improvements in both the groups appear to be similar when the results were compared. In present study overall success rate was 89.7% which is comparable to outcome of surgery performed with post auricular approach with temporalis fascia graft which is 91.3%. When postoperative complications were studied it was observed that Group A had fewer numbers of complications as over Group B which was documented in Table 2. Conclusions: Success of tympanoplasty depends on several host and surgical factors. Tragal perichondrium appears as proven alternate for closure of perforation of tympanic membrane. Cosmetically endomeatal approach appears promising over post auricular approach.

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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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COMPARATIVE STUDY OF TYMPANOPLASTY WITH CONVENTIONAL TEMPORALIS FASCIA GRAFT VERSUS TRAGAL CARTILAGE PERICHONDRIUM GRAFT

10.36106/ijsr/2100918 ◽

2020 ◽

pp. 1-4

Author(s):

Apurba Sarkar ◽

Debabrata Das ◽

Anurag Pradhan ◽

Sk Nawazur Rahaman ◽

arjuman Parveen

Keyword(s):

Success Rate ◽

Failure Rate ◽

Surgical Outcome ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Composite Graft ◽

Cartilage Graft ◽

Temporalis Fascia ◽

Fascia Graft ◽

The Mean

The study was carried out on 50 patients with central perforation in tympanic membrane ( dry & inactive stage ). The study was done in the department of OTORHINOLARYNGOLOGYof BURDWAN MEDICALCOLLEGE AND HOSPITALover a period of one year. The study was done on comparison between tympanoplasty procedure using temporalis fascia as graft versus cartilage composite graft. Precise history was taken from respective patients in detail and were examined clinically. Patients with dry perforation with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Tympanoplasty procedure using temporalis fascia as graft was done in 50% (n=25) patients and tympanoplasty procedure using cartilage composite graft was done in 50% (n=25) patients. In this study the age range of patients were from 13 to 50 years, the mean age was 26.62 years, the number of male and female was equal. Right sided disease was predominant in our study and the mean duration of symptom was 11.24 months. The mean pre-operative hearing loss (pure tone average by pure tone audiometry) was 37.84 ± 4.65 dB and mean pre operative airbone gap was 22.84 ± 4.65 dB . Post operative Mean air conduction was 23.48 ± 5.54 dB among them 24.2 ± 6.26 dB in the fascial group and 22.76 ± 4.73 dB in the cartilage group. This result is not statistically signicant. Post operative mean air-bone gap was 13.84 ± 5.94 dB among them 14.76 ± 5.6 dB in fascial group and 12.92 ± 6.23 dB in the cartilage group which is not signicant stastistically. Successful graft take-up rate of 88.00% (n=44). The overall success rate among tympanoplasty using temporalis fascia graft( GROUP A ) and tympanoplasty using composite cartilage graft ( GROUP B ) technique were 84.00% (n=21) and 92.00% (n=23) respectively. 12.00% (n=6) patients were marked as failure cases during postoperative follow up period. The overall failure rate among tympanoplasty using temporalis fascia graft( GROUPA) and tympanoplasty using composite cartilage graft ( GROUPB ) technique were 16.00% (n=4) and 8.00% (n=2) respectively. So the distribution of surgical outcome in terms of success rate or failure rate was statistically insignicant in the two study groups (p= 0.384). So the distribution of surgical outcome in terms of success rate or failure rate cartilage composite graft gives a denitely better result than temporalis fascia graft. However, the two method did not differ signicantly in terms of hearing improvement.

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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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