Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 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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A prospective study of the hearing gain achieved in relation to the site and size of tympanic membrane perforation after type 1 tympanoplasty with temporalis fascia graft

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195198 ◽

2019 ◽

Vol 6 (1) ◽

pp. 20

Author(s):

Gopinathan N. Pillai ◽

Anjana Mary Reynolds ◽

Nazneen Parammal Ayyappankandi ◽

Cyril C. Ninan

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone ◽

Tympanic Membrane Perforation ◽

Temporalis Fascia ◽

Hearing Gain ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Membrane Perforation

Background: Chronic otitis media (COM) mucosal type is characterised by recurrent ear discharge and hearing loss secondary to tympanic membrane perforation. Type 1 tympanoplasty is the surgical option for its closure. The objective of this study is to record the site and size of tympanic membrane perforation, quantify the hearing loss with pure tone audiogram and to assess the hearing gain achieved following type 1 tympanoplasty with temporalis fascia graft.Methods: This prospective study comprises 120 patients of the age group of 15 to 60 years with COM who attended the otorhinolaryngology department, from June 2015 to May 2018. Site and size of perforation were assessed by the number of quadrants involved. Hearing loss was quantified by pure tone audiometry (PTA) pre-op and 3, 6 and 12 months post-op. The pure tone average with the air-bone gap (ABG) at 12 months is used for the assessment. Results: In this study, mean pure tone average pre-operatively for small, medium, large and subtotal perforations were 26 dB, 32 dB,35 dB, 42 dB respectively and 14.37 dB, 23 dB, 23.66 dB, and 32.5 dB post operatively after one year. On statistical analysis by ANOVA test, postoperative hearing gain was statistically significant.Conclusions: The study shows that hearing loss was proportional to the size of perforation. Air-bone closure following type 1 tympanoplasty was more for subtotal perforation and for perforations involving both anterior and posterior quadrants.

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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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A comparative study of preoperative and postoperative hearing after type I tympanoplasty using temporalis fascia graft at Dr. B. R. Ambedkar Medical College, Bengaluru

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202777 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1258

Author(s):

Muniraju M. ◽

Smita Hegde

Keyword(s):

Disease Duration ◽

Type I ◽

Temporalis Fascia ◽

Hearing Gain ◽

Medical College ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Cortical Mastoidectomy ◽

A Prospective Study

Background: The objective of the study was to identify the factors which significantly influence type 1 tympanoplasty success.Methods: A prospective study was performed on 30 patients who underwent type 1 tympanoplasty via underlay technique using temporalis fascia graft from December 2017 to September 2019 in a teaching hospital. Outcome measures were graft uptake rate and hearing gain. The factors assessed were the age and sex, preoperative condition of the ipsilateral and contralateral ears, perforation size, presence of tympanosclerosis, and whether simultaneous cortical mastoidectomy was performed. Results: None of the factors proved to have a significant influence on tympanic membrane closure or hearing gain.Conclusions: The success rate of a type 1 tympanoplasty is dependent on the skills of the surgeon and the type of graft used. Age, sex, laterality of the disease, duration of dry ear, size of the perforation, presence of tympanosclerosis and simultaneous cortical mastoidectomy have no bearing on hearing gain.

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A Comparative Study of Temporalis Fascia Graft and Full Thickness Tragal Island Cartilage Graft in Type 1 Tympanoplasty

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-021-02459-2 ◽

2021 ◽

Author(s):

Deepakraj Venkatesan ◽

Preethi Umamaheswaran ◽

Ramkumar Vellikkannu ◽

Senthil Kannan ◽

Alagammai Sivaraman ◽

...

Keyword(s):

Comparative Study ◽

Cartilage Graft ◽

Full Thickness ◽

Temporalis Fascia ◽

Type 1 Tympanoplasty ◽

Fascia Graft

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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 hearing outcome in patients undergoing type 1 tympanoplasty using temporalis fascia versus sliced tragal cartilage

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210169 ◽

2021 ◽

Vol 7 (2) ◽

pp. 258

Author(s):

Vinod Shinde ◽

Tejal Sonar ◽

Shikha Shah ◽

Ashutosh Kumar ◽

Anuja Satav

Keyword(s):

Tympanic Membrane ◽

Chronic Otitis Media ◽

P Value ◽

Temporalis Fascia ◽

Duration Of Symptoms ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Group A ◽

The Mean

Background: A tympanoplasty is a surgical procedure to close a tympanic membrane perforation and reconstruct the tympanic membrane and hearing, commonly after chronic otitis media and trauma.Methods: 50 patients were divided into 2 groups and underwent type-1 tympanoplasty using temporalis fascia versus sliced tragal cartilage. The patient was placed in supine position. Antiseptic painting and draping was done. All cases were operated under local anaesthesia. Post aural approach with post aural Wilde’s incision with 15 number blade, the incision was made 5-10 mm posterior to post aural groove. Temporalis fascia graft was harvested. Tragal cartilage, incision was taken over the under surface of the tragus and tragal cartilage was sliced. Results: The mean duration of symptoms was 12.72 and 15.84 months in group A and B respectively. Reduced hearing was noted in 21 and 24 patients, ear discharge in 21 each and giddiness in 2 and 4 patients respectively in group A and B. The difference was non-significant when the symptoms were evaluated. Improvement in AB gap was significantly better in group B with a p value of 0.042. The mean improvement was 14.2 dB and 17 dB respectively.Conclusions: Type-1 tympanoplasty using the sliced tragal cartilage may be associated with better improvement in AB gap and can be regularly employed compared to temporalis fascia method.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175063 ◽

2017 ◽

Vol 4 (1) ◽

pp. 60

Author(s):

Santhanakrishnan K. ◽

Poornima S. Bhat

Keyword(s):

Hearing Loss ◽

Conductive Hearing Loss ◽

Temporalis Fascia ◽

Hearing Gain ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Significant Difference ◽

Considerable Morbidity ◽

Conductive Hearing

Background: COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Type 1 tympanoplasty is a surgical procedure which intends improves the hearing and quality of the life. Comparison of the outcomes will help to determine the merits or demerits of a particular graft. Methods: The study was conducted in the department of ENT, SMVMCH, Pondicherry from April 2015 to April 2017. A detailed history taking, thorough clinical examination done for these patients. PTA was done before the procedure, post operatively at 3rd month. Hearing improvement analysed using different parameters like type of graft used, hearing gain, graft uptake; the data collected was tabulated and subjected to statistical analysis. Results: All the patients had COM, mucosal type, with conductive hearing loss of <40 dB. 23 patients underwent type 1 tympanoplasty by underlay technique using temporalis fascia, 19 patients using tragal perichondrium. There was no significant difference in total hearing gain at 3rd month and graft uptake between temporalis fascia and tragal perichondrium. Conclusions: This study compared the outcomes of temporalis fascia and tragal perichondrium graft with respect to hearing gain and graft uptake. Tragal perichondrium graft equally effective as temporalis fascia graft in terms of hearing gain and graft uptake.

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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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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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