Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes

ABSTRACT Objectives To evaluate the anatomical (an intact tympanic membrane without atelectasis or lateralization) and audiological outcomes of type 1 cartilage palisade tympanoplasty. Methods The prospective study was done at a tertiary referral institute included 30 patients with mucosal type chronic otitis media requiring type 1 tympanoplasty including subtotal or total perforations and revision cases. The tympanic membrane reconstruction was done using full thickness broad cartilage palisades harvested from the tragus or concha with attached perichondrium laterally. Patients were assessed at 1st, 3rd and 6th postoperative months for assessment of graft uptake, healing of tympanic membrane and hearing evaluation using pure tone audiometry. Results Total 27 out of 30 patients had fully epithelized completely healed grafts postoperatively at 1 month (success rate of 90%) while three patients had small defect. One out of these three patients showed complete healing of graft while remaining two had persistent defect at 3rd and 6th months postoperatively. The mean pure tone air bone gap considerably reduced from 33.27 ± 4.29 dB preoperatively to 12.67 ± 5.68 dB postoperatively at 6 months. Conclusion Tympanic membrane reconstruction using full thickness palisades of cartilage provides good anatomical and audiological results with significant improvement of hearing specially in cases of subtotal or total perforations, revision surgery, atelectasis and Eustachian tube disorders where healing of tympanic membrane has much poorer prognosis irrespective of the surgical technique used. How to cite this article Gupta S, Lade H, Verma D, Malik NUD. Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):117-120.

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Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201277 ◽

2020 ◽

Vol 6 (4) ◽

pp. 657

Author(s):

Kiran Gangadar S. ◽

G. Priyadarshini

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Type 1 Tympanoplasty ◽

Membrane Perforation ◽

Group 2

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

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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 Correlative Study Between Size of Tympanic Membrane Perforation, Pure Tone Audiometry and Intraoperative Findings in Tympanoplasty

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2018.v26i1.155 ◽

2018 ◽

Vol 26 (1) ◽

pp. 43-47

Author(s):

Santosh U P ◽

Sridurga J ◽

Aravind D R

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Pure Tone ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Operative Findings

Introduction Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively. In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn. Materials and Methods Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected. Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed. Result In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation. Conclusion In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary.

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Assessment of the Status of Contralateral Ear in Post-Operative Subjects of Unilateral Chronic Otorrhoea

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i1.35174 ◽

2020 ◽

Vol 18 (1) ◽

pp. 31-35

Author(s):

Shama Bhandari ◽

Sulav Shrestha ◽

Dhundi Raj Paudel

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Pure Tone ◽

Continuous Process ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Final Diagnosis ◽

High Incidence ◽

The Status ◽

Contralateral Ear

Introduction: Chronic otitis media is one of the most common ear diseases in developing countries like Nepal and is important cause of the hearing loss. Chronic otitis media is rarely an isolated entity, because the responsible factors for its development in one ear in similar way will impact the contralateral ear, since both ears have a common “nasopharyngeal” drainage. Contralateral ear is defined as asymptomatic ear in cases of unilateral chronic otitis media. Aims: To evaluate the audiological profile of Contralateral ear in post-operative subjects of unilateral otorrhoea. Methods: Patients fulfilling criteria underwent Otoscopic examination, tuning fork test and pure tone audiometry. The findings of contralateral ear like retraction, tympanosclerotic patch (TS patch), thin, dull and atrophied tympanic membrane were noted. The final diagnosis with the type of surgery of diseased ear, as well as status of contralateral ear were entered into the proforma. All the patients were followed till three months in relation to anatomy of Tympanic membrane onotomicroscopy and pure tone audiometry respectively. Results: In postoperative cases of mucosal disease, the cases with abnormality in the contralateral ear reduced from 17 to 10 patients (30.3%) and the normal patients increased from 16 to 23 cases (69.7%). Likewise, in postoperative squamous disease, the cases with abnormality in the contralateral ear reduced from 14 to 11 patients (64.7%) and the normal patients increased from 3 to 6 cases (35.3%). Out of 50 cases, 14 cases (28%) had defective hearing while 36 cases (72%) had normal hearing in the contralateral ear respectively. Conclusion: The high incidence of occurrence of abnormality in contralateral ear indicate that both ears should be regarded as a pair. Unilateral Chronic otitis media should not be taken as a static phenomenon but as a continuous process in the other ear too.

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Study on outcome of tympanopanoplasty: a two year institutional study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210166 ◽

2021 ◽

Vol 7 (2) ◽

pp. 336

Author(s):

Vivek K. Pathak ◽

Rohit Saxena ◽

Pradeepti Nayak ◽

Sonali Tyagi

Keyword(s):

Pure Tone ◽

Tertiary Care ◽

Pure Tone Audiometry ◽

P Value ◽

Medical Sciences ◽

Type 1 Tympanoplasty ◽

The Common ◽

Age Range ◽

Air Conduction

Background: Tympanoplasty is one of the common surgical procedure performed in CSOM (TTD), this study was undertaken to determine the outcome of tympanoplasty at a tertiary care teaching hospital.Methods: This analytical observational study was conducted in the department of E.N.T, School of Medical Sciences and Research, from January 2017 to December 2018. Informed consent was taken to participate in the study pure tone audiometry (PTA) was performed before surgery and post-operatively six months. Air-bone gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). The p value ≤0.05 was considered statistically significant. Results: Over a peroid of 2 years 168 patients underwent type 1 tympanoplasty 86 were male 21 (51.19%), female 82 (48.80%), age (range 15–53 years). Mean pre-operative air-conduction of 43.12 dB was significantly reduced to 16.12 dB with p value of <0.05. Similarly the pre-operative mean air bone gap on PTA of 35.63±6.35 dB was also reduced to statistically significant level of 7.41±3.51 dB on post-operative PTA with p value of <0.05. Graft was taken up well in 152 cases (90.2%).Conclusions: According to our study surgical outcome of tympanoplasty is fairly good and should be done if patient gives consent.

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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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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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Evaluation of Graft Uptake and Hearing Assessment after Palisade Myringoplasty

Journal of Nepal Medical Association ◽

10.31729/jnma.3699 ◽

2018 ◽

Vol 56 (212) ◽

pp. 770-773 ◽

Cited By ~ 1

Author(s):

Poonam KC

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Uptake Rate ◽

Pure Tone ◽

Statistical Significance ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Long Term Results ◽

Hearing Improvement ◽

Hearing Gain

Introduction: Cartilage as a graft for closure of tympanic membrane has got superior benefits than other usual grafts (temporalis fascia and perichondrium). Cartilage supported myringoplasty with palisade technique has good result of graft uptake rate, even under difficult conditions. This technique brings very good functional and better long-term results. This study is done to assess graft uptake rate and hearing improvement after myringoplasty with cartilage palisade technique. Methods: It is a descriptive, hospital based observational study done at Manipal Teaching Hospital, Pokhara between 2014-2017. A total of 45 patients aged between 13 years and 44 years diagnosed with chronic otitis media-mucosal were taken. Pure tone audiometry was done before and six months after surgery. Graft uptake and Post-operative hearing gain was evaluated after six months. Statistical analysis was done by Statistical Package for Social Sciences version 16.0. Statistical significance was set at P<0.05. Results: Graft uptake rate was 41 (91.1%). The mean pre-and post-operative pure tone average were 26.88dB and 8.44dB respectively. The post-operative hearing gain was 18.36dB. Hearing improvement after surgery was found to be statistically highly significant with P<0.001. Conclusions: Cartilage supported myringoplasty using palisade technique is preferred for chronic otitis media-mucosal with large and sub-total tympanic membrane perforation.

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Comparative study of type 1 tympanoplasty with and without gel-foam in the middle ear

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212824 ◽

2021 ◽

Author(s):

G. Abhinav Kiran ◽

Y. Prabhakara Rao ◽

B. Shanthi Priyanka ◽

Supreety .

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Hearing Improvement ◽

Tertiary Referral Hospital ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Hearing Assessment ◽

One Year

Background: Chronic suppurative otitis media is a widespread disease for which tympanoplasty is frequently undertaken. Gel-foam may cause adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. The objectives of this study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gel-foam in the middle ear and without gel-foam in the middle ear and to compare and assess results.Methods: This was a randomized control trial done for a period of one year conducted in the department of ENT, at a tertiary referral hospital. 40 patients with dry perforation underwent type 1 tympanoplasty without gel-foam in the middle ear and 40 patients with dry perforation underwent type 1 tympanoplasty with gel-foam in the middle ear. Post-operative follow-up was done to look for graft uptake. Hearing assessment by pure tone audiometry was done 90 days post-operatively. Results: Graft uptake was 82.5% in type 1 tympanoplasty without gel-foam in the middle ear and 85% with gel-foam in the middle ear. Both types of surgeries had significant hearing improvement.Conclusions: Graft uptake is equally good in cases with gel-foam and without gel-foam. Hearing gain is comparable in both groups of patients.

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Comparative study of type 1 tympanoplasty with and without gelfoam in the middle ear

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174328 ◽

2017 ◽

Vol 3 (4) ◽

pp. 1036

Author(s):

Nabeel Malick ◽

Raveendra P. Gadag ◽

Vidyashree K. M. ◽

Shruthi Puthukulangara

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Randomised Control Trial ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Impedance Curve

Background: Chronic suppurative otitis media is a widespread disease with a significant cause of morbidity with a greater burden in the poor communities of the developing countries for which tympanoplasty is frequently undertaken. Gelfoam may show detrimental effects such as adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. This provides the added advantage of facilitating middle ear ventilation through the Eustachian tube. The objectives of the study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gelfoam in the middle ear and without gelfoam in the middle ear and to compare and assess results for complicationsMethods: This was a randomised control trial done for a period of one year conducted in the department of otorhinolaryngology and head and neck surgery, Karnataka Institute of Medical Sciences, Hubballi which is a tertiary referral hospital. 30 patients underwent type 1 tympanoplasty without gelfoam in the middle ear and 31 patients underwent type 1 tympanoplasty with gelfoam in the middle ear. Post-operative follow up was done to look for graft uptake, hearing assessment by pure tone audiometry and impedance audiometry was done 90 days post-operatively. Results: Graft uptake was 80% in type 1 tympanoplasty without gelfoam in the middle ear and 80.6% with gelfoam in the middle ear. Both types of surgeries had significant hearing improvement, and complications like retraction and residual perforation were also comparable. Ad type of impedance curve is most common post operatively.Conclusions: Graft uptake is equally good in cases with gelfoam and without gelfoam. Hearing gain is comparable in both groups of patients. No significant complications occurred in our study. ‘Ad’ is the most common type of impedance curve after surgery. Long term follow up is important in these patients.

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