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

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

<p class="abstract"><strong>Background:</strong> Type-1 tympanoplasty is the functional restoration of the normal middle ear by repairing the tympanic membrane (TM). Different techniques are still evolving to devise a way to give optimal graft uptake and hearing improvement with minimal instrumentation. Various studies have been done to assess the role of anterior tucking in type-1 tympanoplasty and to assess its superiority over other methods in repairing subtotal perforations and large perforations involving the anterior quadrant.</p><p class="abstract"><strong>Methods:</strong> This study was done to compare the outcomes of endoscopic type-1 tympanoplasty with and without anterior tucking. 60 cases of chronic otitis media (COM) mucosal type were divided into 2 groups of 30 patients each. Group 1 underwent endoscopic type-1 tympanoplasty with anterior tucking and group 2 underwent endoscopic type-1 tympanoplasty without anterior tucking. The outcomes were evaluated after 6 months and compared in terms of graft uptake and hearing gain.</p><p class="abstract"><strong>Results:</strong> The mean air-bone gap improvement was 13.16±2.65 in group 1 and 12.90±3.78 in group 2, which had statistically insignificant differences indicating similar hearing outcomes in both the groups. 96.7% successful graft uptake was achieved in group 1 and 90% in group 2, showing statistically insignificant differences indicating similar graft uptake rates in both the groups.</p><p><strong>Conclusions:</strong> Anterior tucking with endoscopic type-1 tympanoplasty could provide good graft support and efficient hearing improvement but cannot be labelled as a mandatory step in repairing subtotal perforations or large perforations involving anterior quadrant as the outcomes are comparable to the endoscopic type-1 tympanoplasty done without anterior tucking. </p>

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> Graft uptake is equally good in cases with gel-foam and without gel-foam. Hearing gain is comparable in both groups of patients.</p>

Role of Cortical Mastoidectomy in the Management of Mucosal Chronic Suppurative Otitis Media

This is a comparative study done to evaluate outcome of type 1 Tympanoplasty with and without mastoidectomy in terms of hearing improvement and graft uptake. This is a prospective study done in 100 patients at a tertiary care referral centre during November 2018 to march 2020. Patients were divided in two groups, Group A consists of 50 patients in whom type 1 Tympanoplasty was done and in Group B 50 patients were there who had undergone Type 1 Tympanoplasty with cortical mastoidectomy. Patients were evaluated postoperatively at 2nd wk, 4th wk, 2nd month and 3rd month for graft uptake, disease clearance, and hearing improvement. PTA was done at 3rd month postoperatively. In our study we observed graft uptake in 94% of patients in Group A as compared to 98% of patients in Group B and in terms of hearing improvement there is not much difference in both the groups i.e. in Group A it is 13.996 ± 4.235 while in Group B it is 14.172 ± 5.381 P value is 1 which means there is no statistically significant difference in two groups. Though better results were observed for cortical mastoidectomy with Type 1 Tympanoplasty than Type 1 Tympanoplasty alone but the difference was insignificant. Keywords: Cortical Mastoidectomy; Mucosal Chronic Suppurative Otitis Media; CSOM.

Pre-operative and post-operative audiological evaluation of type 1 tympanoplasty and comparison between temporalis fascia graft and tragal perichondrium graft

<p><strong>Background: </strong>Aim of the study was<strong> </strong>to evaluate the hearing improvement of type 1 tympanoplasty performed by using autologous temporalis fascia and autologous tragal perichondrium graft in successfully operated and graft uptake cases, with respect to age, sex, size of perforation and type of graft.</p><p><strong>Methods:</strong> This prospective study consists of total 100 patients with chronic suppurative otitis media (CSOM) tubotympanic disease who have undergone type 1 tympanoplasty. Randomization of patients was done. Every alternate patient was divided accordingly in to two groups-one in temporalis fascia graft group and another in tragal perichondrium graft group. Pure tone audiometry (PTA) was performed preoperatively and 3 months after surgery. Cases with successful graft uptake were included in the study. Statistical comparisons were performed using the t test, and ANOVA test.</p><p><strong>Results: </strong>In this study maximum numbers of patients were found in the age group of 15-30 years. Study showed that audiological benefits were more in males in comparison to females. Large size of perforation showed more improvement due to more air bone gap in comparison to medium size and small size perforation of ears. Audiological improvement occurred in 94% of cases, 3% cases worsened and 3% cases showed no change. More improvement was found in temporalis fascia graft in comparison to tragal perichondrium graft.</p><p><strong>Conclusions: </strong>Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. Size of perforation, type of graft was found to have a major effect on the final outcome of surgery.</p>

Outcome of Interlay Type 1 Tympanoplasty for Large Central Perforation

Background: Perforation of the tympanic membrane may occur from various reasons. Most of these perforations heal spontaneously, whereas the remaining long-standing perforations that lead to recurrent ear discharge need tympanoplasty. Interlay Type 1 Tympanoplasty,a newer technique has shown promising results with higher success ratein terms of hearing gain and graft uptake. Objective: To analyze the results of interlay Type 1 Tympanoplasty in terms of graft uptake and hearing improvement in cases of inactive mucosal chronic otitis media (COM) with large central perforation. Methods: This is a prospective study of 24 months (January 2018 to December 2019) duration conducted in department of E.N.T, Khulna medical college, Khulna and data was collected from the 60 patients admitted for tympanoplasty. Results were calculated in terms of graft accepted or rejected and decrease in air bone gap. Result: The graft uptake rate in the present study was found to be 91.67% and the patients reported an improvement in terms of hearing. Pre operatively mean air bone gap was 26.5dBand post operatively after 12 weeks mean air bone gap improved to 17.58dB. Conclusion: Interlay Type 1 Tympanoplasty is an effective technique over conventional methods in terms of both graft uptake as well as hearing improvement in large central perforation. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 86-91

A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations

<p class="abstract"><strong>Background:</strong> The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO₂)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.</p><p class="abstract"><strong>Methods:</strong> This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO₂ (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO₂ laser myringoplasty was compared with conventional type 1 tympanoplasty. </p><p class="abstract"><strong>Results:</strong> Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.</p><p class="abstract"><strong>Conclusions:</strong> A closure rate of 80% (24/30) was achieved with a CO₂-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size &lt;3 mm, where the CO₂ facility is available before they undergo formal conventional microscopic surgery.</p><p class="abstract"> </p>