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

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.

scholarly journals Is cartilage shield tympanoplasty better than fascia tympanoplasty

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

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

scholarly journals Endoscopic tympanoplasty using Tutoplast versus conventional microscopic tympanoplasty

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Taha M. Abdelaal ◽  
Ahmed A. Ibrahim
Keyword(s):  
Tympanic Membrane ◽  
Operative Time ◽  
Tympanic Membrane Perforation ◽  
Temporalis Fascia ◽  
Fascia Graft ◽  
Significant Difference ◽  
Membrane Perforation ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background Temporalis fascia and perichondrium are still the most successful graft materials for primary microscopic repair of tympanic membrane perforations worldwide with 80% to 90% success rate. However, minimally invasive surgery is becoming standard in many fields and the endoscope has been largely incorporated in ear surgery over the past 10 years. This study aimed to evaluate the success rate of endoscopic transcanal closure of tympanic membrane perforation using Tutoplast® compared with the conventional post auricular approach using homologous temporalis fascia graft. Results Our study was conducted on 50 patients, were equally divided into 2 groups. Group A patients have been operated endoscopic transcanal using the Tutoplast as a graft material. Group B patients have been operated using a temporalis fascia graft through a post-auricular approach. The graft take rate, the pre- and post-operative pure tone audiogram, and operative time were compared in both the groups. The graft uptake rate was 100% in both groups. The mean of ABG showed significant improvement in both groups. In group A, the mean of ABG was 28.2 pre-operatively and became 12.12 post-operatively. In group B, the mean of ABG was 29.72 pre-operatively then became 15.2 post-operatively. Comparing the mean of post-operative ABG between both groups showed statistically significant difference as p value was 0.000496. We found a significant difference of the mean average operative time between both groups as the mean average time for group A was 48.08 min compared to 69.4 min for group B with p value 0.049772295. Conclusions Endoscopic closure of tympanic membrane perforation using Tutoplast is successful short-time procedure avoiding the postauricular or endaural incisions with shorter operative time.

scholarly journals Comparative study between fascia lata and temporalis fascia in myringoplasty

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.

scholarly journals Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

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

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.

Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

2018 ◽  
Vol 16 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Sundar Dhungana ◽  
Pabina Rayamajhi ◽  
Rakesh Prakash Shrivastav
Keyword(s):  
Tympanic Membrane ◽  
Uptake Rate ◽  
Chronic Otitis Media ◽  
Tympanic Membrane Perforation ◽  
Hearing Results ◽  
Flap Technique ◽  
Significant Difference ◽  
Membrane Perforation ◽  
Subtotal Perforation ◽  
The Mean

Background: Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between ‘U’ flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation.Methods: Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sizedanterior and subtotal perforationof tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in ‘U’ flap group and thirty twocases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.Results: Graft uptake rate was 90.3%(28/31) in‘U’ flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in ‘U’ flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504).Conclusions: The graft uptake rate and hearing results of ‘U’ flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group.

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 A comparative study of hearing outcome in patients undergoing type 1 tympanoplasty using temporalis fascia versus sliced tragal cartilage

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

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

scholarly journals Comparison of Graft Uptake and Postoperative Hearing Results between Butterfly-Cartilage and Temporalis-Fascia Myringoplasty

2020 ◽  
Vol 42 (1) ◽  
pp. 7-11
Author(s):  
Amiya K Sah ◽  
Pabina Rayamajhi ◽  
Hari Bhattarai
Keyword(s):  
Otitis Media ◽  
Uptake Rate ◽  
Chronic Otitis Media ◽  
Temporalis Fascia ◽  
Hearing Results ◽  
Pars Tensa ◽  
Hearing Status ◽  
Significant Difference ◽  
The Mean ◽  
The Difference

Introduction Myringoplasty is one of the commonest surgeries done in Otology for chronic otitis media- mucosal type (COM-mucosal type). The objective of this study was to compare the graft uptake and post-operative hearing status between butterfly-cartilage and temporalis-fascia myringoplasty. MethodsPatients of age ≥15 years with COM-mucosal type with dry, small to medium sized central perforation of pars tensa with clearly visible perforation margin were randomized into two groups of butterfly-cartilage myringoplasty and temporalis-fascia myringoplasty. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups. ResultsThirty-one patients in butterfly cartilage group and twenty-nine patients in temporalis fascia group were analysed. Graft uptake rate was 93.5% (29/31) in butterfly group and it was 86.2% (25/29) in temporalis fascia group with no statistically significant difference (p= 0.34) between the two groups. The mean pre and post-operative air bone gap in butterfly cartilage group were 20.65dB±8.35 dB; 12.86dB±7.39dB and that in the temporalis fascia group were 19.72±6.14dB, 13.16dB±6.26dB respectively. The difference of preoperative and postoperative hearing status, obtained within the two groups was statistically highly significant (p< 0.001). However, there was no statistically significant difference in hearing results between the two groups (p= 0.54). ConclusionThe graft uptake rate and hearing results of butterfly-cartilage group and temporalis-fascia group were statistically significant within the group after myringoplasty but there was no statistically significant difference in between the two methods.

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