Details
Category: Volume 07 Issue 11 November 2019
Hits: 858

Title: A Comparative Study on Morphological and Audiological Outcome in Type Ι Tympanoplasty for Chronic Otitis Media Mucosal Disease Using Temporalis Fascia versus Cartilage Graft

Authors: Amrutha P Raman, Satheesh Somaraj

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.136

Abstract

Objective: To compare the morphological and audiological outcome of Type I tympanoplasty in Chronic otitis media mucosal disease using temporalis fascia and cartilage graft.

Materials and Methods: A prospective comparative study among 110 patients with complaints of ear discharge and hearing loss due to Chronic otitis media mucosal disease who underwent Type I tympanoplasty. There were 52 patients where cartilage graft was used and 58 patients where temporalis fascia graft was used. The pre-operative clinical and audiological findings of the study subjects were noted using a proforma. In the post-operative period, they were followed up after 3 months and 6 months. At 3rd month, patients were assessed for perforation closure and audiological evaluation by Tuning Fork Test and Pure Tone Audiometry. At 6thmonth patients were subjected to clinical examination for integrity of tympanic membrane, PTA and Tympanometry.

Results: Otorrhea was the commonest presenting complaint and majority had a large central perforation. The preoperative hearing loss was between 25dB to 45 dB. Majority of the cases had post aural approach for surgery. Tympanosclerosis was seen in 24 patients. Temporalis fascia graft was used in 58 patients, and cartilage graft in 52 patients. Among the temporalis fascia group graft failure was seen in 19 cases while in cartilage graft group there was only 3 cases. The AB gap closure of more than or equal to 10 dB in temporalis fascia was 82.8% while that in cartilage graft was 94.2%. The tympanometry curve of A or C was considered as a successful outcome. In 53% of patients with cartilage graft A or C was obtained, while in temporalis fascia graft group it was 47%. In the short term follow up of 6 months it was found that cartilage graft had reduced chance of re-perforation and better hearing outcome

Keywords: Cartilage graft, Temporalis fascia, Type 1 Tympanoplasty.

References

  1. Chronic suppurative otitis media - Burden of Illness and Management Options. WHO Libr Cat Data [Internet]. 2004;84. Available from: http://www.who.int/pbd/publications/Chronicsuppurativeotitis_media.pdf
  2. Yang T, Wu X, Peng X, Zhang Y, Xie S, Sun H. Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis. Acta Otolaryngol. 2016;136(11):1085–90.
  3. Alnori HA, Mohammed AAM, Alhamdani RM. Temporalis Fascia Versus Cartilage Graft in Myringoplasty = اللفافة الصدغية مقابل الغضروف في ترقيع الطبلة . Jordan Med J. 2016;48(2):113–20
  4. Aneesa AM, Pillai A, Rajamma KB. Outcome of Type 1 Tympanoplasty with Cartilage-perichondrium Graft in Comparison with Temporalis Fascia [Internet]. Vol. 62, International Journal of Scientific Study. 2019 [cited 2019 May 8]. Available from: www.ijss-sn.com
  5. Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: A comparison with the temporalis fascia technique. Eur Arch Oto-Rhino-Laryngology. 2007;264(9):985–9.
  6. Sharma N, Sharma P, Sharma P, Gourav K, Goyal VP. Comparison of otological and audiological outcome of type-I tympanoplasty using composite tragal perichondrium and temporalis fascia as graft. Int J Otorhinolaryngol Head Neck Surg [Internet]. 2018 Aug 25 [cited 2019 May 6];4(5):1182. Available from: http://www.ijorl.com/index.php/ijorl/article/view/1112
  7. Vivek V Harkare, Rakesh K Mishra, Nitin V Deosthale, Sonali P Khadakkar, Priti R Dhoke, Kanchan Dhote, Nudrat Kamal, Sudheer T Reddy. “A comparative study of different tissues used for tympanic membrane grafting”. Journal of Evolution of Medical and Dental Sciences 2013; Vol. 2, Issue 41, October 14; Page: 7834-7840.
  8. Batni G, Goyal R. Hearing outcome after type I tympanoplasty: a retrospective study. Indian J Otolaryngol Head Neck Surg [Internet]. 2015 Mar [cited 2019 May 10];67(1):39–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25621230
  9. Dabholkar JP, Vora K, Sikdar A. Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian J Otolaryngol Head Neck Surg [Internet]. 2007 Jun [cited 2019 May 9];59(2):116. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23120407
  10. Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol. 2016;82(6):695–701.
  11. Iacovou E, Vlastarakos P V., Papacharalampous G, Kyrodimos E, Nikolopoulos TP. Is cartilage better than temporalis muscle fascia in type I tympanoplasty? Implications for current surgical practice. Eur Arch Oto-Rhino-Laryngology [Internet]. 2013 Nov 16 [cited 2019 May 10];270(11):2803–13. Available from: http://link.springer.com/10.1007/s00405-012-2329-4
  12. Ulkü CH. Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. Kulak Burun Bogaz Ihtis Derg [Internet]. [cited 2019 May 11];20(1):7–12.
  13. Albirmawy OA. Comparison between cartilage–perichondrium composite ‘ring’ graft and temporalis fascia in type one tympanoplasty in children. J Laryngol Otol [Internet]. 2010 Sep 20 [cited 2019 May 11];124(9):967–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20403227
  14. International Journal of Otorhinolaryngology and Head and Neck Surgery Chhabra G et al. Int J Otorhinolaryngol Head Neck Surg. 2018 Jul;4(4):951-955 http://www.ijorl.com
  15. Tsuzuki K, Yanagihara N, Hinohira Y, Sakagami M. Tympanosclerosis involving the ossicular chain: Mobility of the stapes in association with hearing results. Acta Otolaryngol. 2006;126(10):1046–52.

Corresponding Author

Dr Satheesh Somaraj

Professor and Head, Dept of Otorhinolaryngology, Govt Medical College, Thiruvanathapuram,

Kerala, Pin 695011, India