A Comparison of Cartilage Palisades and Fascia in Type 1 Tympanoplasty in Children

Özbek, Cem; Çiftçi, Onur; Tuna, Evrim E. Ünsal; Yazkan, Özlem; Özdem, Cafer

doi:10.1097/mao.0b013e31817dad57

Cited by 85 publications

(87 citation statements)

References 24 publications

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“…In elderly patients, the mental state and metabolic (diabetes mellitus) and cardiovascular diseases are more important than the age, whereas in children (especially in those younger than 6 years of age), the risk of perforation or retraction is related to underdeveloped immunity, serous otitis media, and recurring middle ear infections [9,20] . Furthermore, the small middle ear structure and narrow external ear canal lower the success of tympanoplasty [20] .…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Success and Results of Cartilage-Perichondrium Island Graft in Revision Tympanoplasty

Şahan¹,

Derin²,

Deveer³

et al. 2014

Int Adv Otol

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OBJECTIVE:The chance of complete postoperative healing of the tympanic membrane is relatively low due to poor blood supply of the graft in patients who undergo revision tympanoplasty. The aim of this study is to assess postoperative healing and the factors affecting closure of the tympanic membrane and hearing gain after revision tympanoplasty with cartilage-perichondrium island graft. MATERIALS and METHODS:This study was conducted as a retrospective review of charts of patients who underwent revision tympanoplasty with composite cartilage-perichondrium island graft at our clinic. Patients who underwent radical or modified radical mastoidectomy for the treatment of cholesteatoma and who had stapes fixation were excluded. All grafts were placed using over-under technique. Ossiculoplasty and mastoidectomy were performed as needed. Closure of the tympanic membrane and hearing thresholds were evaluated at the end of postoperative year 1. RESULTS:Thirty-three cases, 14 females and 19 males with mean age 37.5±12.7, were included in the study. Ossiculoplasty was performed in 8 cases, and mastoidectomy was added to tympanoplasty in 12 cases. Tympanic membrane was intact in 29 cases (87.4%) in the 12th postoperative month. Large perforation, adhesive tympanic membrane, and especially hypertrophic middle ear mucosa were found to have negative impact on success of graft (p<0.01). The success of graft in patients with mastoidectomy was lower than without mastoidectomy (p<0.001). Age (p=0.491), gender (p=0.567), surgical approach (p=0.378), and the number of operations (p=0.283) did not contribute to the success of the graft. Average improvement of postoperative air conduction hearing threshold was 13.2±5.5 dB, and average decrease in air bone gap was 11.7±5.5 dB. CONCLUSION:Postoperative closure rate of the tympanic membrane was high and audiologic improvement was satisfactory with cartilage-perichondrium island graft in revision tympanoplasty. Cartilage-perichondrium island graft may be preferred for reconstruction of the tympanic membrane because of its resistance to inflammation and poor feeding in revision tympanoplasty.

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Section: Discussionmentioning

confidence: 99%

“…Otherwise, cartilage or composite cartilage grafts are more resistant to infections, middle ear pressure, and lack of capillary feed. Therefore, it can be preferred in revision tympanoplasty in which the risk of perforation or retraction is higher [4,5,6,8,9] .…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Success and Results of Cartilage-Perichondrium Island Graft in Revision Tympanoplasty

Şahan¹,

Derin²,

Deveer³

et al. 2014

Int Adv Otol

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“…Albirmawy (20) evaluated 82 pediatric patients who underwent type I tympanoplasty surgery, and he found the success rate to be 95% in the cartilage group and 76.2% in the fascia group. In addition, Ozbek et al (21) compared the results of type I tympanoplasty surgeries performed using palisade cartilage technique and a fascia graft and found that the anatomical success rate was significantly higher in the cartilage group. Despite the fact that anatomical success rates are higher for cartilage than for fascia, there are still doubts about the use of cartilage, because it is assumed that such a thick and rigid material can affect post-operative hearing in negative way.…”

Section: Discussionmentioning

confidence: 99%

Anatomic and Functional Results of Cartilage Type 1 Tympanoplasty in Children and the Evaluation of the Success of Surgery with Parental Perceptions

Yılmaz¹,

Güven²,

Kayabaşoğlu³

et al. 2014

Turk Arch Otolaryngol

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Objective: This study aims to determine the anatomic and functional results of cartilage Type 1 tympanoplasty in children and to evaluate the success of surgery with parental perceptions. Methods:Only pediatric patients who had undergone cartilage Type 1 tympanoplasty were included in this study. Patients older than 16 years and patients who had otorrhoea during the previous month, chronic otitis media with cholesteatoma and patients who had undergone mastoidectomy or ossiculopasty were excluded. The 'anatomical' success was accepted as an intact graft in the last control in the at least 6 th month postoperatively. A satisfaction questionnaire with four questions about the perceptual results of surgical intervention was applied to the patients' parents on the telephone. Results:In total, 44 ears of 41 cases (22 male 19 female) were included in the study. The mean age was 13.2±2.7 (8-16) and the mean follow-up time was 17 (7-36) months. Anatomical success rate was 88.6% (39/44). As a preoperative mean, the pure tone hearing threshold was 30.7±7.7 dB and the postoperative mean pure-tone hearing threshold was 18.8±7.8 dB. Among the operated ears, 88.6% (39/44) of the perforations were treated successfully. Of the 41 paediatric patients' parents, only 28 (68.2%) could be reached by telephone; nineteen (68%) of the 28 parents contacted thought that the hearing level had improved postoperatively and only 10 parents (35%) stated that his/her child could attend a preoperatively-restricted activity postoperatively. Conclusion:Outcomes of cartilage tympanoplasty in children satisfy both surgeons and parents. Chronic otitis media in children must be managed with surgery as soon as favourable conditions are provided.

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“…Although better hearing outcomes have been documented in type III tympanoplasty using synthetic ossicular grafts as demonstrated in various past literatures, a substantial proportion of the patients require revision surgery because of displacement and extrusion of graft in the postoperative period [5][6][7]. There are very few studies conducted in the past showing cartilage being exclusively used for ossiculoplasty and tympanic membrane grafting (classical type III tympanoplasty) in canal wall down mastoidectomy [8] although it has been widely used for type I cartilage tympanoplasty for the reconstruction of a large central perforation and for the repair of attic defect in limited attic disease [9][10][11][12]. A similar study conducted by Quaranta et al [13] taking patients undergoing cartilage tympanoplasty in intact canal wall mastoidectomy has demonstrated 100% anatomical closure of tympanic membrane without any extrusion of cartilage graft in the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Cartilage Palisade Grafting in Retrograde Canal Wall Down Mastoidectomy: A Review of 80 Cases

Pradhan¹,

Lal²

2017

Otolaryngol (Sunnyvale)

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Objective: Although synthetic grafts have been extensively used for tympanoplasty in canal wall down mastoidectomy, a substantial proportion of the patients show graft extrusion. Conchal cartilage grafts can be effectively used for the above purpose for a better graft uptake and hearing gain. Here, anatomical and functional outcomes have been assessed in 80 patients undergoing retrograde canal wall mastoidectomy with cartilage tympanoplasty. Material and methods:This study was conducted in a tertiary care referral hospital during the period from July 2012 to June 2015. A total 80 patients of active squamous disease with conductive hearing had undergone canal wall down mastoidectomy. Pure tone audiogram and speech reception thresholds were carried out in preoperative and each postoperative visit i.e. at 3, 6, 12 months of surgery. ≥ 10 dB closure of air-bone (AB) gap and ≥ 10 dB improvement in speech reception threshold were considered significant. Results:Out of 80 patients, 58 (72.50%) were males and 22 (27.50%) were females and 68 (85.00%) were fresh cases and 12 (15.00%) were revision cases. Overall closure of the tympanic membrane was achieved in 76 (95.00%) cases. At the end of 12 months, mean air conduction threshold was 34.30 dB with 8.2 dB closures of AB gap was found in new cases and 35.08% of them had significant improvement in hearing. Again the mean air conduction thresholds for the revision cases was 40.8 dB with 6.9 dB closure of AB gaps noticed at the end of 12 months and 25% of the them had significant improvement in hearing (≥ 10 dB closure). Conclusion:Autologous conchal cartilage can be used for the tympanic membrane grafting in patients undergoing canal wall down mastoidectomy with minimal rejection rate. Although significant improvement in hearing was achieved in 33.80% cases, almost all had social serviceable hearing till the end of 12 months.

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A Comparison of Cartilage Palisades and Fascia in Type 1 Tympanoplasty in Children

Cited by 85 publications

References 24 publications

Factors Affecting Success and Results of Cartilage-Perichondrium Island Graft in Revision Tympanoplasty

Factors Affecting Success and Results of Cartilage-Perichondrium Island Graft in Revision Tympanoplasty

Anatomic and Functional Results of Cartilage Type 1 Tympanoplasty in Children and the Evaluation of the Success of Surgery with Parental Perceptions

Cartilage Palisade Grafting in Retrograde Canal Wall Down Mastoidectomy: A Review of 80 Cases

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