Butterfly Cartilage Graft Inlay Tympanoplasty for Large Perforations

Ghanem, Marcielle A.; Monroy, Angelo; Alizade, Farmarz S.; Nicolau, Yamileth; Eavey, Roland D.

doi:10.1097/01.mlg.0000231742.11048.ed

Cited by 88 publications

(93 citation statements)

References 15 publications

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“…6 The perceived disadvantage of the cartilage graft is that it creates an opaque tympanic membrane, which could potentially hide a residual cholesteatoma. 7 The results of our study were found to be comparable with other studies done by various authors. Neumann et al reported a graft take rate of 100% in their palisade cartilage tympanoplasty study, and they did not observe resorption or recurrent defects of the rebuilt tympanic membrane.…”

Section: Graft Used Take Up In % Hearing Results Khan Et Al [13]supporting

confidence: 83%

Is cartilage- perichondrium composite graft tympanoplasty the ideal treatment for revision tympanoplasty

Tyagi¹,

Tyagi²,

Srivastava³

et al. 2016

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONTympanoplasty has undergone tremendous evolution since it was first described by by Wullstein in 1952 andZoellner in 1955. 1,2 Over the decades various autologus (temporalis fascia, fascia lata, periosteum, perichondrium, cartilage with or without peri-chondrium, veins, fatty tissue, and skin) and homologus (dura mater, pericardium, cartilage, amniotic membrane, skin, cornea, peritoneum, veins, and aortic valve) grafting materials and techniques were used in tympanoplasty operations.3 Temporalis fascia remains the most commonly used material for tympanic membrane reconstruction, with a success rate of 93% to 97% in primary tympanoplasties. 4 In high risk situations such as the subtotal perforation, atelectatic ear, cholestetoma, and revision tympanoplasty, the results have not been found to be commendable. In these situations, fascia and perichondrium have shown to undergo atrophy and subsequent failure in post-operative period.5 Heerman claimed to have used the cartilage palisade technique for middle ear and mastoid cavity reconstruction since 1960, in over 13,000 cases. Reconstruction of tympanic membrane with cartilage counteracts the tendency to retraction of soft autologus materials like temporalis fascia or perichondrium. Because of its low turn-over rate, cartilage is more resistant to infection. 6 METHODS55 patients who underwent revision tympanoplasty were taken from the department of Otorhinolaryngology, Harsh ENT Hospital, Ghaziabad. Data were collected from the record section and analysed in various aspects. A retrospective chart review was performed of all patients who underwent cartilage composite graft revision tympanoplasty. All the cases were thoroughly examined and investigated before taking them for surgery, findings ABSTRACT Background: The objective of the study was to evaluate the anatomical and audiological outcomes of cartilageperichondrium composite graft tympanoplasty by underlay technique in revision tympanoplasties. Methods: A series of 55 patients who underwent revision tympanoplasty with cartilage-perichondrium composite Island graft, at the department of Otorhinolaryngology, Harsh ENT Hospital, Ghaziabad. Tympanoplasty with cartilage-perichondrium composite island graft was done using underlay technique after slicing the cartilage with help of slicer. Ossiculoplasty was performed as and when needed. Results: Graft uptake rate was found to be 96.36% (53 of the 55 cases) in our study without any serious complications. Audiological outcomes with closure of 94.55% air bone gap within 0 to 30 dB was achieved (p <0.05). Conclusions: Nearly 97% success rate can be achieved with cartilage-perichondrium composite graft tympanoplasty for Revision tympanoplasty.

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Section: Graft Used Take Up In % Hearing Results Khan Et Al [13]supporting

confidence: 83%

Is cartilage- perichondrium composite graft tympanoplasty the ideal treatment for revision tympanoplasty

Tyagi¹,

Tyagi²,

Srivastava³

et al. 2016

Int J Otorhinolaryngol Head Neck Surg

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“…For optimal acoustic transfer behaviour, the cartilage should be cut as thin as possible. The cartilage plates with the thickness of 0.5 mm show stiffness similar to that of healthy tympanic membrane and might be considered an acceptable compromise between satisfactory acoustic properties and sufficient mechanical stability [30]. In our study, Postoperative hearing was accessed 6 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of cartilage is high mechanical stability and long lasting vitality ever years after surgery. The success rate of ''take up'' by using cartilage grafts is reported up to 100% [24][25][26][27][28][29][30]. In our study, all the patients were followed up for 2 years.…”

Section: Discussionmentioning

confidence: 99%

Cartilage–Perichondrium: An Ideal Graft Material?

Chhapola¹,

Matta²

2011

Indian J Otolaryngol Head Neck Surg

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Temporalis fascia has long been regarded as the ideal graft material for tympanic membrane repair. However it often does not seem to withstand negative middle ear pressure in the post operative period. Tragal cartilage with perichondrium would appear to be a better graft material with good hearing outcome. It can be obtained easily with cosmetically acceptable incision. In the present study, we have compared the graft properties of temporalis fascia verses tragal cartilage perichondrium with respect to healing, hearing and rate of post operative retraction or reperforation. 132 patients of chronic otitis media with pure conductive hearing loss were posted for tympanoplasty. Temporalis fascia graft was used in 71 patients and cartilage perichondrium (composite graft) was used in 61 patients. Post operative healing, hearing and rate of retraction or reperforation was compared for both the graft materials. All the patients were followed up for 2 years. Patients where temporalis fascia graft was used, 60 (84.5%) showed a good neotympanum, 7(9.85%) had reperforation and 5(7.04%) had retraction pockets. Patients where tragal cartilage perichondrium was used, 60(98.36%) showed a healed tympanic membrane and only 1(1.63%) had reperforation. None of the patients showed retraction pocket or cholestetoma. Postoperative hearing was accessed 6 months after surgery. Patients with temporalis fascia graft showed an air bone gap of less than 10 dB in 49 (82%) patients and more than 10 dB in 11 (18%) patients. Air bone gap closure with tragal cartilage perichondrium was less than 10 dB in 45 (78%) patients and more than 10 dB in 13 patients (22%). Tragal cartilage perichondrium (\0.5 mm) seems to be an ideal graft material for tympanic membrane in terms of postoperative healing and acoustic properties. It can easily withstand negative middle ear pressure which may have contributed to the development of otitis media and significantly affect healing outcomes in postoperative period. Tragal cartilage being composed of collagen type II is also physiologically similar to the nature of the tympanic membrane.

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“…Couloigner V et al 6 assessed the results of cartilage tympanoplasty in 59 children and reported a 71% take rate compared to 83% take rate obtained with underlay fascia temporalis tympanoplasty. Hearing improvement was almost the same.…”

Section: Discussionmentioning

confidence: 99%

Audiometric Evaluation of Tympanoplasty for Hearing Improvement

Chapparbandi¹,

Mithun²,

Chapparbandi³

2015

jemds

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AIM:To determine the hearing improvement in tympanoplasty by preoperative and postoperative audiometric evaluation after I month and 3 months and 6 months of tympanoplasty. MATERIALS & METHODS:50 Patients presenting having CSOM and presenting with complaints of deafness or ear discharge in ENT OPD at Basaveshwar Teaching and General Hospital, Gulbarga from 2012 to 2014. Pre-operative audiometry and appropriate investigation was done followed by tympanoplasty. Patient was followed up regularly with post-operative audiometry at 1 month, 3 month and 6 month. Assessment of hearing improvement was done by comparing preoperative and postoperative A-B gap at speech frequency. RESULTS: The number of patients who underwent Type l tympanoplasty was 26, Type II was 5, Type III was 6 and Type 4 was 1. They had a mean A-B gap closure of 10.3dB, 10.2dB, 9.33dB and 5dB respectively. When mastoidectomy was included as a part of the procedure the hearing improvement was comparatively lesser. The mean Air-Bone gap closure was 8.9dB.The mean A-B gap closure was 10.2 dB for temporalis fascia graft, 4dB for temporalis fascia with conchal cartilage and 9.2dB in case of autograft incus. The mean A-B gap closure of medium, large and subtotal perforation were 4.7, 11.7 and 6.6 respectively. The total success rate in terms of graft uptake rate was 88%. CONCLUSION: The study shows that A-B gap closure is greatest for Type I followed by Type II, Type III and Type IV in decreasing order. Tympanoplasty in which modified radical mastoidectomy was a part of the procedure did not give as much hearing improvement as otherwise. The grafting material also had significant bearing on the success of surgery. The Airborne gap closure is greatest for temporalis fascia graft than dura or autograft incus. Air-bone gap closure is also greater for temporalis fascia when used alone compared to when it is used along with conchal cartilage. Reperforation rates are higher when temporalis fascia is used alone compared to cases where reinforcement with cartilage is done showing greater graft stability in cartilage tympanoplasty.

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Butterfly Cartilage Graft Inlay Tympanoplasty for Large Perforations

Cited by 88 publications

References 15 publications

Is cartilage- perichondrium composite graft tympanoplasty the ideal treatment for revision tympanoplasty

Is cartilage- perichondrium composite graft tympanoplasty the ideal treatment for revision tympanoplasty

Cartilage–Perichondrium: An Ideal Graft Material?

Audiometric Evaluation of Tympanoplasty for Hearing Improvement

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