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

Abstract

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.

The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

“…At the end of one year, 35.08% of new cases and 25% of revision cases had had significant improvement in hearing. 14 In our study, we achieved 92.85% success rate in cholesteatoma group (14 cases) with one failure. Functionally, there was no statistically significant (p>0.05) difference between pre-and post-op PTA-ABG.…”