Cartilage tympanoplasty: a reliable technique for smokers

Abstract

The aim of this study was to report our experience with cartilage tympanoplasty (CT) in smokers and compare it with that of non-smokers using a retrospective chart review at a tertiary referral center. Between September 2008 and September 2010, cartilage tympanoplasty was performed in 52 patients. Among them, 27 were active smokers and 25 former or non-smokers. The entire tympanic membrane was replaced with conchal cartilage, shaped either as a shield for cases with intact canal wall mastoidectomies, or crashed for cases with canal wall down procedures. The mean post-operative follow-up was 12 months (range 6-18 months). A complete pre- and post-operative audiologic evaluation was obtained in all patients. Graft take was successful in all patients. The overall average pre-operative and post-operative pure tone average air-bone gaps (PTA-ABG) was 52.2 dB ± 17.7 dB and 35.4 dB ± 17.9 dB, respectively, with an overall improvement of 16.8 dB (p < 0.001). A post-operative PTA-ABG of 25 dB or less was achieved in 39 (75 %) patients (p < 0.001). In smokers, the hearing improvement was 17.6 dB (p < 0.001) with a PTA-ABG of 25 dB or less in 19 (70 %). In non-smokers, the average hearing improvement was 16.8 dB (p < 0.0005) with a post-operative PTA-ABG of 25 dB or less in 19 (76 %), (p < 0.001). The results showed that the CT technique is a very effective procedure for smokers. Excellent graft take and satisfactory hearing results can be accomplished regardless of smoking habits.

Hacettepe cartilage slicer: a novel cartilage slicer and its performance test results

“…However, there has been a growing interest over the last decade in light of its high closure rates, even with difficult cases such as Eustachian tube dysfunction, and similar audiological results to those of temporalis muscle fascia have been documented 1 3 , 8 …”

“…Compared with temporalis muscle fascia, cartilage has higher structural strength, and greater resistance against retraction and infection, which makes it ideal for Eustachian tube dysfunction, atelectasis and chronically infected ears 1 5 , 8 , 9 Its resistance against ischaemia makes cartilage a good choice for smokers and revision cases where temporalis fascia may fail 8 . Although some chondrocyte degeneration occurs over time, especially towards the centre of large perforations, cartilage matrix remains intact, and retains most of its structural support and elasticity 1 .…”

A systematic review of the impact of cigarettes and electronic cigarettes in otology

“…Prognostic effects of cigarette smoking on middle-ear surgery have been investigated in several trials and have been subject to a prior review assessing outcomes up to six months (Table 2). 8,16–25 Cigarette smoking is proposed to lead to poorer outcomes because of defective middle-ear aeration secondary to the effects described above and also because of the vasoconstrictive effects of nicotine which have been demonstrated to adversely affect neovascularisation of newly grafted tissue. 26…”

“…Trialists with increased success rates amongst smokers have attributed this to use of cartilage grafts rather than temporalis fascia owing to its metabolic properties and resistance to retraction, atelectasis and perforation. 21,24,25 In one trial utilising both graft tissues, a 75 per cent failure was reported amongst smokers when temporalis fascia was used compared with similar success rates between smokers and non-smokers (88.9 per cent and 76.8 per cent, respectively) when cartilage grafts were used, further advocating the use of cartilage as routine in smokers. 19…”

Results of cartilage shield tympanoplasty in revision cases of myringoplasty

“…Kyrodimos et al performed cartilage tympanoplasty in 52 patients and reported that graft take was successful in all patients. 12 Khan et al did primary cartilage tympanoplasty in 223 ears. The overall success rate was 98.20% in terms of perforation closure.…”