Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal-type chronic otitis media

Background: Tympnaoplasty has been well accepted as the surgery of choice for chronic otitis media. Since the introduction of tympanoplasty, there has been many modifications in terms of technique, approach, and materials used for grafting the tympanic membrane; each with their respective advantages and disadvantages. But irrespective of procedure done, very large and subtotal perforations have always posed a problem with failure after surgery. This demands further modification of the procedure to support the graft. This study was done to know the role of Anterior tucking of graft in subtotal perforation of tympanic membrane in terms of graft uptake rate and hearing outcome.Methods: A systemic retrospective analysis of case files was done. The case files of patient who fulfilled the inclusion criteria were selected. Detailed preoperative and postoperative clinical and audiometric findings were noted down. Results: Total of 40 cases with 3 cases being bilateral, 43 ears were operated by cortical mastoidectomy with tympanoplasty along with anterior tucking of the graft. Our success rate was 95.3% (n=40). 40 patients had showed the improvement in hearing with average air bone gap gain of 12.7 dB HL.Conclusions: Underlay grafting for subtotal perforations of tympanic membrane is a surgically challenging and results in poor outcome. Modification to this method by anterior tucking of the graft is an effective surgical technique with satisfactory outcomes and hence is advocated for the routine practice.

Section: Discussionsupporting

confidence: 92%

The role of anterior tucking of graft in subtotal perforation of tympanic membrane

Prakash

Abhilasha

2018

“…AAT) showed graft uptake was 95.45% in anterior and subtotal and concluded with anterior tagging of graft material is a suitable for anterior and subtotal perforations; in our study we attained drum healing in 86.67% in the group who underwent anteriorly anchoring flap tympanoplasty which is comparable to the above study. 23 Hence in our study in the individual groups viz STT and AAT we attained drum healing in 93.33% and 86.67% respectively, which when compared with each other shows no statistical significant difference (p value of 0.5428which is more than 0.05).…”

Section: Discussionmentioning

confidence: 51%

A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type

Rathi

Gite

Bhargava

et al. 2018

Underlay technique is widely used and relatively simple to perform as the graft is placed entirely medial to the ABSTRACT Background: The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking. Methods: In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db. Results: Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db. Conclusions: Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.

“…There was statistically significant association between pre-operative and post-operative air bone gap (p=0.001) and there was significant difference in air bone gap in postoperative follow-up at second month (Table 4). 11 Creation of a pocket between the anterior canal skin and its underlying bony canal wall for graft placement was described by Faramarzi et al in 2012. 12 A three-flap technique and an inferior flap technique have also been used for closing anterior and subtotal perforations, with impressive results.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of circumferential tympanomeatal flap tympanoplasty in large central perforation

Venkatesha

Yogeesha

khan

2018

Background: Tympanoplasty is the commonest procedure performed in patients with chronic otitis media. Circumferential elevation of tympanomeatal flap and underlay graft placement is thought to be a good surgical technique as it ensures elevation of canal skin over the Eustachian tube area to form a good assemble between the temporalis graft and the flap to increase the success rate. In our study we intend to study the surgical and hearing outcome in patients undergoing tympanoplasty with circumferential tympanomeatal flap in large central perforations.Methods: A prospective study with 25 patients in a tertiary care hospital for a period of 2 years, who underwent circumferential tympanomeatal flap tympanoplasty. Patients were followed up on one month and two months. Graft outcomes and hearing outcomes were studied. Results: Graft uptake was 92%. Blunting was noticed in 4% and medialisation in 4% of patients in circumferential group. Average air-bone gap closure achieved was 17.468 dB.Conclusions: Circumferential flap elevation in tympanoplasty is an effective surgical technique in patients with anterior and large central perforations with satisfactory outcomes.