Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft

Parelkar, Kartik; Thorawade, Vandana; Marfatia, Hetal; Shere, Devika

doi:10.1016/j.bjorl.2018.12.006

Cited by 18 publications

(15 citation statements)

References 5 publications

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“…The 97 per cent closure rate presented compares well to the 84-95 per cent rate in over-under temporalis fascia grafts, [20][21][22] and the rate of 88-98 per cent in other over-under cartilage tympanoplasty procedures. 3,4,6,[11][12][13][14] This was reliable in younger patients as well, though we avoided performing tympanoplasty on young patients with active Eustachian tube dysfunction. The closure rate presented in this article is likely due to the use of cartilage for grafting material, the placing of the graft snugly onto the malleus and the addition of the cartilage shim, which, when required, brings the graft in contact with the native tympanic membrane.…”

Section: Discussionmentioning

confidence: 99%

“…28 Comparing our findings of high frequency loss to the literature is challenging. Concurrent articles on cartilage tympanoplasty frequently report hearing thresholds or averages using the highest frequency of 2000 Hz, 3,5,13,29 3000 Hz 1 , 8,28,[30][31][32] or 4000 Hz. 2,4,6,12,14,15,[33][34][35][36] Were we to narrow our reporting to these same levels or simply present a pure tone average, the high frequency loss presented here would have been missed, since statistical significance was only noted at 4000, 6000 and 8000 Hz.…”

Section: Discussionmentioning

confidence: 99%

“…1 Various techniques of cartilage tympanoplasty have been proposed. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] We use an over-under technique, where the cartilage-perichondrial island graft is placed lateral to the malleus and medial to the annulus. We also use a cartilage shim between the native tympanic membrane and the cartilage graft when the graft does not make contact with the tympanic membrane, and we believe this additional step is unique.…”

Section: Introductionmentioning

confidence: 99%

“…We have found overunder cartilage tympanoplasty to be a flexible and versatile approach in addressing the tympanic membrane, but the available articles on this only briefly describe the approach. [2][3][4][5][6][10][11][12][13][14][15] The objectives of this article are to describe the technique we use for the microscopic over-under cartilage tympanoplasty and to report the hearing outcomes and complications. We hypothesised that hearing would be shown to improve across the hearing spectrum and that reperforation would be rare.…”

Section: Introductionmentioning

confidence: 99%

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Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

et al. 2020

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Objective This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. Method This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. Results Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3–71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4–9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. Conclusion Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

et al. 2020

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“…The cartilaginous portion of the EAC is often pushed posteriorly using the shaft of the endoscope. Certain techniques such as the Tarabichi's stitch can be used to straighten the EAC and increase the working space for the endoscope [9,10].…”

Section: Introductionmentioning

confidence: 99%

Self-Expandable Retainer for Endoscopic Visualization in the External Auditory Canal: Proof of Concept in Human Cadavers

et al. 2020

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This study was conducted to investigate the efficacy of a self-expandable retainer (SER) for endoscopic visualization of the external auditory canal (EAC). Tympanomeatal flap (TMF) elevation was performed in six cadaveric heads. Two different types of SER were placed. The procedural feasibility was assessed by endoscopic images. Technical success rate, procedure time, endoscopy lens cleaning, and presence of mucosal injuries were analyzed. TMF elevation and SER placement were successful in all specimens and there were no procedure-related complications. The mean procedure time with the SERs was significantly shorter than without (p < 0.001). The mean number of times the endoscopy lens was cleaned during the procedure was significantly lower in the SER group (p < 0.001). In the SER group, endoscopy insertion into the EAC was easier without tissue contact with the lens during the TMF elevation compared with the non-SER group. There were no mucosal injuries. SER placement is effective for endoscopic visualization via the expanded and straightened EAC. A fully covered type of SER is preferable. The device can be useful for endoscopic ear surgery, reducing procedure time and reducing the need for endoscopy lens cleaning during the procedure.

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Split‐Thickness Cartilage Graft Combined With Perichondrium for Endoscopic Repair of Total and Subtotal Drum Perforations

Abdelghany,

Gadulhaq

2024

Otolaryngol.--head neck surg.

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ObjectiveThis study aims to describe our new modification to cartilage tympanoplasty for endoscopic repair of total and subtotal tympanic membrane perforations and evaluate its outcomes.Study DesignRetrospective case series.SettingMultiple institutions.MethodsThe study was conducted using records of patients who underwent tympanoplasty for subtotal and total perforations from January 2018 to June 2022. Utilizing an endoscopic transcanal approach, we employed a double graft consisting of outer tragal perichondrium supported by inner split‐thickness tragal cartilage as separate layers, both placed in an underlay fashion lateral to the malleus, without the need to elevate a tympanomeatal flap. Anatomical success was defined as complete primary closure of the perforation, while functional success was defined as achieving an air‐bone gap of ≤20 dB at 12 months postoperative.ResultsThe series involved 64 patients, predominantly males (53%). The mean age was 30.8 years. 56.3% of patients had subtotal perforations. The anatomical success rate was 90.6% while the functional success rate was 87.5%. Postoperative speech discrimination scores significantly increased in all patients.ConclusionOur modification provides effective anatomical and audiological outcomes. This technique reliably resists graft displacement and shrinkage before adequate healing. It avoids problems of elevating tympanomeatal flaps with comparable results to traditional approaches.

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Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft

Cited by 18 publications

References 5 publications

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

Self-Expandable Retainer for Endoscopic Visualization in the External Auditory Canal: Proof of Concept in Human Cadavers

Split‐Thickness Cartilage Graft Combined With Perichondrium for Endoscopic Repair of Total and Subtotal Drum Perforations

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