Indian Perspectives on Graft Materials Used for Repair of Tympanic Membrane

Malhotra, Manu; Varshney, Saurabh; Malhotra, Rashmi; Joshi, Poonam

doi:10.7860/jcdr/2017/26289.10199

Cited by 4 publications

(2 citation statements)

References 53 publications

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“…22 Modern tympanoplasty started with the use of microscope and various materials have been used for the graft, ranging from skin, fascia and vein. [23][24][25] Cartilage as a graft material has been used in managing retraction pockets. Cartilage as a graft is seen to be more rigid which makes it more resistant to resorption and retraction.…”

Section: Discussionmentioning

confidence: 99%

Graft Uptake and Hearing After Endoscopic Palisade Cartilage Myringoplasty at Nepal Medical College Teaching Hospital

Rijal,

Joshi,

Shrestha

et al. 2023

JCMC

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Background: Chronic otitis media mucosal type is commonly encountered in otorhinolaryngology. Myringoplasty is a common surgery performed to repair the tympanic membrane (TM). Management of subtotal perforation of the TM has become better with the use of endoscopes. The use of cartilage as palisade for repair of the TM has become popular. The aim of the study was to assess graft uptake and hearing after endoscopic palisade myringoplasty. Methods: A prospective study was conducted in the otorhinolaryngology department from April, 2022 to January, 2023. The study included 65 patients, aged 21 years and above diagnosed as chronic otitis media mucosal type, inactive with subtotal perforation and conductive hearing loss. History, clinical examination, otoscopy, tuning fork tests, examination under microscope (EUM) were conducted preoperatively. All patients underwent endoscopic palisade cartilage myringoplasty. Pre-operative and post-operative pure tone audiograms of the patients were done to record the air conduction threshold (ACT), bone conduction threshold (BCT) and air bone gap (ABG). SPSS 16 software was used for analysis of results. The statistical tests used for analysis was paired t-test, level of statistical signiﬁcance was set at the P < 0.05. Results: The mean age of the patients was 28.51±7.20 years with a female preponderance (57.9%). Graft uptake following surgery was 91.9%. There was significant reduction (p<0.001) in the air bone gap postoperatively that suggested improvement in hearing. The mean hearing gain was 13.91±6.79 dB. Conclusions: The use of endoscopic palisade cartilage myringoplasty to correct subtotal perforation has good results in terms of graft uptake and hearing improvement.

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Section: Discussionmentioning

confidence: 99%

Graft Uptake and Hearing After Endoscopic Palisade Cartilage Myringoplasty at Nepal Medical College Teaching Hospital

Rijal,

Joshi,

Shrestha

et al. 2023

JCMC

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“…11 Various surgical techniques have been devised for myringoplasty, among them overlay and underlay are the commonly practiced ones. 12 To minimize the disadvantages of these two procedures, another technique, over-underlay myringoplasty has been devised for a better outcome in terms of hearing improvement and graft uptake. 13 In this technique the graft is placed under the tympanicus annulus but over the handle of the malleus, thus avoids the disadvantages of the plain underlay or overlay techniques.…”

Section: Discussionmentioning

confidence: 99%

Over-Underlay technique of myringoplasty.

Hameed

Naveed

Akbar

et al. 2021

TPMJ

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Objective: To observe the success rate of Over-underlay technique of myringoplasty in patients with inactive tubo-tympanic type of CSOM. Study Design: Descriptive, Observational study. Setting: ENT Department Fauji Foundation Hospital Rawalpindi. Period: December 2018 to December 2019. Material & Methods: A total of 80 patients with inactive tubo-tympanic type of CSOM, from both genders, within age range of 15-45 years, having pure conductive hearing loss with an Air-Bone gap of not less than 15 dB were selected by convenient sampling technique. Patients having an active ear disease or previous history of ear surgery, an active sinus or URT disease, or any comorbidity were excluded from the study. Complete general and head-neck examination was done after taking history. Patients’ affected ears were examined under surgical microscope to see the drum perforation, condition of middle ear mucosa and the status of the ossicles. Hearing assessment was done by Pure Tone Audiometry through both air and bone conduction. Temporalis fascia graft myringoplasty was done in all these patients by over-underlay technique, and they were discharged on 5th post-operative day, and were followed up in ENT OPD after 3 weeks. Status of graft was seen under surgical microscope after removing the BIPP. After three months the patients were reviewed for graft status and hearing assessment. Successful outcome was taken as those patients in whom graft uptake was successful with complete closure of perforation, and secondly, closure of the Air-Bone gap by at least 10 dB. Data was analyzed by SPSS 19. Results: Mean age of the patients (n = 80) was found to be 30.8 Years. Gender distribution showed 57 (71.25%) Males and 23 (28.75%) Females with a M:F ratio of 2.5:1. Success rate was found significantly better among younger aged males. Graft uptake was successful in 74 (92.5%) of the patients. With respect to closure of A-B gap, post-operative mean difference in Air-Bone gap was found to be 9.6 dB ± 3.9 SD as compared to preoperative mean A-B gap of 28.5 dB ± 4.2 SD, thus a closure of A-B gap by 18.9 dB ± 2.4 SD. Conclusion: Over-underlay technique is found to be a successful technique for myringoplasty in terms of graft uptake and improvement in hearing thresholds in the patients with inactive tubo-tympanic type of CSOM.

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Study of Different Types of Graft Materials Use in Type - I Tympanoplasty at Ent Department of Skmch, Muzaffarpur, Bihar

Sinha

Jana

2020

ijsr

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Background: The present study was undertaken to compare the results of various autogenous tissues as grafting materials for the repair of the tympanic membrane defect. As all the materials used previously were not easily available. So the present study comprised of the materials, which were easily available in adequate amount. These were temporalis fascia, tragalperichnodrium, areolar tissue and Ear lobule fat. Methods: In 100 subjects tympanoplasty operation was performed in 100 ears. The age of subjects ranged from 11 years to 50 years with mean age being 28.9 years. 33 cases were male and 67 cases were female. Majority (62%) of them were residing in rural areas and rest (38%)were from urban population. The period of study was from May 2019 to April 2020 starting from the pre-operative assessment to post– operative follow up all findings were noted in specific proforma. All of them attended ENT outpatient department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, with the chief complaints of discharging ear of varying duration. Slight impairment of hearing of varying degree was also complained of. Few of them presented with active stage of the disease and they were treated conservatively so that they attained the criteria as mentioned previously for myringoplasty operation of the present study. Results: Temporal fascia – None of the operated case reached the excellent result of post operative A-B gap closure by 0 – 10 dB. 23 cases showed good A-B gap closure of 11 – 20 dB followed by 9 cases with fair A – B gap closure of 21 – 30 dB and 5 cases showed poor result of >30 dB A-B gap closure. Tragal perichondrium –None of the operated case reached the excellent result of post operative A-B gap closure by 0 -19 dB 5 cases showed good A-B gap closure by 11 -20 dB, followed by 3 cases of fair A-Bgap closure 21 – 30 dB and 1 case of poor result with >30 dB A- B gap closure. Areolar tissue – None of the operated case reached the excellent result of post operative A-B gap closure by 0 -10 dB. 6 cases showed good A-B gap closure by 11 – 20 dB, followed by 2 cases of fair i.e. 21 – 30 dB A- B gap closure. Ear Lobule fat – 8 out of 45 cases showed excellent result with post operative A-B gap closure by 0 – 10 dB followed by 32 cases with good A-B gap closure by 11 – 20 dB, followed by 5 cases of fair i.e. 21 – 30 dB A-B gap closure. Conclusion: Tympanoplasty using Fat from ear lobule has high success rate of 90% for tiny small perforations. It is an office procedure which is cost effective with minimum post operative morbidity. But it is an underused procedure. We should practice it more for the benefit of our patients. Further long term study with more number of patients and verities of graft materials are necessary to achieve detailed and accurate results.

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Indian Perspectives on Graft Materials Used for Repair of Tympanic Membrane

Cited by 4 publications

References 53 publications

Graft Uptake and Hearing After Endoscopic Palisade Cartilage Myringoplasty at Nepal Medical College Teaching Hospital

Graft Uptake and Hearing After Endoscopic Palisade Cartilage Myringoplasty at Nepal Medical College Teaching Hospital

Over-Underlay technique of myringoplasty.

Study of Different Types of Graft Materials Use in Type - I Tympanoplasty at Ent Department of Skmch, Muzaffarpur, Bihar

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