Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure

Abstract

The aim of this study is to compare the inlay butterfly transcanal cartilage tympanoplasty with the conventional underlay tympanoplasty. Operation time, pre- and postoperative hearing levels, successful closure rate of tympanic membrane (take rate) and long-term re-perforation in dry perforated chronic otitis media were evaluated. The study design consists of case series with a chart review. The study settings are tertiary referral center. Of the 72 patients (age range 14-57 years) with dry perforated chronic otitis media, 29 patients underwent inlay butterfly transcanal cartilage tympanoplasty (group 1) and 43 patients underwent conventional underlay tympanoplasty without mastoidectomy (group 2) between January 2010 and June 2012. The outcome measures were the duration of surgery, "take rate" at the 30th postoperative day and the audiometric results at the 45th postoperative day. Long-term re-perforation was evaluated at least postoperative 1 year. The graft take rate was 96.5 % in group 1 and 90.7 % in group 2 at the 30th postoperative day (p > 0.05). Mean air-bone gap was improved from 18.8 ± 8.09 to 11.9 ± 7.12 dB in group 1 and from 21.9 ± 7.32 to 11.6 ± 8.43 dB in group 2. The improvement of air-bone gap in both groups was statistically significant (p < 0.05) but the improvement between the groups was not statistically significant (p > 0.05). The average duration of the surgery was 29.9 ± 5.38 min for inlay tympanoplasty group and 58.9 ± 12.1 min for underlay tympanoplasty group (p < 0.05). Two patients in group 2 had re-perforations after an initial take of the graft in 1-year follow-up period. Inlay butterfly transcanal cartilage tympanoplasty is a good choice in selected cases. Although this technique has the similar take rate and audiological results with conventional underlay tympanoplasty, it is a time-saving procedure.

Comparison of cartilage with temporalis fascia tympanoplasty: A meta‐analysis of comparative studies

“…A total of 37 articles were finally included in our meta‐analysis, resulting in a pooled population of 3,606 patients: 1,795 undergoing cartilage tympanoplasty and 1,811 undergoing fascia tympanoplasty. There were 11 PCSs, three of which were randomized .…”

“…There were 11 PCSs, three of which were randomized . The remaining 26 comparative studies were retrospective . Three prospective studies and 12 retrospective studies were considered as low‐bias studies (see the online Supporting Table SI about the characteristics of the included studies).…”

“…Data regarding graft integration rate (Fig. ) were available for 35 eligible articles (11 prospective studies and 24 retrospective studies). Fifteen of them were at low risk of bias (score ≥ 5 in the quality assessment).…”

Transcanal Tympanoplasty with Cartilage-Perichondrium Composite Graft

“…Even though it has a success rate of between 80% and 95%, it may cause some problems during the postoperative period. A larger incision is made in order to remove the graft, the middle ear cavity and the anatomy of the external auditory canal are temporarily deformed with the elevation of the tympanomeatal flap, and more stringent postoperative care is required (6). This process extends the total duration of surgery and the patients become susceptible to infection.…”

“…In the study by Haksever et al (6), while the operating time in butterfly cartilage tympanoplasty was measured as 29.9±5.38 min, the underlay tympanoplasty procedure was measured to take 58.9±12.1 min (6). In our study, the operation time was similar because of the technical similarities.…”