Revision Myringoplasty Using Thin-Sliced Cartilage for Postoperative Reperforation in Patients with Chronic Otitis Media

Abstract

Myringoplasty is one of the basic procedures in otologic surgery, and is important to achieve good hearing outcome. The temporal fascia is most widely used and considered to be a stable graft in this procedure, although 10-20% of patients develop reperforation after surgery, which is often hard to repair, even by revision surgery. We herein conducted revision myringoplasty using a cartilage graft to repair postoperative reperforation in 7 patients (8 ears) with chronic otitis media. The patients were 3 males and 4 females, aged 13-80 years with an average of 53.9 years. A cartilage graft was harvested from the tragus, sliced in 0.3 mm thickness with perichondrium attached on one side, and trimmed into an appropriate shape and size. The graft was then underlaid beneath the perforation and fixed with fibrin glue. The operation was Wullstein type I tympanoplasty in 5 ears and myringoplasty in 3 ears, using the temporal fascia in 7 ears and subcutaneous tissue in 1 ear. The postoperative follow-up period ranged from 16 to 44 months with an average of 30.0 months. Perforation of the tympanic membrane was successfully closed in 7 ears (87.5%). Hearing outcome was judged successful in 5 ears (62.5%) according to the criteria of the Otological Society of Japan (postoperative hearing level < 30 dB, hearing gain > 15 dB, or postoperative air-bone gap < 15 dB). These results indicate that cartilage is a stable and reliable graft material for revision myringoplasty to repair postoperative reperforation in patients with chronic otitis media.

Results of pediatric endoscopic and endoscopically assisted tympanoplasty

“…Large reviews of pediatric tympanoplasty, regardless of surgical technique report significant rates of graft failure months to years after surgery, persistent small perforations near the annulus, myringitis, and recurrence of middle ear disease after initial tympanic closure. 13 , 14 , 15 , 16 , 17 Continuing eustachian tube dysfunction, immunologic immaturity and less than optimal cooperation with postoperative care have been cited as potential reasons for imperfect results in pediatric tympanoplasty. 18 , 19 , 20 Some otologists argue that persistent middle ear or mastoid inflammation from biofilm disease not addressed by tympanic membrane repair alone may lead to surgical failure.…”