Dataset Information

Cartilage support for fascia graft in type I tympanoplasty.

ABSTRACT: To evaluate the success rate, in terms of anatomical and functional results, in our technique of cartilage support for fascia graft in type I tympanoplasty. Retrospective study of tragal cartilage support for fascia graft in tympanoplasty for large central perforation in 748 patients was carried at an academic institution during January 2004 to March 2012. Patients' age ranged from 11 to 65 years. 325 (43.4 %) male and 423 (56.6 %) female patients were operated and mean post-operative follow up was of 24 months (range 6-48 months). The inclusion criteria were large central or subtotal perforation, anterior quadrant perforation, anterior tympanosclerotic patch with perforation and revision myringoplasty. Small central perforation, posterior perforations, traumatic perforations and Ossiculplasty were excluded from this study. In this technique, a piece of tragal cartilage carved in semi lunar shape is inserted medial to anterior remnant of tympanic membrane. Temporalis fascia graft is sandwiched between cartilage and anterior remnant of tympanic membrane. Post-operative closure of perforation was noted. Pure-tone average pre and post-operative air-bone gap in dB at 250, 500, 1000, 2000, and 4,000 Hz were compared. The overall success rate of our technique was 98.3 % in terms of graft uptake and within 13.35 ± 5.22 dB of air bone gap closure in terms of hearing improvement. This study reveals that cartilage support for fascia graft in type I tympanoplasty is a highly reliable technique and gives significant improvement in graft take-up and hearing status.

SUBMITTER: Kulkarni S

PROVIDER: S-EPMC4071426 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Cartilage support for fascia graft in type I tympanoplasty.

Kulkarni Shreeya S Kulkarni Vinay V Burse Kiran K Sancheti Vandana V Roy Gaurav G

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 20140201 3

To evaluate the success rate, in terms of anatomical and functional results, in our technique of cartilage support for fascia graft in type I tympanoplasty. Retrospective study of tragal cartilage support for fascia graft in tympanoplasty for large central perforation in 748 patients was carried at an academic institution during January 2004 to March 2012. Patients' age ranged from 11 to 65 years. 325 (43.4 %) male and 423 (56.6 %) female patients were operated and mean post-operative follow up ...[more]

PMID: 25032117

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Project description:The three well recognized tympanoplasty approaches: permeatal, postaural, and endaural, each have advantages and disadvantages. The permeatal approach is suitable only for ears with adequate canal size. The postaural approach limits visualization of the posterior eardrum margin. The endaural approach limits the view of the eardrum's anterior margin. This study describes a modified endaural approach, developed to overcome these limitations. A retrospective case series review and collection of a prospective cohort of patient reported outcome data were undertaken to assess the technique.Standard incisions as used in an endaural approach are placed within the ear canal. The novel incision extends from the superior canal incision into the conchal cavum. This allows a flap of the thick, hairbearing skin from both the bony and cartilaginous portions of the canal to be raised, and everted, to provide an excellent view of the entire drum. Perichondrium can be harvested for grafting from the conchal cavum. The clinical charts of all patients operated on by the first author using this technique from 2010-2012 were retrospectively reviewed. The size and position of the perforation, size of the canal, whether primary or revision surgery, graft take rate, hearing results and the occurrence of chondritis/perichondritis were recorded. To investigate the morbidities and the acceptance by the patients of the incision/scar in the conchal cavum, all patients undergoing the procedure in the 8 months up to the end of August 2013 were prospectively recruited to complete a self-assessment Likert scale questionnaire recording postoperative pain, and satisfaction with the cosmesis of the operative site. The clinician recorded if there was any evidence of chondritis/perichondritis.A 100% graft take rate was achieved in the 75 adults treated by the first author from 2010 to 2012 regardless of the size and position of the perforation, configuration of the canal, primary or revision surgery. Preoperative Pure Tone Audiometric (PTA) Air Bone Gap (ABG) averaged over 3 frequencies (0.5, 1 and 2 K Hz) was 19.4dB (standard deviation?=?9.6, range 2 to 50). Postoperative PTA ABG average was 6.2 dB (standard deviation?=?8.3, range -7 to 37), demonstrating a statistically significant post-surgery mean improvement of 13.2 dB (paired T-test, p?<?0.001). Twenty-one patients who underwent the procedure in 2013, reported minimal postoperative analgesic use, and scored the acceptability of the incision scar highly (4.8 out of a maximum of 5). There was no case of chondritis/perichondritis in the 96 cases.Whilst it is the surgeon's decision to use a permeatal, postaural or endaural approach, the endaural approach with the conchal cavum modification is an excellent alternative to the traditionally described approaches.NCT02000843 at ClinicalTrials.gov.

Project description:Chronic suppurative otitis media (CSOM) continues to be an important public health problem despite significant advances in medical science. Ear discharge, pain, discomfort, difficulty in hearing, limitation of routine activities and emotional problems due to CSOM cause a significant impact on the health and general well being of the patient. We have done Type 1 tympanoplasty in tubotympanic type of COM to reconstruct the tympanic membrane and alleviate the symptoms of the patients. This study presents an analysis of the impact of the surgery on the patient subjectively and its correlation with objective outcomes. 45 patients were selected to fill the chronic otitis media-5 (COM-5) questionnaire and underwent pure tone audiometry preoperatively. All the patients underwent Type 1 tympanoplasty by using temporalis fascia graft. The status of the ossicles was checked and documented intraoperatively. Patients requiring ossicular reconstruction or with attico antral disease were excluded. Patients were followed up for a period of 6 months and those with an intact graft after 6 months were included in the study. These patients were again made to fill the questionnaire and undergo pure tone audiometry postoperatively. 37 out of 45 patients (82 %) had an intact graft 6 months after surgery. Marked improvement was observed in subjective scores as documented by the questionnaire, pre- and postoperatively with the mean improvement in total scores being 7.89 ± 4.81 on a Visual Analogue Scale. Also significant improvement was achieved in closure of air-bone gap with the mean improvement being 14.73 ± 8.58 dB. Significant correlation was found between subjective and objective scores in most patients. This study showed that Type 1 tympanoplasty brings about a significant improvement in the quality of life of chronic suppurative otitis media patients. Most patients showed a marked improvement in subjective scores which correlated well with the objective findings of the status of the graft and improvement in air-bone gap. Asymptomatic patients with less preoperative scores showed less improvement in subjective scores which did not correlate with the objective outcomes.

Dataset Information

Cartilage support for fascia graft in type I tympanoplasty.

Publications

Cartilage support for fascia graft in type I tympanoplasty.

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