EFFECT OF AUDIOLOGICAL OUTCOMES BETWEEN TRAGAL CARTILAGE PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT IN TYMPANOPLASTY TYPE-1 SURGERY

Main Article Content

Dr. Soudha Sadhiya
Dr. Jayagar Prabakaran

Keywords

Tympanoplasty Grafts, Tragal Perichondrium, Temporalis Fascia, Hearing Outcome, Audiometry, Tympanometry

Abstract

Background: Among the leading causes of hearing loss in the world, Chronic Otitis Media (COM) is one of them. Tympanoplasty is the surgical treatment to repair the defective tympanic membrane in such patients.


Aim: To compare the audiological outcomes using temporalis fascia versus cartilage perichondrium grafts in tympanoplasty type-1.


Methods: A prospective randomized comparative cohort trial was conducted to compare the post-operative audiological outcomes of two graft materials, tragal cartilage perichondrium and temporalis fascia, in tympanoplasty type1 surgery among 60 patients randomized into 2 groups.


Results: Out of the 57 patients out of 60, who complied with the study follow-up, Tympanoplasty type-1 was performed in patients in Group A with Tragal cartilage perichondrium (n=27) and in Group B with Temporalis fascia (n=30). After 3 months, hearing levels were found to have significantly improved in all 57 patients. There was no statistically significant difference in improvement of hearing between the two groups in Pure Tone Audiometry as Group A, patients had a pre-operative mean air-bone gap value of 26.12 dBHL which had improved to 19.19 dBHL while in Group B, the pre-operative mean air-bone gap value was 25.48 dBHL and the post-operative value was 18.8dBHL. Post-operative mean impedance in tragal perichondrium graft Group A was 2.8 daPa was significantly higher than that of Group B with 1.96 daPa.


Conclusion: The results of this study shows that tragal cartilage perichondrium is significantly better than temporalis fascia in terms of audiological outcomes as  a graft material in Type-1 tympanoplasty.

Abstract 60 | pdf Downloads 52

References

1. Glasscock ME, Shambaugh GE. Surgery of the ear, 6th edition. AJ Gulya, LB Minor, DS Poe; 2010, People’s Medical Publishing House – USA, Shelton, Connecticut.
2. Jose A. Chronic otitis media: Burden of Illness and management Child and Adolescent Health and Development Prevention of Blindness and Deafness. Geneva, Switzerland: World Health Organization (WHO); 2004.
3. Chhapola S, Matta I. Cartilage–Perichondrium: An Ideal Graft Material? Indian J Otolaryngol Head Neck Surg 2012;64(3):208–13.
4. Zahnert T, Huttenbrink KB, Murbe D, Bornitz M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322-8.
5. Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD. Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope 2006;116:1813-6.
6. Szabo LZ. How can an under laid fascia graft from the middle layer of a reconstructed tympanic membrane? Laryngoscope 2006;116:1674-7.
7. Page C, Charlet L, Strunski V. Cartilage tympanoplasty: postoperative functional results. Eur Arch Otorhinolaryngol 2008;265(10):1195-8.
8. Mundra RK, Sinha R, Agrawal R. Tympanoplasty in Subtotal Perforation with Graft Supported by a Slice of Cartilage: A Study with Near 100 % Results. Indian J Otolaryngol Head Neck Surg 2013;65(Suppl 3):S631-5.
9. Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V. The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2014;66(4):449–54.
10. Cavaliere M, Mottola G, Rondinelli M, Iemma M. Tragal cartilage in tympanoplasty: anatomic and functional results in 306 cases. Acta otorhinolaryngologica italica 2009;29:27-32.
11. Neumann A, Schultz-Coulon H, Jahnke K. Type III tympanoplasty applying the palisade cartilage technique: A study of 61 cases. Otol Neurotol 2003;24:33-7.
12. Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope 1997;107:1094–9.
13. Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope 2003;113:1844-56.
14. Puls T. Tympanoplasty using conchal cartilage. Acta Oto Rhino-Laryngol Belg 2003;57:187-91.