Evaluation of different graft material in type 1 tympanoplasty

Our Experience of Comparison of Hearing Outcomes in Patients Undergoing Type-1 Tympanoplasty with Different Graft Materials

The present study was undertaken to compare the results of various autogenous tissues: temporalis fascia, sliced tragal cartilage and fascia lata as graft materials for type I tympanoplasty in terms of hearing improvement in safe type of chronic suppurative otitis media. A total of 75 cases with central perforation were considered in the study. Of the 75 cases, temporalis fascia graft was used in 25 cases (Group-A), fascia lata graft in 25 cases (Group-B), and sliced tragal cartilage graft in 25 cases (Group-C). The results were evaluated in the form of hearing improvement with respect to the graft materials. A significant association was observed between the groups, that is, temporalis fascia (Group-A), fascia lata (Group-B), and sliced tragal cartilage (Group-C) in terms of improvement in AB gap (P = 0.047). Improvement in AB gap was statistically significant between groups B and A, but not between the other groups. In the present study, fascia lata showed better graft uptake as compared to temporalis fascia and sliced tragal cartilage. The hearing assessment at post-operative 3rd month showed statistically significant hearing improvement with fascia lata when compared to temporalis fascia.

Is Cartilage a Better Option than Temporalis Fascia for Grafting in Type 1 Tympanoplasty?: An Institutional Study

Chronic suppurative otitis media (CSOM) is one of the important health problems in our country. The present study was conducted to compare Cartilage and Temporalis Fascia as graft material for Type 1 Tympanoplasty for CSOM. The study was conducted to assess hearing outcome as average AB Gap closure respect to age of the patient and size of perforation, to evaluate Graft uptake with both grafting material and with respect to size of perforation and to find the complication rate. Prospective Comparative study was conducted on 60 patients of CSOM divided in two groups and randomly selected for cartilage Typanoplasty and Temporalis Fascia Tympanoplasty. Hearing result are compared pre and post operative. Group 1(cartilage): Average AB Gap closure was 55% for Small CP, 50% for Moderate CP, 40% for Large CP, 38% for Subtotal CP. In Group 2(Temoralis Fascia): Average AB Gap closure was 81% for Small CP, 72% for Moderate CP, 64% for Large CP, 52% for Subtotal CP. In Group 1, 46% and in Group 2, 69% Average closure of AB gap observed at 12 weeks post operatively. The p value for our study was found to be < 0.05, which statistically indicates better hearing outcome with TF graft. Cartilage is an excellent grafting material because of its accessibility, resistance to negative pressure and high graft uptake rate. Temporalis Fascia is easily available with similar thickness to TM. It showed inferior morphological uptake rate compared to cartilage though functional gain was better.

Which is Better for Management of Tympanic Membrane Perforation Temporalis Fascia or Fascia Lata Graft?

A good graft material is the one which is easily available and harvestable, tough and is easy to be handling and survival is good. Both temporalis fascia and fascia lata graft satisfy all these criteria. Keeping all these factors in mind, the comparative study of temporalis fascia and fascia lata graft in tympanoplasty is undertaken. All the patient reporting to ENT OPD with tympanic membrane perforation who are fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy were included in the study. Our observation and data analysis have shown that fascia lata is definitely better than temporalis fascia in terms of intactness of graft (95.1% in fascia lata and 90.24% in temporalis fascia) and PTA average improvement is higher in fascia lata graft (11.56 ± 5.005) as compared to temporalis fascia graft (10.32 ± 4.634) and ABG improvement is higher in fascia lata graft (2.7317 ± 1.118) as compared to temporalis fascia graft (2.634 ± 1.089). Fascia lata has better dimensional stability, easy handling and thickness of the graft and it provides more resistant to negative middle ear pressure. Hence, fascia lata is one of the good choices in otologist's armentorium for tympanoplasty graft material.

Myringoplasty Outcomes From a 5-Year Single Surgeon's Experience and Important Surgical Technical Aspects

BACKGROUND AND OBJECTIVES

The United Kingdom (UK) national standard for the closure rate for myringoplasty is 89.5% (90.6% and 84.2% for primary and revision surgeries, respectively). The average hearing gains for primary and revision myringoplasty are 9.14 dB and 7.86 dB, respectively. This study compared the myringoplasty outcomes for a single surgeon over 5 years.

SUBJECTS AND PURPOSE

Data for 68 cases were analyzed retrospectively. The outcome measures were achievement of the tympanic membrane closure and the average hearing gain or loss.

RESULTS

The overall and primary closure rates were 97% and 98%, respectively and significantly higher than the UK national standard (p=0.0210 and p=0.0287, respectively). The revision closure rate was 93%; however, it was not significantly higher than the national standard (p=0.1872). The average hearing gain was 5.18 dB. The gains for primary and revision surgeries were 5.15 dB and 5.25 dB, respectively.

CONCLUSIONS

We propose that these outcomes are a result of our surgical technique, including the simultaneous use of cortical mastoidectomy in ears with discharge.