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Chen K, Zhao R. Comparison of cartilage and temporalis fascia grafts in type 1 tympanoplasty: A meta-analysis. EAR, NOSE & THROAT JOURNAL 2022:1455613221137122. [PMID: 36300279 DOI: 10.1177/01455613221137122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE To systematically review the results of type 1 tympanoplasties with temporalis fascia (TF) vs cartilage grafts in patients with chronic otitis media. METHODS Eligible studies were identified from PubMed, Ovid, and EMBASE databases prior to November 2021. We analyzed the pure tone audiometry (PTA) and air-bone gap (ABG) data as continuous variables, and the success rate was analyzed as a dichotomous variable. RESULTS Forty-four studies, including 4582 patients, were eligible. The cartilage graft overall morphologic success rate was higher than that of the TF grafts (P < .001). In the palisade (P < .004) and island grafts (P < .001) subgroups, the analysis was significantly different. However, there was no significant difference in the inlay butterfly grafts subgroup. For hearing outcomes, the analysis revealed that TF grafts had a smaller mean post-operative ABG (P = .009). However, the subgroup analysis showed no significant difference in the mean post-operative ABG. For PTA, there was no significant difference in hearing improvement. However, the palisade cartilage graft subgroup resulted in a better hearing outcome than the TF graft subgroup in terms of the mean post-operative PTA (P = .007). There was no significant difference in the functional success rate or mean ABG gain. CONCLUSION Cartilage grafts have a better success rate than TF grafts in tympanoplasty. Both cartilage and TF tympanoplasty provided similar improvements in hearing outcome, while TF grafts generated a better outcome in post-operative ABG and palisade cartilage grafts in post-operative PTA. This may be related to the biological characteristics of the grafts. Further thorough studies need to be conducted.
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Affiliation(s)
- Kai Chen
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui Zhao
- Otorhinolaryngology-Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Zhu X, Zhang Y, Xue R, Xie M, Tang Q, Yang H. Predictors of anatomical and functional outcomes following tympanoplasty: A retrospective study of 413 procedures. Laryngoscope Investig Otolaryngol 2021; 6:1421-1428. [PMID: 34938883 PMCID: PMC8665455 DOI: 10.1002/lio2.689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/17/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To identify the predictors of anatomical and functional outcomes following tympanoplasty. STUDY DESIGN A retrospective cohort study. METHODS Patients with chronic suppurative otitis media (CSOM) who underwent a tympanoplasty at Peking Union Medical College Hospital from January 1, 2015 to December 31, 2019 were retrospectively included. Outcome measures included graft success and postoperative pure tone audiometry air-bone gap (PTA-ABG) at last follow-up (≥6 months). PTA-ABG and MERI were calculated. Descriptive, univariable, and multivariable logistic regression analyses were conducted to evaluate the predictors of the graft and hearing outcomes. RESULTS During the study, 385 patients (167 male, 218 female, median age 44 years) undergoing 413 procedures were studied. Out of this, 219 ears underwent tympanoplasty, 45 ears had tympanoplasty with canal wall up mastoidectomy, and 149 ears had tympanoplasty with canal wall down mastoidectomy. At the last follow-up, the overall graft success rate was 91.3% (377/413) and the overall hearing success rate was 40% (165/413). Multivariable analysis results showed that the obstructed aditus ad antrum (OR 2.67, 95%CI 1.13-6.30; P = .025) was an independent prognostic factor for graft failures. Moreover, the obstructed aditus ad antrum (OR 2.18, 95%CI 1.16-4.08; P = .015) and MERI >3 (OR 6.53, 95%CI 3.55-12.02; P < .001) were independent predictors of hearing failures (PTA-ABG > 20 dB). CONCLUSIONS Aditus ad antrum patency was an independent predictor of both graft and hearing success among patients following tympanoplasty. MERI score greater than three was found to be a significant predictor of postoperative hearing and could serve as a useful tool for assisting clinicians in perioperative risk assessment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Xiao‐Hui Zhu
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yong‐Li Zhang
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ruo‐Yan Xue
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Meng‐Yao Xie
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qi Tang
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hua Yang
- Department of OtolaryngologyPeking Union Medical College HospitalBeijingChina
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Xing C, Liu H, Li G, Li J, Li X. Type 1 tympanoplasty in patients with large perforations: Comparison of temporalis fascia, partial-thickness cartilage, and full-thickness cartilage. J Int Med Res 2021; 48:300060520945140. [PMID: 32790512 PMCID: PMC7543155 DOI: 10.1177/0300060520945140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to compare the results of different graft materials in type I tympanoplasty for patients with a large perforation of the tympanic membrane. Methods We performed a retrospective study on 180 patients with type I tympanoplasty. The patients were divided into three groups according to the repair materials used. Age, sex, pre- and postoperative hearing levels, mean air–bone gap, rate of graft success, hearing gain, and the postoperative graft failure rate were evaluated. We continued to follow-up the patients to 1 year after surgery. Results The air conduction threshold was significantly higher before the operation than after the operation in the temporalis fascia, partial-thickness cartilage, and full-thickness cartilage groups. Although the hearing gain in the temporalis fascia group and the partial-thickness cartilage group was higher than that in the full-thickness cartilage group, there was no significant difference in the graft success rate among the groups. Conclusions Temporalis fascia, partial-thickness cartilage, and full-thickness cartilage can be used as appropriate transplantation materials for tympanoplasty type I in patients with a large perforation. Temporalis fascia and partial-thickness cartilage may be best for improvement of hearing.
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Affiliation(s)
- Caixia Xing
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| | - Hong Liu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, P.R. China
| | - Guodong Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| | - Jianfeng Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
| | - Xin Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, P.R. China
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Success rate of type 1 tympanoplasty: a comparative study. The Journal of Laryngology & Otology 2021; 135:315-319. [PMID: 33691826 DOI: 10.1017/s0022215121000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to compare graft take rate after tympanoplasty between adults and paediatric patients, cartilage and fascia grafts, and overlay and underlay techniques. METHODS Data were analysed in groups according to the technique (underlay vs overlay), age (paediatric patients vs adults) and graft (cartilage vs temporalis fascia). The main outcome measures were full graft take and the incidence of complications. RESULTS A total of 198 patients (208 ears) were included. Overall, full graft take was achieved in 200 ears (96 per cent). The success rate was higher in adults compared with paediatric patients (97.5 per cent vs 92.25, respectively) but the difference was insignificant. Similarly, higher but insignificant graft take rate was found in the cartilage group compared with fascia group (98.6 per cent vs 94.9 per cent, respectively). CONCLUSION All cases of overlay tympanoplasty had full graft take (success rate 100 per cent). In the underlay group, successful graft take was achieved in 154 cases (95 per cent). This difference was statistically insignificant.
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Verma B, Dawat N, Dabholkar Y, Patil S. Prospective study of use of Island of tragal cartilage in revision tympanoplasty. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_224_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bayram A, Bayar Muluk N, Cingi C, Bafaqeeh SA. Success rates for various graft materials in tympanoplasty - A review. J Otol 2020; 15:107-111. [PMID: 32884562 PMCID: PMC7451680 DOI: 10.1016/j.joto.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this paper is to review how successful each type of grafts is in tympanoplasty. Methods Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “graft”, “success” “tympanoplasty”, “success rate” with the search limited to the period 1955 to 2017. Results Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are significant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is. Conclusion Although temporal fascia is the most commonly used graft material for tympanoplasty, poor graft stability may cause failure. This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia. Cartilage grafts offer better ability to resist infection, pressure, and cope with insufficient vascular supply. This means that cartilage grafts are suitable for use in revision cases.
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Affiliation(s)
- Ali Bayram
- Kayseri Training and Research Hospital, Department of Otorhinolaryngology, Kayseri, Turkey
| | - Nuray Bayar Muluk
- Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey
| | - Sameer Ali Bafaqeeh
- King Saud University, Department of Otorhinolaryngology, Riyadh, Saudi Arabia
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Gozeler MS, Sahin A. Comparison of Temporalis Fascia and Transcanal Composite Chondroperichondrial Tympanoplasty Techniques. EAR, NOSE & THROAT JOURNAL 2019; 100:192-195. [PMID: 31544506 DOI: 10.1177/0145561319875663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to compare the success rates and hearing outcomes of transcanal composite chondroperichondrial cartilage graft with that of underlay temporal muscle fascia (TMF) graft for myringoplasty. In this retrospective study, the medical records of patients who underwent type 1 myringoplasty between September 2015 and February 2018 at Otorhinolaryngology Department of Erzurum Ataturk University were reviewed. Demographic properties, preoperative otological findings, preoperative pure ton audiogram findings, postoperative pure ton audiogram findings, and duration of surgeries were reviewed from medical records. The patients with lack of one or more of these information at medical records or lost to at least 3 months of follow-up were excluded from the study. According to the graft material used in the operation, the patients were divided into 2 groups. The patients operated with cartilage graft by transcanal composite chondropericondrial cartilage graft myringoplasty (TCM) technique was regarded as first group, while patients operated with temporal fascia was regarded as the second group (TMF). Both groups were compared according to preoperative and postoperative air-bone gap (ABG), graft acceptance rate, and duration of operation using SPSS version 20.0 software. A total of 113 patients whose medical records met the inclusion criteria were included in the study. Of these, 59 underwent TCM and 54 underwent TMF myringoplasty. Tympanic membrane perforation closure success rate was higher in the cartilage group (94.9%) than in the fascia group (83.3%; P = .046). In the former, preoperative and postoperative ABG was 19.5 ± 5 and 10.8 ± 4.8 dB, respectively. In the latter, the corresponding values were 20.7 ± 5.4 and 11.5 ± 5.4 dB, respectively (P < .05). Duration of surgery was 29.5 ± 3.4 minutes in the TCM group and 61.5 ± 6.0 minutes in the TMF group (P < .05). Transcanal cartilage myringoplasty could be considered as an appropriate surgical option because of its simplicity, shorter operation time, and rapid patient recovery, with no significant difference in terms of hearing outcomes compared to temporal fascia.
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Affiliation(s)
- Mustafa Sitki Gozeler
- Faculty of Medicine, Department of Otorhinolaryngology, 64060Ataturk University, Erzurum, Turkey
| | - Abdulkadir Sahin
- Faculty of Medicine, Department of Otorhinolaryngology, 64060Ataturk University, Erzurum, Turkey
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Cayir S, Kayabasi S, Hizli O. Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts. Acta Otolaryngol 2019; 139:734-738. [PMID: 31271337 DOI: 10.1080/00016489.2019.1633018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air-bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) (p < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p = .68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.
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Affiliation(s)
- Serkan Cayir
- Department of ENT, Aksaray University, Aksaray Education and Research Hospital, Aksaray, Turkey
| | - Serkan Kayabasi
- Department of ENT, Aksaray University, Faculty of Medicine, Aksaray, Turkey
| | - Omer Hizli
- Department of ENT, Giresun University, Prof Dr A. Ilhan Ozdemir Education and Research Hospital, Giresun, Turkey
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Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results. J Craniofac Surg 2019; 30:e297-e300. [PMID: 30839461 DOI: 10.1097/scs.0000000000005278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ± 6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.
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Çayir S, Kayabaşi S. Type 1 tympanoplasty in pediatric patients: Comparison of fascia and perichondrium grafts. Int J Pediatr Otorhinolaryngol 2019; 121:95-98. [PMID: 30878559 DOI: 10.1016/j.ijporl.2019.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/17/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of this study was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and to evaluate the prognostic factors that may affect its success. MATERIALS AND METHODS A retrospective study of 42 pediatric patients who were younger than 18 years and underwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia from January 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and 18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type (central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia, perichondrium), length of follow up and surgical outcomes were collected. RESULTS The overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantly higher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group(p = 0.023). The functional success rate (postoperative air-bone gap<20 dB) obtained in the perichondrium group was 90.4% (19/21) and 85.7% (18/21) in the fascia group, respectively. After a mean follow-up of 27.5 ± 11.55 months, the mean hearing improvement was 11.26 ± 7.53 dBHL for overall the group. Presence of contralateral otitis media with effusion (OME) was found a risk for reperforation and bilateral perforations were negatively affected graft success rate (p < 0.01). Graft success did not affected by age, gender and type and location of perforation (p > 0.05). CONCLUSION Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatric tympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be the first choice of graft material due to its high success rates. There were no significant differences between the fascia and perichondrium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations and contralateral OME, and should be treated with perichondrium or cartilage graft.
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Affiliation(s)
- Serkan Çayir
- Aksaray University Faculty of Medicine, Department of Ear Nose and Throat and Head and Neck Surgery, Turkey.
| | - Serkan Kayabaşi
- Aksaray University Faculty of Medicine, Department of Ear Nose and Throat and Head and Neck Surgery, Turkey.
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Balcı MK, İşlek A, Ciğer E. Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques. Eur Arch Otorhinolaryngol 2019; 276:673-677. [PMID: 30600345 DOI: 10.1007/s00405-018-5262-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels. METHODS Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed. RESULTS One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively). CONCLUSION In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.
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Affiliation(s)
- Mustafa Koray Balcı
- Department of Otorhinolaryngology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi Mh. Karabağlar, Izmir, 35170, Turkey.
| | - Akif İşlek
- Department of Otorhinolaryngology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi Mh. Karabağlar, Izmir, 35170, Turkey
| | - Ejder Ciğer
- Department of Otorhinolaryngology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Basın Sitesi Mh. Karabağlar, Izmir, 35170, Turkey
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The wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia for type 1 tympanoplasty: a prospective, randomized study. Eur Arch Otorhinolaryngol 2018; 275:2975-2981. [DOI: 10.1007/s00405-018-5171-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/10/2018] [Indexed: 11/27/2022]
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Tseng CC, Lai MT, Wu CC, Yuan SP, Ding YF. Short-term Subjective and Objective Outcomes of Patients Receiving Endoscopic Transcanal Myringoplasty for Repairing Tympanic Perforations. Otolaryngol Head Neck Surg 2017; 158:337-342. [DOI: 10.1177/0194599817735501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Endoscopic transcanal myringoplasty (ETM) has been an emerging technique for repairing tympanic perforations since the late 1990s. Objective outcomes (ie, graft success rates and hearing results) of patients who received ETM are well documented; however, subjective outcomes of these patients have rarely been reported. Hence, this study evaluated subjective and objective outcomes of patients who received ETM for repairing tympanic perforations. Study Design Prospective study. Setting Tertiary care university hospital. Patients and Methods Patients who underwent ETM for perforations of the tympanic membrane were included. We evaluated subjective variables of patients receiving ETM as the primary outcome and objective variables as the secondary outcome. Results In total, 91 ears that underwent ETM were included. The mean pain scale score was 0.1 (range, 0-2) on postoperative day 3. The mean duration of pain medication was 2.0 (range, 0-3) days. The mean number of days required to resume routine activities was 1.0 (range, 1-2) days. The overall graft success was determined postoperatively at 3 months in 80 of 91 ears (87.9%). Closure of the air-bone gap to within 20 dB was achieved in 79 (86.8%) ears. Conclusion In this study, patients who received ETM had mild postoperative pain and resumed routine activities early. These patients also exhibited favorable graft success rates and hearing results at 3 months postoperatively. On the basis of our results, we conclude that patients who receive ETM for the repair of tympanic perforations have favorable short-term subjective and objective outcomes.
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Affiliation(s)
- Chih-Chieh Tseng
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, PoJen General Hospital, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Tang Lai
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Chia-Che Wu
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Po Yuan
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Yi-Fang Ding
- Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
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Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies. Laryngoscope 2016; 127:2139-2148. [PMID: 27933630 DOI: 10.1002/lary.26451] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To systematically review the results of type 1 tympanoplasty with temporalis fascia (TF) versus cartilage in patients with chronic otitis media (COM) for graft integration and hearing improvement. DATA SOURCES The English language literature (until June 1, 2016) was searched, using Medline (via PubMed), Scopus, ProQuest, Ovid, Cochrane database, and Google Scholar. REVIEW METHODS A comprehensive review of the literature was performed. Prospective and retrospective studies enrolling patients with COM were included. Relevance and validity of selected articles were evaluated. Heterogeneity was assessed using I2 statistics. For dichotomous variables, absolute rate differences, and number needed to treat (NNT) were calculated. For continuous variables, standard mean differences were calculated. RESULTS A total of 11 prospective and 26 retrospective studies involving 3,606 patients were included. In general, the overall graft integration rates of cartilage and fascia tympanoplasty were 92% and 82%, respectively (NNT = 11.1, P < 0.001). Although there was no significant difference in the air-bone gap (ABG) closure of < 10 dB between the two groups, the subanalysis of prospective studies showed that patients in the TF group had less mean postoperative ABG (P = 0.02). Subgroup analysis of palisade grafts compared with that of TF graft revealed a significant difference in the graft integration rate favoring cartilage tympanoplasty (P = 0.01). CONCLUSION Cartilage grafting seemed to show a higher graft integration rate compared with TF grafting. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome postoperatively. Large prospective trials are necessary to collect high-quality data. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2139-2148, 2017.
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Affiliation(s)
- Mir Mohammad Jalali
- Nose and Sinus Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Motasaddi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kouhi
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Soleimani
- Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Bişkin S, Erdem D, Sakallı E. Reply to the letter to the editor ‘‘in response to: a better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials’’ 10.1007/s00405-016-4019-0. Eur Arch Otorhinolaryngol 2016; 273:4047-4048. [DOI: 10.1007/s00405-016-4122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/28/2016] [Indexed: 11/30/2022]
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Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol 2016; 82:695-701. [PMID: 27068884 PMCID: PMC9444745 DOI: 10.1016/j.bjorl.2015.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. Objective To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. Methods In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7–18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant. Results The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females. Conclusions Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.
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Affiliation(s)
- Yakup Yegin
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Mustafa Çelik
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
| | - Arzu Karaman Koç
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Levent Küfeciler
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Mustafa Suphi Elbistanlı
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
| | - Fatma Tülin Kayhan
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey
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A new graft material for myringoplasty: bacterial cellulose. Eur Arch Otorhinolaryngol 2016; 273:3561-3565. [DOI: 10.1007/s00405-016-3959-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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Clinical advantages of cartilage palisades over temporalis fascia in type I tympanoplasty. Auris Nasus Larynx 2014; 41:422-7. [DOI: 10.1016/j.anl.2014.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
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