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Valiya V, Kumar R, Kapadia PB, Panchal AJ, Luhana MA, Tailor U. Association of Pre-operative Eustachian Tube Function with the Graft Uptake After Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2024; 76:540-544. [PMID: 38440657 PMCID: PMC10908895 DOI: 10.1007/s12070-023-04208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 03/06/2024] Open
Abstract
To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results-i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery.
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Affiliation(s)
- Vipul Valiya
- ENT Department, 3rd Floor, SMIMER Hospital, SMIMER (Surat Municipal Institute of Medical Education & Research), Medical College, Bombay Market Road, Near Sahara Darwaja, Umarwada, Surat, 395010 Gujarat India
| | - Rakesh Kumar
- ENT Department, 3rd Floor, SMIMER Hospital, SMIMER (Surat Municipal Institute of Medical Education & Research), Medical College, Bombay Market Road, Near Sahara Darwaja, Umarwada, Surat, 395010 Gujarat India
| | - Parth B. Kapadia
- ENT Department, 3rd Floor, SMIMER Hospital, SMIMER (Surat Municipal Institute of Medical Education & Research), Medical College, Bombay Market Road, Near Sahara Darwaja, Umarwada, Surat, 395010 Gujarat India
| | - Ajay J. Panchal
- ENT Department, 3rd Floor, SMIMER Hospital, SMIMER (Surat Municipal Institute of Medical Education & Research), Medical College, Bombay Market Road, Near Sahara Darwaja, Umarwada, Surat, 395010 Gujarat India
| | - Mitanshi A. Luhana
- ENT Department, 3rd Floor, SMIMER Hospital, SMIMER (Surat Municipal Institute of Medical Education & Research), Medical College, Bombay Market Road, Near Sahara Darwaja, Umarwada, Surat, 395010 Gujarat India
| | - Urvashi Tailor
- ENT Department, 3rd Floor, SMIMER Hospital, SMIMER (Surat Municipal Institute of Medical Education & Research), Medical College, Bombay Market Road, Near Sahara Darwaja, Umarwada, Surat, 395010 Gujarat India
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Moneir W, El-Kholy NA, Ali AI, Abdeltawwab MM, El-Sharkawy AAR. Correlation of Eustachian tube function with the results of type 1 tympanoplasty: a prospective study. Eur Arch Otorhinolaryngol 2023; 280:1593-1601. [PMID: 36018358 PMCID: PMC9988816 DOI: 10.1007/s00405-022-07611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aims to evaluate Eustachian tube (ET) function tests and their impact on outcomes of tympanoplasty in patients with inactive chronic suppurative otitis media. MATERIALS AND METHODS A prospective study was conducted involving patients diagnosed with chronic suppurative otitis media (CSOM) and having a central dry perforation. Assessment of the ET function was done for all included cases by three tests; pressure swallow equalization test, saccharine test and methylene blue test. The primary outcome is the graft success rate defined as intact graft without any residual perforation at 6 months postoperatively. Secondary outcomes include hearing assessment and possible associated complications. RESULTS 64 patients were included in the study with an average age of 36.59 ± 11.96 years. All patients underwent assessment of the ET function by saccharine test, methylene blue test and pressure equalization test (PET) followed by microscopic post-auricular tympanoplasty. Successful tympanoplasty is achieved in 93.75% of cases with residual perforation in four patients. Mean air-bone gap is significantly improved from 23.73 ± 2.80 preoperatively to 10.93 ± 5.46 postoperatively. Results of Methylene blue test has no statistical impact on graft take rate (p value = 0.379), while saccharine test and pressure equalization test results have statistically significant correlation with graft success (p value ≤ 0.001). CONCLUSIONS Saccharine and Pressure equalization tests have a good positive correlation with the graft healing in tympanoplasty, while methylene blue test was found to have no correlation with the success rate.
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Affiliation(s)
- Waleed Moneir
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Noha Ahmed El-Kholy
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Ismail Ali
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media. Indian J Otolaryngol Head Neck Surg 2019; 71:10-13. [PMID: 30906705 DOI: 10.1007/s12070-018-1525-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022] Open
Abstract
To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016-July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12 months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.
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Pöyhönen L, Kivekäs I, Silvola J, Poe D, Rautiainen M. Mucociliary function of the eustachian tube in the eustachian tube dysfunction. Acta Otolaryngol 2019; 139:238-242. [PMID: 30870045 DOI: 10.1080/00016489.2018.1562218] [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: 10/27/2022]
Abstract
BACKGROUND Most of the tests to evaluate the eustachian tube (ET) function are focused on the ventilation function of the ET. AIM Here we evaluate mucociliary function of the ET in patients with ET dysfunction. MATERIALS AND METHODS Ten patients with ET dysfunction were enrolled into the study. Six patients had chronic tympanic membrane retraction and four patients had chronic middle ear effusion (MEE). All patients had intact tympanic membranes. Tympanometry and clinical examinations were done to all patients. Mucociliary function was evaluated with technetium labeled albumin and blue dye. Tympanometry and clinical examinations were done to six patients with chronic tympanic membrane retraction and four patients with chronic middle ear effusion (MEE). Mucociliary function of the ET was evaluated with technetium labeled albumin and blue dye placed into middle ear through an intact tympanic membrane and followed from nasopharynx ET orifice (blue dye) and with gamma camera (technetium). RESULTS Blue dye was observed in tubal orifice in six (6 of 10) patients during 30 min observation. Five of those patients (5 of 6) had tympanic membrane retraction and one patient (1 of 6) had MEE. Tracer activity decreased from middle ear in six (6 of 10) patients. Four of those patients had tympanic membrane retraction and two had MEE. CONCLUSION Mucociliary function of the ET seems to be better in patients with tympanic membrane retraction than patients with middle ear effusion. SIGNIFICANCE Mucociliary function of the ET is an important function for middle ear aeration, blue dye test is easily available to be used also in clinical practice.
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Affiliation(s)
- Leena Pöyhönen
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
| | - Juha Silvola
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
- Department of Otorhinolaryngology, Akershus Universitetssykehus HF, Lorenskog, Norway
| | - Dennis Poe
- Department of Otolaryngology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Markus Rautiainen
- Department of Otorhinolaryngology, University of Tampere, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
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Eser BÇ, Yılmaz AŞ, Önder SŞ, Toros SZ, Oysu Ç. The Effect of Nasal Functions on the Integrity of Grafts after Myringoplasty. Turk Arch Otorhinolaryngol 2017. [PMID: 29515926 DOI: 10.5152/tao.2017.2518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate the effects of nasal functions for the integrity of grafts after myringoplasty. Methods In our study 78 patients who underwent myringoplasty operation between 2011-2013 were included. Group I was defined as the group with an intact tympanic membrane following surgery. Group II was defined as the group with a tympanic membrane perforation following surgery. Group I consisted of 44 and Group II consisted of 34 patients. Subjective and objective measurements of nasal functions, Eustachian tube function (ETF), and allergic status were performed using nasal obstruction symptom evaluation (NOSE) scale, visual analog scale (VAS), and the score for allergic rhinitis (SFAR) questionnaires and acoustic rhinometry and saccharin test. It was investigated whether there was any difference between these two groups in terms of these parameters. Results There was statistically no significant difference between groups according to the age, sex and the presence of tubal dysfunction and allergic rhinitis (p>0.05). In the group of intact tympanic membranes, the likelihood of right ear being the operated one was significantly higher compared to the group of myringoplasty failures (p=0.037). The VAS and NOSE scales did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). The nasal congestion index (NCI) and the mucociliary clearance (MCC) did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). Conclusion This study has shown that nasal functions measured by objective and subjective methods had no effects on the success of myringoplasty.
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Affiliation(s)
- Başak Çaypınar Eser
- Clinic of Otorhinolaryngology, University of Health Sciences Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Aslı Şahin Yılmaz
- Clinic of Otorhinolaryngology, University of Health Sciences Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Serap Şahin Önder
- Clinic of Otorhinolaryngology, University of Health Sciences Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Sema Zer Toros
- Clinic of Otorhinolaryngology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Çağatay Oysu
- Department of Otolaryngology, Marmara University School of Medicine, İstanbul Turkey
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Akyıldız MY, Özmen ÖA, Demir UL, Kasapoğlu F, Coşkun HH, Basut Oİ, Sığırlı D. Should Nasal Function be Considered Prior to Tympanoplasty? J Int Adv Otol 2017; 14:53-57. [PMID: 29165311 DOI: 10.5152/iao.2017.3624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS AND METHODS The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.
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Affiliation(s)
| | - Ömer Afşın Özmen
- Department of Otolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Uygar Levent Demir
- Department of Otolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Fikret Kasapoğlu
- Department of Otolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Hamdi Hakan Coşkun
- Department of Otolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Oğuz İbrahim Basut
- Department of Otolaryngology, Uludağ University School of Medicine, Bursa, Turkey
| | - Deniz Sığırlı
- Department of Biostatistics, Uludağ University School of Medicine, Bursa, Turkey
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Usefulness of the Saccharin Test for Assessment of Eustachian Tube Function in Patients With Chronic Otitis Media With Perforation. Otol Neurotol 2017; 38:60-65. [DOI: 10.1097/mao.0000000000001249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tolerability of Nasal Delivery of Humidified and Warmed Air at Different Temperatures: A Randomised Double-Blind Pilot Study. Pulm Med 2016; 2016:7951272. [PMID: 27127650 PMCID: PMC4834170 DOI: 10.1155/2016/7951272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/06/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives. Delivery of warmed, humidified air via nasal high flow therapy could potentially reduce replication of temperature-sensitive viruses in the upper respiratory tract. This study investigates whether nasal high flow therapy is well tolerated by healthy adults at 37°C and 41°C. Methods. In this randomised, double-blind, controlled crossover pilot trial, nasal high flow therapy was used to deliver humidified air at 35 L/min, at either 37°C or 41°C, for three one-hour sessions of use over one day. The alternative was delivered at least 14 days later. Ten healthy, nonsmoking adults were asked, via questionnaire after each day's use, whether they would use nasal high flow therapy while being unwell with a cold or flu if it was demonstrated to improve symptoms. Results. All participants completed both interventions. Eighty percent responded “yes” to future use of nasal high flow therapy, for both 37°C and 41°C. There was no significant change from baseline in saccharin times following either intervention or in the following morning. Conclusions. Delivering humidified air via nasal high flow therapy at both 37°C and 41°C is well tolerated by healthy adults. This supports investigation into the potential use of nasal high flow therapy as treatment in viral upper respiratory tract infections. Trial Registration. This trial is registered with ACTRN12614000183684 (tolerability study of nasal delivery of humidified & warmed air).
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Kurien R, Chrisolyte S, Rupa V. Inflation-deflation test as a predictor of aditus patency in patients with chronic suppurative otitis media. Indian J Otolaryngol Head Neck Surg 2009; 61:169-72. [PMID: 23120629 DOI: 10.1007/s12070-009-0060-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To assess eustachian tubal function (ETF) preoperatively in patients with chronic suppurative otitis media (CSOM) with central perforation by performing the inflation-deflation test. To correlate the results of the inflation-deflation test with the finding of aditus patency or block in patients with CSOM STUDY DESIGN: Prospective, cohort SETTING Tertiary care hospital SUBJECTS Eighty adult patients with chronic suppurative otitis media and central perforation were recruited into the study. There were 45 males and 35 females. METHODS All patients underwent preoperative inflation-deflation test followed by cortical mastoidectomy and tympanoplasty. The patency of the aditus was assessed intraoperatively. MAIN OUTCOME MEASURE Equalization of pressure on inflation-deflation test and intraoperative assessment of aditus patency RESULTS Of a total of 80 patients, 49 patients were found to have discharging ears and 31 had dry ears at the time of surgery. In dry ears the inflation-deflation test had a sensitivity of 93% in predicting aditus patency although the specificity was lower at 67%. In discharging ears the sensitivity in predicting aditus patency was 72% and the specificity was 67%. CONCLUSION The eustachian tube inflation-deflation test is a sensitive test for predicting aditus patency in patients with dry ears but less so in patients with discharging ears. Hence, it could be used in the former to avoid unnecessary exploration of the mastoid.
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Affiliation(s)
- Regi Kurien
- Department of ENT, Speech & Hearing, Christian Medical College Hospital, Vellore, India
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Prasad KC, Hegde MC, Prasad SC, Meyappan H. Assessment of eustachian tube function in tympanoplasty. Otolaryngol Head Neck Surg 2009; 140:889-93. [DOI: 10.1016/j.otohns.2009.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/19/2009] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
Abstract
Objective: A clinically useful test for eustachian tube function (ETF) is still lacking. Here we plan to evaluate the mucociliary function of the ET by saccharin and methylene blue test, and compare the outcome of surgery with normal and abnormal ET functions. Study Design: Case series with planned data collection. Setting: Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore (Manipal University), a tertiary care center in South India. Subjects and Methods: This study comprised 86 patients diagnosed with mucosal chronic otitis media in quiescent/inactive stage. All were subjected to a detailed clinical examination and investigations. Preoperative evaluation of ETF was compared with postoperative outcome of surgery, and the results were analyzed. Results: The saccharin test and methylene blue dye test had a good correlation in evaluating ETF. The mean value for saccharin perception time and the clearance time for methylene blue were 17.5 and 8.1 minutes, respectively. ETF was best in anterior, worst among posterior, and intermediate in subtotal perforations. Type 1 tympanoplasty was successful in 94 percent with normal ETF and in 68 percent with partial dysfunction. Conclusion: The saccharin test is a simple, cost-effective, and valuable diagnostic tool to assess the mucociliary function of the ET. The outcome of middle ear surgery would be a success in normal ETF, whereas in partial dysfunction the outcome need not necessarily be a failure.
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Affiliation(s)
- Kishore Chandra Prasad
- Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - Mahesh Chandra Hegde
- Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - Sampath Chandra Prasad
- Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - Hari Meyappan
- Department of Otolaryngology–Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
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Abstract
OBJECTIVES/HYPOTHESIS Animal experiments and human studies show that autologous fascia lata and temporal fascia change their dimensions during first 5 days of healing. Poor dimensional stability of the temporal fascia grafts may be responsible for the residual perforation sometimes seen in clinical practice. STUDY DESIGN Retrospective. METHODS Tympanoplasties performed for large perforations or granular myringitis using either fascia lata or temporal fascia as graft material are included. The ears are divided into two groups. Group I includes ears with fascia lata, and group II includes ears with temporal fascia as graft material. Ears with minimum 1-year follow-up are included in the study. RESULTS The results are studied in terms of 1) rate of primary closure of perforation, 2) rate of recurrent perforation, and 3) hearing improvement. It is noted that the ears with very large or subtotal perforations fared better (alpha = 0.05) in group I than similar ears in group II with respect to rate of primary closure of perforations. Similarly, ears in group I also have a lesser rate of recurrent perforation on long-term follow-up than ears in group II. No significant difference is noted in hearing improvement between the two groups. CONCLUSION Shrinkage of graft during healing phase appears to have significant relevance in the clinical situation. Ears having large perforations have high chances of residual perforations caused by limited margin of remnant tympanic membrane overlapping the graft. It seems logical to use fascia lata as graft material for large perforations because it has better dimensional stability.
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