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Arora M, Goel K, Sharma DK, Bhagat S, Yadav V, Aggarwal A. Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2024; 76:758-763. [PMID: 38440451 PMCID: PMC10908680 DOI: 10.1007/s12070-023-04274-3] [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: 07/26/2023] [Accepted: 10/09/2023] [Indexed: 03/06/2024] Open
Abstract
To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120 dB which was improved to 13.387 ± 5.253 dB postoperatively at 12 weeks which was statistically significant. The mean postoperative ABG closure was 8.700 dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.
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Affiliation(s)
- Manika Arora
- Department of Head and Neck Oncology, Medanta the Medicity Hospital, Gurgaon, Haryana India
| | - Khushboo Goel
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Patiala, Punjab India
| | - Dinesh Kumar Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Patiala, Punjab India
| | - Sanjeev Bhagat
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Patiala, Punjab India
| | - Vishav Yadav
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Patiala, Punjab India
| | - Ankita Aggarwal
- Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Patiala, Punjab India
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Varma A, Bansal C, Pandey AK. An Exposition on Endoscopic Broad Palisade Cartilage Tympanoplasty: Procedural Illustrations and Connotations in Context of Audiological and Morphological Outcomes. Indian J Otolaryngol Head Neck Surg 2022; 74:4381-4387. [PMID: 36742903 PMCID: PMC9895713 DOI: 10.1007/s12070-021-03043-4] [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: 07/26/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023] Open
Abstract
The objective of this study was to evaluate graft take up rate and hearing improvement in type I and type III endoscopic tympanoplasty using broad palisade cartilage graft and to compare the results with other studies who have used single piece cartilage as graft. This retrospective observational descriptive study was done in a tertiary care hospital. This study included 64 cases, who met the inclusion criteria, which were operated over 2 years and were followed for 3 years. The results were evaluated using graft uptake rates and hearing improvement comparing the preoperative and postoperative air conduction threshold (ACT) and air bone gap closure (ABG). The graft take rate was 92.1% and 87.5% at the end of 1 year and 3 years respectively. The preoperative and post-operative air conduction threshold were 35 ± 6.0 dB HL and 17.5 ± 2.7 dB HL in type I tympanoplasty respectively (p value <0.0001) while in type III tympanoplasty, preoperative and post-operative air conduction threshold (ACT) were 43.3 ± 8.6 dB HL and 23.1 ± 4.2 dB HL respectively (p value <0.0001). The preoperative and postoperative air bone gap (ABG) were 29.0 ± 5.6 dB HL and 14.4 ± 4.20 dB HL in type I tympanoplasty respectively (p value <0.0001). In type III preoperative and post-operative air bone gap were 36. 1 ± 7.5 dB HL and 16.4 ± 3.3 dB HL respectively (p value < 0.0001). Endoscopic broad palisade cartilage tympanoplasty has similar outcomes in morphological and audio logical perspectives as single piece cartilage tympanoplasty. Further studies with long term follow up period are required to corroborate the result of this study.
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Affiliation(s)
| | - Chetan Bansal
- Department of ENT, Satya Pal Wahi ONGC Hospital, Dehradun, Uttarakhand India
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Exclusive Two Handed Endoscopic Cartilage Type 3 Tympanoplasty with Endoscope Holders. Indian J Otolaryngol Head Neck Surg 2022; 74:686-691. [PMID: 36032902 PMCID: PMC9411377 DOI: 10.1007/s12070-021-02484-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
In present world of contemporary techniques of microscopic ear surgery and single handed endoscopic ear surgery, we propose the technique of two handed endoscopic tympanoplasty using endoscope holders. The aim of the study is to evaluate the functional and anatomical results of our technique of endoscopic type 3 cartilage tympanoplasty using endoscope holder. It is a Retrospective Non Randomized Clinical Study. A total of 67 endoscope holder assisted exclusively two handed endoscopic type 3 cartilage tympanoplasties performed from December 2014 to March 2017 with our technique were included in the study. Patients with pars tensa retractions and perforations with absent incus were included in the study. Those with cholesteatoma were excluded from the study. Full thickness tragal cartilage disc of 3 × 3 mm dimensions with a circular slot of 1 mm to fit onto the head of the stapes was used for reconstruction. Tympanic membrane reconstruction was done along with attic reconstruction, using sliced tragal cartilage of 0.5 mm thickness. Patients were assessed at 6, 12 and 24 months for graft status. In early follow up period ranging from 24 to 52 months, the graft take up was seen in 64 ears with three perforations giving a success rate of 95.52%. The pre-operative air-bone gap was 42.6 ± 3.26 dB and the post-operative air-bone gap at 6 months, 1 and 2 years was 18.36 ± 3.46 dB, 19.42 ± 4.32 dB and 19.53 ± 4.33 dB respectively. The study reports good air-bone closure to 20 dB postoperatively following type 3 endoscopic tympanoplasty using endoscope holder. Slotted cartilage graft is definitely an excellent option for ossiculoplasty in cases of absent incus providing a stable assembly. Level of evidence: Level 4.
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Thakur V, Malhotra T, Jha S, Kama D. Tympanoplasty in high-risk perforation and atelectatic ear using perichondrium-cartilage island graft and temporalis fascia: A comparative analysis. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_41_21] [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] Open
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Saini YK, Singhal P, Prabhu KPS, Nagaraj S, Amreen, Sharma S, Yadav R, Aeron BS, Munjal S, Sharma MP. Vertical Strut Ossiculoplasty: A Versatile Alternate to Conventional Techniques-A Randomized study. Indian J Otolaryngol Head Neck Surg 2021; 73:360-365. [PMID: 34471627 PMCID: PMC8364591 DOI: 10.1007/s12070-021-02614-9] [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: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Various ossicular reconstruction materials and techniques have been described in literature using autologous ossicle, cortical bone, autologous cartilage, synthetic materials and implants like total/partial ossicular replacement prosthesis (TORP/PORP) etc., but it has always been a topic of controversy in terms of the efficacy, longevity and complications of the material or method used. MATERIAL AND METHODS This is a prospective, interventional, comparative, double-blind randomized control study which was done at a tertiary care center to compare outcomes of conventional and carved conchal cartilage (vertical strut) type III Tympanoplasty in terms of graft uptake and hearing gain. A total number of 52 cases were enrolled, randomized and allocated to 2 groups (26 each) i.e. group A (conventional type III) and group B (vertical strut technique). RESULTS Graft uptake was seen in 25 (96.16%) patients in group B while it was observed in 23 (88.5%) cases in group A. Hearing gains were also better in group B. CONCLUSION This study suggests that Vertical Strut technique can be studied further as it gives better gains in Air Conduction threshold and A-B Gap along with graft uptake as it provides better middle ear space and ossicular / tympanic membrane interface resulting in better hearing.
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Affiliation(s)
- Yogendra Kumar Saini
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | | | - Sushmitha Nagaraj
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Amreen
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Shivam Sharma
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
| | - Rajeev Yadav
- Department of Preventive and Social Medicine, SMS Medical College, Jaipur, India
| | | | | | - Man Prakash Sharma
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, 302004 Rajasthan India
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Larrosa F, de Osso JT, Dura MJ, Bernal-Sprekelsen M. Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study. Eur Arch Otorhinolaryngol 2020; 277:1955-1959. [PMID: 32253534 DOI: 10.1007/s00405-020-05947-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The endoscopic approach to tympanoplasty is gaining popularity, but its adoption for the palisade tympanoplasty technique is unstudied. The aim of the present study was to evaluate the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations. METHODS Retrospective study of 42 adult patients who underwent endoscopic tympanoplasty for a subtotal perforation in a university tertiary referral center from January 2018 to June 2019. Patients underwent transcanal tympanoplasty either with cartilage palisade grafts or with one-piece composite cartilage-perichondrium grafts. Both techniques were compared for graft take rate and audiometric results. RESULTS Twenty palisade and 22 single-piece tympanoplasties were analyzed. No statistically significant differences between groups were found in terms of tympanic membrane closure (85% vs. 86.3%, p = 0.5) or hearing improvement. CONCLUSION The results of the present study suggest that similar results can be obtained with palisade cartilage grafts compared to the one-piece composite cartilage-perichondrium technique for endoscopic tympanic membrane closure. Further studies with long-term results will be needed to confirm these findings.
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Affiliation(s)
- Francisco Larrosa
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain. .,University of Barcelona Medical School, Barcelona, Spain.
| | - Jose Tomas de Osso
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona, C Villarroel 170, 08036, Barcelona, Spain
| | - Maria Jose Dura
- Department of Physical Medicine and Rehabilitation, Hospital Germans Trias I Pujol, Badalona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Quironsalud Valencia, Valencia, Spain.,University of Valencia Medical School, Valencia, Spain
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Parab SR, Khan MM. New Cartilage Slicer for Slicing Techniques in Tympanoplasty: Design and Applications. Indian J Otolaryngol Head Neck Surg 2018; 70:515-520. [PMID: 30464908 PMCID: PMC6224832 DOI: 10.1007/s12070-018-1467-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022] Open
Abstract
ABSTRACT Cartilage-perichondrium composite graft is used in middle ear surgery for tympanic membrane, ossicular and for soft wall reconstruction. The thickness of the cartilage is thought to interfere with the sound conduction. In our otology practice for tympanic membrane reconstruction, we prefer the sliced cartilage graft to achieve acoustic benefit. At times in the process of slicing, the cartilage gets wasted if not sliced with a precision slicing instrument. We have designed and developed a multi-purpose cartilage slicer for precise reduction of the thickness of the cartilage. To describe the design of our cartilage slicer and to report our preliminary experience with the cartilage slicer. Descriptive study. The technique of slicing with our new cartilage slicer and its usage has been described in detail. A total number of 689 cartilages in tympanoplasty and mastoidectomy have been sliced with it from 2013 to 2017. Our study reports the technique of slicing the tragal cartilage for tympanoplasty, highlighting its advantages and precision of the cartilages slices obtained. Our cartilage slicer is a good option for cartilage slicing in tympanoplasty. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Sapna Ramkrishna Parab
- Department of Otorhinolaryngology, M.I.M.E.R. Medical College, Talegaon D, Pune, 410507 India
| | - Mubarak M. Khan
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, Pune, India
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Mohanty S, Manimaran V, Umamaheswaran P, Jeyabalakrishnan S, Chelladurai S. Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations — A prospective study in a tertiary care hospital. Auris Nasus Larynx 2018; 45:936-942. [DOI: 10.1016/j.anl.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
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Menéndez-Colino LM, Bernal-Sprekelsen M, Alobid I, Traserra-Coderch J. Preliminary Functional Results of Tympanoplasty with Titanium Prostheses. Otolaryngol Head Neck Surg 2016; 131:747-9. [PMID: 15523459 DOI: 10.1016/j.otohns.2004.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE: To assess the use of titanium prostheses in tympanoplasty for reconstruction of the sound pressure and to evaluate the audiometric results obtained. STUDY DESIGN AND SETTING AND PATIENTS: Retrospective chart review in a tertiary referral center. Between September 1998 and October 2000, 23 titanium middle ear implants (23 TORP) were used for reconstruction of the ossicular chain after tympanomastoidectomy. Preliminary functional results were obtained in 23 cases. RESULTS: Average follow-up time was 18 months (range, 12-40) and no adverse reactions or extrusions occurred. Seven of 16 canal wall down tympanoplasties (43.7%), and 3 of 7 canal wall up tympanoplasties performed (42.9%) had a postoperative air-bone gap of between 0 and 10 dB. CONCLUSIONS: Preliminary results show that titanium prosthesis provide a promising hearing result after total ossicular reconstruction, although long-term results are not yet available. The low weight of these prostheses may be the reason for the decrease in the air-bone gap.
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Affiliation(s)
- L M Menéndez-Colino
- Department of Otorhinolaryngology, Hospital Clinic of Barcelona, Barcelona 08036, Spain
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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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Vashishth A, Mathur NN, Verma D. Cartilage palisades in type 3 tympanoplasty: functional and hearing results. Indian J Otolaryngol Head Neck Surg 2014; 66:309-13. [PMID: 25032120 DOI: 10.1007/s12070-014-0717-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
To evaluate the functional and hearing outcomes using full thickness broad cartilage palisades for tympanic membrane reconstruction in type 3 tympanoplasty with titanium prostheses. The retrospective study performed at a tertiary referral institute included 30 patients with posterior mesotympanic retraction pockets or tympanic membrane perforations requiring tympanic membrane and type 3 ossicular reconstruction. Patients with disease extending beyond the aditus requiring canal wall down mastoidectomy were excluded. Disease removal from posterior mesotympanic and epitympanic recesses was confirmed using angled endoscopy and ossicular reconstruction was performed using titanium partial or total ossicular replacement prostheses. Tympanic membrane reconstruction was done, with or without attic reconstruction, using full thickness broad cartilage palisades harvested from the tragus with perichondrium attached laterally. Patients were assessed at 24 and 48 weeks for graft status and any evidence of implant extrusion. Hearing evaluation was done using subjective assessment and pure tone audiometry. In total, 27 out of 30 patients had intact and completely healed grafts at 48 weeks postoperatively (a success rate of 90 %) showing full union and epithelialization of palisades, and with three patients displaying small defects. The mean pure tone air bone gap pre- and postoperatively was 32.4 and 8.8 dB, respectively, with most patients reporting satisfactory postoperative hearing. No evidence of implant extrusion was found in the 48-week period. Tympanic membrane reconstruction using full thickness palisades of tragal cartilage provides good functional and hearing outcomes in type 3 tympanoplasty with titanium prostheses.
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Affiliation(s)
- Ashish Vashishth
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neeraj Narayan Mathur
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Deepak Verma
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Zaoui K, Kromeier J, Neudert M, Beleites T, Zahnert T, Laszig R, Offergeld C. Clinical investigation of flat panel CT following middle ear reconstruction: a study of 107 patients. Eur Radiol 2013; 24:587-94. [DOI: 10.1007/s00330-013-3068-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/15/2013] [Accepted: 10/20/2013] [Indexed: 11/24/2022]
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Type I tympanoplasty with island chondro-perichondral tragal graft: the preferred technique? The Journal of Laryngology & Otology 2013; 127:354-8. [PMID: 23433000 DOI: 10.1017/s0022215113000121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This retrospective, comparative study aimed to assess anatomical and functional results in a group of adults undergoing type I tympanoplasty for subtotal tympanic membrane perforation, using two different types of graft. SUBJECTS AND METHODS The study included 106 patients affected by chronic otitis media, who underwent underlay type I tympanoplasty, 53 using an autologous chondro-perichondral tragal graft and 53 using temporalis fascia. Anatomical and functional outcomes were evaluated over time. RESULTS Audiometric results comparing the cartilage and fascia groups at six months and one year after surgery showed no statistically significant differences. Assessment of anatomical outcomes indicated a greater number of complications in the fascia group. CONCLUSION Functional results indicate the validity of the cartilage tympanoplasty, while anatomical results indicate a slightly better outcome in terms of graft re-perforation and retraction, compared with temporalis fascia at one-year follow up. These results suggest that the cartilage technique is preferable for type I tympanoplasty.
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Yu H, He Y, Ni Y, Wang Y, Lu N, Li H. PORP vs. TORP: a meta-analysis. Eur Arch Otorhinolaryngol 2013; 270:3005-17. [PMID: 23400405 DOI: 10.1007/s00405-013-2388-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 01/29/2013] [Indexed: 11/24/2022]
Abstract
After the surgical procedure of ossicular chain reconstruction, the effectiveness and/or stability of partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) were systematically compared and evaluated using meta-analysis. A total of 40 eligible investigations with 4,311 subjects were included in our study. There was a significant difference in the effectiveness of the reconstruction of the ossicular chain between PORP and TORP; the data showed a combined risk ratio (RR) of 1.28 (95 % CI 1.17-1.41, p < 0.00001), but no notable difference was obtained in staged procedures subgroup and cholesteatoma subgroup, with a combined RR of 1.13 (95 % CI 0.60-2.11, p = 0.70) in staged procedures subgroup and RR of 2.60 (95 % CI 0.20-36.21, p = 0.59 in cholesteatoma subgroup). There was a statistically significant difference in the stability of the prostheses in long-term follow-up, with a combined RR of 0.37 (95 % CI 0.16-0.85, p = 0.02), but no significant difference was observed in the total sample, with a combined RR of 0.64 (95 % CI 0.40-1.03, p = 0.06). Our overall results suggest that the effectiveness of PORP was higher than TORP, except within staged procedures subgroup and cholesteatoma subgroup. In addition, the stability of PORP was significantly superior to TORP in long-term follow-ups, but no significant effect was detected in the general study.
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Affiliation(s)
- Huiqian Yu
- Department of Otorhinolaryngology, Shanghai Eye and ENT Hospital, Shanghai Medical College, Fudan University, 200031, Shanghai, China
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Comparison of Different Grafting Techniques in Type I Tympanoplasty in Cases of Significant Middle Ear Granulation. Otol Neurotol 2012; 33:586-90. [DOI: 10.1097/mao.0b013e31824b78ba] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cartilage-perichondrium: an ideal graft material? Indian J Otolaryngol Head Neck Surg 2011; 64:208-13. [PMID: 23998021 DOI: 10.1007/s12070-011-0306-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 08/23/2011] [Indexed: 10/17/2022] Open
Abstract
Temporalis fascia has long been regarded as the ideal graft material for tympanic membrane repair. However it often does not seem to withstand negative middle ear pressure in the post operative period. Tragal cartilage with perichondrium would appear to be a better graft material with good hearing outcome. It can be obtained easily with cosmetically acceptable incision. In the present study, we have compared the graft properties of temporalis fascia verses tragal cartilage perichondrium with respect to healing, hearing and rate of post operative retraction or reperforation. 132 patients of chronic otitis media with pure conductive hearing loss were posted for tympanoplasty. Temporalis fascia graft was used in 71 patients and cartilage perichondrium (composite graft) was used in 61 patients. Post operative healing, hearing and rate of retraction or reperforation was compared for both the graft materials. All the patients were followed up for 2 years. Patients where temporalis fascia graft was used, 60 (84.5%) showed a good neotympanum, 7(9.85%) had reperforation and 5(7.04%) had retraction pockets. Patients where tragal cartilage perichondrium was used, 60(98.36%) showed a healed tympanic membrane and only 1(1.63%) had reperforation. None of the patients showed retraction pocket or cholestetoma. Postoperative hearing was accessed 6 months after surgery. Patients with temporalis fascia graft showed an air bone gap of less than 10 dB in 49 (82%) patients and more than 10 dB in 11 (18%) patients. Air bone gap closure with tragal cartilage perichondrium was less than 10 dB in 45 (78%) patients and more than 10 dB in 13 patients (22%). Tragal cartilage perichondrium (<0.5 mm) seems to be an ideal graft material for tympanic membrane in terms of postoperative healing and acoustic properties. It can easily withstand negative middle ear pressure which may have contributed to the development of otitis media and significantly affect healing outcomes in postoperative period. Tragal cartilage being composed of collagen type II is also physiologically similar to the nature of the tympanic membrane.
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Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Otorhinolaryngol 2011; 268:471-4. [DOI: 10.1007/s00405-010-1473-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE Evaluation of morphologic and functional long-term results of palisade cartilage tympanoplasty (PCT) combined with titanium ossicular replacement prostheses. STUDY DESIGN Retrospective review of tympanoplasties. SETTING Tertiary referral center. PATIENTS Twenty-nine patients (12 women and 17 men; mean age, 39 yr; range, 17-72 yr) operated on more than 9 years ago (mean follow up, 9.1 yr) because of cholesteatoma, adhesive otitis, chronic otitis media, subtotal tympanic membrane defects, and tympanic fibrosis requiring tympanoplasty. INTERVENTIONS Tympanoplasty, applying the PCT. For ossiculoplasty, total or partial titanium ossicular replacement prostheses were used. MAIN OUTCOME MEASURES Questionnaire on postoperative course, otoscopic findings, and hearing results using a 4-frequency pure-tone average air-bone gap. RESULTS A recurrent defect was not observed. The graft take rate was 100%. There was one case of prosthesis protrusion which required revision surgery and insertion of a shorter prosthesis. A pure-tone average air-bone gap of 0 to 10 dB was seen preoperatively in 1 ear, 11 to 30 dB in 16 ears, and 31 to 59 dB in 12 ears. Postoperatively, the corresponding numbers were 10, 15, and 4 ears. CONCLUSION The PCT is a reliable surgical method to manage difficult middle ear pathology on a long-term (>9 yr) basis. It offers satisfactory morphologic and functional results in combination with titanium prosthesis ossiculoplasty.
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Offergeld C, Kromeier J, Merchant SN, Lasurashvili N, Neudert M, Bornitz M, Laszig R, Zahnert T. Experimental investigation of rotational tomography in reconstructed middle ears with clinical implications. Hear Res 2010; 263:191-7. [PMID: 19969056 PMCID: PMC2866829 DOI: 10.1016/j.heares.2009.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/09/2009] [Accepted: 12/02/2009] [Indexed: 11/24/2022]
Abstract
A large air-bone-gap after ossiculoplasty may be due to a malpositioned or displaced prosthesis. Rotational tomography (RT) has the potential to provide high-resolution images of implants without artifacts and with less radiation dosage than CT scan. Twenty-seven temporal bone specimens underwent measurements of middle ear transfer function using Laser-Doppler-Vibrometry (LDV) before and after placement of ossicular replacement prostheses (PORPs, TORPs) made of titanium. RT was performed on all specimens. RT allowed 3-dimensional viewing of the temporal bone, accurate localization of implants within the reconstructed middle ear and determination of angles between the inserted prostheses and the tympanic membrane (TM) and/or the malleus handle (MH). Presence or absence of contact between the implant and the TM, malleus or stapes could be clearly visualized. Displaced prostheses were readily identified. The functional LDV-measurements for TORPs showed a trend favoring coupling to the malleus handle, while for PORPs, coupling to the TM was favored. For PORPs, sound transmission was worse with increasing angles between the PORP and stapes superstructure (p<0.05). Following our experimental results RT is an innovative, relevant and useful imaging technique to obtain immediate postoperative feedback after ossicular reconstruction and to precisely determine the position of middle ear implants.
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Affiliation(s)
- Christian Offergeld
- Dept. of ORL, HNS; University of Freiburg; Killianstrasse 5; 79106 Freiburg; Germany
| | - Jan Kromeier
- Dept. of Radiology; St. Josef’s Hospital; Sautierstrasse 1; 79104 Freiburg; Germany
| | - Saumil N. Merchant
- Dept. of Otology and Laryngology; Harvard Medical School, MEEI; 243 Charles Street; Boston, MA 02114; USA
| | - Nicoloz Lasurashvili
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
| | - Marcus Neudert
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
| | - Matthias Bornitz
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
| | - Roland Laszig
- Dept. of ORL, HNS; University of Freiburg; Killianstrasse 5; 79106 Freiburg; Germany
| | - Thomas Zahnert
- Dept. of ORL, HNS; University of Dresden; Fetscherstrasse 74; 01307 Dresden; Germany
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Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears. Eur Arch Otorhinolaryngol 2009; 267:507-13. [DOI: 10.1007/s00405-009-1084-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Accepted: 08/21/2009] [Indexed: 11/24/2022]
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Ichimura K, Ishikawa K, Nakamura KI, Saito C. [Cartilage palisade tympanoplasty for adhesive otitis media]. NIHON JIBIINKOKA GAKKAI KAIHO 2009; 112:474-479. [PMID: 19610589 DOI: 10.3950/jibiinkoka.112.474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE We evaluated the clinical utility of cartilage palisade tympanoplasty (CRPT) in adhesive otitis media, a condition known to recur frequently with poor success in hearing gain. OBJECTIVE Specimens were 9 ears having adhesive otitis media and undergoing CPT in January 2006 and December 2007. Cases of pars tensa cholesteatoma were excluded. Mean subject age was 35.2 years. Seven had total drum adhesion and 2 posterior half-adhesion. Preoperative pure-tone hearing averaged 20-102 dB (mean: 56 dB). METHODS A small piece of cartilage harvested from the cymba was obliquely sectioned to yield wide, thin cartilage strips. Strips were overlapped slightly anteriorly to posteriorly parallel to the malleus handle when present. Tympanoplasty type 1 was conducted in 2 cases, type 3c in 6, and type 4c in 1. RESULTS No ears undergoing CPT produced recurrent adhesion or perforation although 2 suffered transient partial erosion healed easily in topical management. An air-bone gap of <15 dB was achieved in 3 ears, a hearing gain exceeding 15 dB in 5, and a hearing level of less than 30 dB in 3. Conditions falling in at least 1 of the above categories are considered successful based on Japan Otological Society criteria. Seven of the 9 (78%) were regarded as audiologically successful. CONCLUSION CPT conducted for adhesive otitis media appears worthwhile, given the present better-than-expected results in our cases, although further study is needed to confirm this conclusion.
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Affiliation(s)
- Keiichi Ichimura
- Department of Otolaryngology-Head and Neck Surgery Jichi Medical University School of Medicine, Shimotsuke
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Cayé-Thomasen P, Andersen J, Uzun C, Hansen S, Tos M. Ten-year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction cholesteatoma in children. Laryngoscope 2009; 119:944-52. [DOI: 10.1002/lary.20195] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol 2009; 29:679-83. [PMID: 18580702 DOI: 10.1097/mao.0b013e31817dad57] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the anatomic and functional results of primary Type1 cartilage tympanoplasty performed with the palisade technique and to compare them with the results of primary Type 1 tympanoplasty performed with temporalis fascia in children. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS The records of 45 children with intact ossicular chain and no history of mastoidectomy or tympanic perforations occupying more than 50% of the membrane area were evaluated. Patients with similar age and middle ear pathologic findings were selected in an effort to make the groups as homogeneous as possible. Of those, 21 children were included in the cartilage study group, and 24 patients were included in the fascia group. INTERVENTIONS An over-under tympanoplasty technique using either a palisaded tragal cartilage or temporalis muscle fascia. MAIN OUTCOME MEASURES Successful outcome was defined as full, intact healing of the graft without perforation, retraction, or lateralization for at least 12 months after the operation and with improvement of hearing. Postoperative speech reception thresholds and postoperative air-bone gap were compared with preoperative levels within and between the groups. RESULTS Tympanoplasty with the palisade cartilage technique resulted in a significantly higher graft acceptance rate (100%) than with the fascia technique (70.2%; p = 0.008). Speech reception threshold levels, pure-tone average, and air-bone gaps improved significantly with surgery in both the palisade and fascia groups (p < 0.001). Comparison of audiologic results between the groups did not reveal any statistically significant difference (p > 0.05). CONCLUSION Palisade tympanoplasty in children yielded good anatomic and functional results. The anatomic results obtained using this technique were superior to those obtained using temporalis muscle fascia. Children who underwent Type 1 tympanoplasty with palisaded cartilage had equivalent postoperative audiometric results compared with children who underwent Type 1 tympanoplasty with temporalis fascia. Thus, palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closure and hearing improvement in children.
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Tringali S, Dubreuil C, Bordure P. [Tympanic membrane perforation and tympanoplasty]. ACTA ACUST UNITED AC 2008; 125:261-72. [PMID: 18778811 DOI: 10.1016/j.aorl.2008.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/18/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report anatomic and physiologic characteristics of the tympanic membrane, to discuss the etiology and pathogenesis of tympanic perforation, and to discuss its management. MATERIAL AND METHODS After a review of the literature, different surgical techniques and the postoperative results were evaluated. RESULTS The rate of tympanic membrane closure is greater than 90% for the majority of authors. Age, mucosa inflammation, pathological contralateral ear (perforation, otitis media, cholesteatoma), and surgical experience influence this result. DISCUSSION Even if surgical results are good, abstention must always be proposed and all complications must be explained. CONCLUSION Palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closures.
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Affiliation(s)
- S Tringali
- Service d'oto-neurochirurgie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite cedex, France.
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Yamane H, Takayama M, Sunami K, Morinaka M, Minowa Y, Yoshioka S, Takahashi H. Cartilage ossiculoplasty by lever method. Acta Otolaryngol 2008; 128:744-9. [PMID: 18568515 DOI: 10.1080/00016480701411536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION We invented a new ossicular chain reconstruction by lever methods (OCRLM) in tympanoplasty type III with the canal wall down technique and investigated the postoperative hearing results of the 24 patients who had undergone this surgery. Postoperative air-bone gaps (ABGs) followed up for 2.1-3.2 years gave satisfactory improvement audiometrically compared with former reports. OBJECTIVE To present newly devised methods applied from the viewpoint of mechanical dynamics for ossicular chain reconstruction in tympanoplasty. MATERIALS AND METHODS A total of 24 cholesteatoma patients who underwent tympanoplasty with mastoidectomy using the canal wall down technique and ossicular chain reconstruction with OCRLM between May 2003 and April 2004 were investigated. The postoperative ABG of a four-frequency (0.5, 1, 2, and 4 kHz) average of OCRLM followed up for 2 years or more was assessed. RESULTS Patients who underwent OCRLM showed good postoperative hearing results. Average postoperative ABGs of less than 10, 15, 20, 25, and 30 dB were 4.2, 37.5, 70.8, 91.6, and 100%, respectively. A gap of >30 dB was absent and the mean postoperative ABG was 17.2dB. The OCRLM method was satisfactory to improve hearing and effectively reduce the ABG postoperatively over the period of observation.
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Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 2007; 264:985-9. [PMID: 17401572 DOI: 10.1007/s00405-007-0291-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED The use of cartilage as a grafting material has been advocated in cases at high risk for failure, such as subtotal perforations, adhesive processes, tympanosclerosis and residual defects after primary tympanoplasties. The cartilage palisade technique, in which the TM is fully reconstructed with palisade-shaped cartilage pieces, was first described by Heermann. Cartilage material has been criticized because of concerns regarding hearing results, however, large cartilage plates with thicknesses <or=0.5 mm have been suggested as an acceptable comprise and the graft take of this technique has been reported to be excellent. The purpose of this study was to compare the graft take rates and hearing results of primary type I cartilage tympanoplasty operations with palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. STUDY DESIGN retrospective chart review. SETTING tertiary medical center. The study population included 51 patients who were operated between January 2000 and 2006 at the Department of Otorhinolaryngology of Ataturk Training and Research Hospital, Izmir, Turkey. Primary tympanoplasty cases with pure subtotal perforations (perforation >50% of the whole TM area), intact ossicular chain, at least more than 1 month dry period and normal middle ear mucosa were included in the study. Palisade cartilage tympanoplasty group included 23 cases, whereas 28 patients were were in the fascia group. INTERVENTION therapeutic. Graft take rates were noted in 51 patients and pre- and post operative audiograms were compared using the chi-square test with Yates' continuity correction, Fisher's exact test, t test and repeated measures ANOVA. Graft take was achieved in 22 patients (95.7%) in palisade cartilage group and in 21 patients (75%) in temporalis fascia group (P = 0.059). Mean speech reception threshold, air-bone gap and pure-tone average scores comparing the gain between both techniques showed no significant changes in the threshold (P > 0.05). However the functional success was achieved with the palisade cartilage technique postoperatively, regarding to mean air-bone gap and speech reception threshold changes. Our experience with palisade cartilage technique demonstrates that subtotal or total perforations at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the TM with reasonable hearing can be achieved.
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Affiliation(s)
- K Cagdas Kazikdas
- Department of Otorhinolaryngology, Ankara Military Hospital, Ankara, Turkey.
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Offergeld C, Kromeier J, Aschendorff A, Maier W, Klenzner T, Beleites T, Zahnert T, Schipper J, Laszig R. Rotational tomography of the normal and reconstructed middle ear in temporal bones: an experimental study. Eur Arch Otorhinolaryngol 2006; 264:345-51. [PMID: 17047976 DOI: 10.1007/s00405-006-0180-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Accepted: 09/21/2006] [Indexed: 10/24/2022]
Abstract
Imaging is an essential diagnostic tool in reconstructive middle ear surgery, especially in pre-operative planning. Due to ongoing improvement of imaging quality and development of new imaging techniques like e.g. rotational tomography (RT) post-operative follow-up and immediate evaluation of surgical results may become more important. The aim of this experimental study was to evaluate RT as a new tool for postoperative determination of middle ear anatomy and implant position in temporal bones. RT was performed in ten temporal bone specimen after insertion of different middle ear prostheses concerning material, shape and length (PORP; TORP; Stapes piston). An implantable hearing device (Symphonix Soundbridge) was also implanted and visualized. For comparison some specimen additionally underwent conventional computed tomography (CT), including the newest technology. Characterization of anatomical structures of the temporal bone using RT was of comparable quality to conventional CT-scans in all investigated specimen while requiring approximately 30% of the CT's irradiation exposure. Unlike CT the RT showed almost no problems due to metallic artefacts of the implanted prostheses. Furthermore RT enabled a 3-dimensional view of the temporal bone and angle determination of inserted prostheses towards the tympanic membrane and/or the malleus handle. Detailed imaging of the prostheses allowed determination of shape, material and localization within the specimen's reconstructed middle ear. The new imaging technique of RT allows precise presentation of anatomical structures and middle ear implants in temporal bones. Following these experimental results it will be our future work to evaluate this method in clinical practise.
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Affiliation(s)
- Ch Offergeld
- Department of ORL, HNS, University of Freiburg, Freiburg, Germany.
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Sudhoff H, Lindner N, Gronemeyer J, Dazert S, Hildmann H. Study of Osteointegration of a Titanium Prosthesis to the Stapes: Observations on an Accidentally Extracted Stapes. Otol Neurotol 2005; 26:583-6. [PMID: 16015150 DOI: 10.1097/01.mao.0000178118.38667.9b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Titanium is a well-established implant material, and its use in ossicular chain reconstruction during middle ear surgery is increasing. HYPOTHESIS Bony fixation of titanium prostheses has to be considered using this material. Contact with bony structures of the middle ear may result in immobilization. In revision procedures, there is a potential risk of damaging or extracting adherent structures such as the stapes. METHODS This is a case report of an accidentally extracted stapes resulting from bony fixation of a titanium prosthesis in revision tympanoplasty. The surgical specimen was examined by microscopy, histology, and scanning electron microscopy. Energy dispersive x-ray analysis was used to confirm the elemental composition of the extracted stapes and the titanium prosthesis. RESULTS The prosthesis showed good biocompatibility at the implantation site, with signs of bone resorption of the stapes suprastructure. However, bony fixation of the undersurface of the prosthesis foot to the stapes footplate was confirmed by ultrastructural analysis. CONCLUSION In revision tympanoplasty, bony fixation of the titanium prosthesis should be considered.
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Affiliation(s)
- Holger Sudhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, University of Bochum, Bochum, Germany.
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Anderson J, Cayé-Thomasen P, Tos M. A comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction cholesteatoma in children. Otol Neurotol 2005; 25:856-63. [PMID: 15547412 DOI: 10.1097/00129492-200411000-00002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction cholesteatoma in children, with respect to postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing. MATERIAL From March 1995 to October 2000, a total of 64 children, aged 5 to 15 years, underwent surgery for either sinus or tensa retraction cholesteatoma. The eardrum was reconstructed using cartilage palisades in 32 children and fascia or perichondrium in 32 children. Postoperatively, the patients were seen as out-patients and were recently reevaluated by otomicroscopy and audiometry. MAIN OUTCOME MEASURES Postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing (pure tone average, speech reception threshold, and air-bone gap). RESULTS All patients in the palisade group and all but one patient in the fascia group attended the follow-up examination. In the palisade group, the mean follow-up period was 37 months (range, 3-65 mo) and in the fascia group 52 months (range, 17-75 mo). Two (6%) retractions and no perforations were found in the palisade group, versus 12 (36%) retractions and 4 perforations (12%) in the fascia group at follow-up (both significant differences). No cholesteatoma recurrence occurred. Late hearing results in sinus cholesteatomas were significantly better in the palisade group. CONCLUSIONS The comparison of fascia and cartilage palisade grafting for drum reconstruction after tensa cholesteatoma surgery in children indicates that the palisade technique may be superior in respect to prevention of drum retraction and perforation. Further, in sinus cholesteatoma surgery, the long-term hearing results are better when grafting cartilage palisades.
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Affiliation(s)
- Joanne Anderson
- Department of Otorhinolaryngology-Head and Neck Surgery, Gentofte University Hospital, Hellerup, Denmark
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Uzun C, Cayé-Thomasen P, Andersen J, Tos M. Eustachian tube patency and function in tympanoplasty with cartilage palisades or fascia after cholesteatoma surgery. Otol Neurotol 2005; 25:864-72. [PMID: 15547413 DOI: 10.1097/00129492-200411000-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the Eustachian tube patency and function after tympanoplasty with either cartilage palisades or fascia grafting after one-stage surgery in children with tensa cholesteatoma. STUDY DESIGN In children operated for tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. The patency of the Eustachian tube was evaluated by the Valsalva maneuver before the operation, 1 to 3 months after the operation, and at a follow-up examination 46(1/2) months later (median). Eustachian tube function was evaluated by the nine-step inflation/deflation tympanometric test and the Toynbee test at the follow-up examination. Otomicroscopy and hearing evaluation were performed before and after surgery as well as at the follow-up. MAIN OUTCOME MEASURES Eustachian tube patency and function. Hearing, postoperative eardrum perforation/retraction, and cholesteatoma recurrence. RESULTS The Valsalva maneuver was positive in 30% of the ears before the operation, in 65% primarily after the operation, and in 78% at the follow-up examination. A poor tubal function was found in 57% at follow-up. Overall, the late functional hearing results were better in ears with a positive Valsalva maneuver. There were no differences in tubal patency or function in relation to graft material, cholesteatoma, and tympanoplasty type. In ears with a poor tubal function, the hearing results were significantly better in the palisade group (63% success), compared with the fascia group (17% success). All of the four perforations, most of the retractions, and a single moist eardrum were found in the fascia group at the reevaluation. We found no correlation between the condition of the eardrum and the Eustachian tube function at the last evaluation. However, in ears with a poor tubal function, a nonretracted, nonperforated drum was found with higher frequency in the palisade group. Decision matrix analysis showed that the last postoperative Valsalva maneuver was the best predictor of the drum condition at the reevaluation. CONCLUSIONS The Eustachian tube patency frequently improves after tympanoplasty after cholesteatoma surgery in children, regardless of graft material. The patency and function of the Eustachian tube seem to be without relation to graft material, cholesteatoma, or tympanoplasty type. Cartilage palisade tympanoplasty may be a better reconstruction technique after cholesteatoma surgery, especially in ears with a poor tubal function.
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Affiliation(s)
- Cem Uzun
- Department of Otolaryngology, Gentofte University Hospital of Copenhagen, Denmark.
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Abstract
Autogenous cartilage-perichondrium-composite-grafts have become essential and well established transplant materials in reconstructive middle ear surgery. They have proven to be particularly appropriate for surgical situations which benefit from the bradytrophy and stiffness of the cartilage (adhesive otitis, retraction pockets, subtotal tympanic membrane defects, revision tympanoplasty). Of the numerous techniques available, the perichondrium-island technique and the palisade-cartilage technique are described in detail in this review, also regarding modifications and comments in the literature. Both methods show good functional and morphological results and should be chosen according to individual surgical requirements. The data of experimental investigations are involved in the decision which technique should be favored.
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Affiliation(s)
- A Neumann
- Universitäts-Hals-Nasen-Ohrenklinik, Universitätsklinikum Essen.
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