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Ferlito S, Fadda G, Lechien JR, Cammaroto G, Bartel R, Borello A, Cavallo G, Piccinini F, La Mantia I, Cocuzza S, Merlino F, Achena A, Brucale C, Mat Q, Gargula S, Fakhry N, Maniaci A. Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study. J Clin Med 2022; 11:jcm11237000. [PMID: 36498572 PMCID: PMC9740685 DOI: 10.3390/jcm11237000] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.
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Affiliation(s)
- Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Gianluca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Ambroise Paré Hospital (APHP), Paris Saclay University, 75016 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1000 Brussels, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75016 Paris, France
| | - Giovanni Cammaroto
- Department of Otolaryngology-Head and Neck Surgery, Morgagni Pierantoni Hospital, 47121 Forli, Italy
| | - Ricardo Bartel
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitario Mutua Terrasa, 8080 Barcelona, Spain
| | - Andrea Borello
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Francesca Piccinini
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Universita degli Studi di Torino, 10121 Turin, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Andrea Achena
- U.O.C. di Otorinolaringoiatria ASST Grande Ospedale Metropolitano Niguarda, 20100 Milano, Italy
| | - Cristina Brucale
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
| | - Quentin Mat
- Department of Medicine, Neurology, CHU de Charleroi, 15022 Charleroi, Belgium
| | - Stéphane Gargula
- Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, 75016 Paris, France
| | - Nicolas Fakhry
- Service d’Otorhinolaryngologie et de Chirurgie Cervico-Faciale, Université Aix-Marseille, Hôpital de La Conception, 147, Boulevard Baille, 13005 Marseille, France
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-3204154576
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General anaesthetic vs local anaesthetic myringoplasties: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 280:2237-2245. [PMID: 36376527 DOI: 10.1007/s00405-022-07734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
AIMS To assess all available data and determine the success rates and tolerability of local anaesthetic myringoplasty in comparison with those undertaken under general anaesthetic myringoplasty. MATERIALS AND METHODS The study was designed following a PRISMA-P protocol and registered with the PROSPERO database. MEDLINE, Cochrane Library (CDSR/Central), EMBASE and CINHAL-were directly searched for studies, which met the inclusion criteria. OBJECTIVES Primary objective was to compare perforation closure rates between patients undergoing myringoplasty under local anaesthetic and those under general anaesthetic from all available published data. Secondary outcomes include complications, such as 'any minor complications', infection rates in the first 6 month post-op, facial nerve weakness, dysgeusia and patient satisfaction. RESULTS 27 studies were included in the final analysis and found that myringoplasty had an overall perforation closure rate of 89%. The pooled proportion of closures after myringoplasty under local anesthesia was 87% and for myringoplasties under general anesthesia was 91%. Analysis of myringoplasty under local anaesthesia focusing on 'in-office' performed procedures only, found a closure rate of 88%. CONCLUSIONS There is no significant difference in the success rate of myringoplasty surgery when performed under local or general anaesthetic as measured by perforation closure rates. However, there are other factors, which can drive choosing local anaesthetic surgery, such as minimising anaesthetic risks, reducing costs and reducing environmental impact.
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Vadiya S, Makwana P, Khetani S, Mehta N. Comparison of tragal cartilage and conchal cartilage in tympanoplasty. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_142_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]
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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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Genç S, Özel HE, Altıparmak E, Başer S, Eyisaraç Ş, Bayakır F, Özdoğan F. Rates of success in hearing and grafting in the perichondrium-preserved palisade island graft technique. Braz J Otorhinolaryngol 2019; 87:305-309. [PMID: 31753779 PMCID: PMC9422520 DOI: 10.1016/j.bjorl.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/09/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Various graft materials have been used in the tympanoplasty technique. Cartilage grafts are being used increasingly in recent years. OBJECTIVE The aim of this study was to present the comparative outcomes of the perichondrium-preserved palisade island graft technique previously defined by ourselves. METHODS We retrospectively compared the hearing and graft success rates in 108 patients with chronic otitis media, who had undergone cartilage tympanoplasty, where both island and perichondrium-preserved palisade graft techniques were used. RESULTS The success rates among the study and the control groups with regard to graft take were 97% and 93%, respectively. No significant difference was observed between the groups with regard to the postoperative mean pure tone values, improvement in air-bone gaps and reduction in air-bone gaps to under 20dB. However, better results were observed in the study group. CONCLUSION The perichondrium-preserved palisade island graft technique is an easy method with high graft success rates and hearing outcomes.
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Affiliation(s)
- Selahattin Genç
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey.
| | - Halil Erdem Özel
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Erdem Altıparmak
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Serdar Başer
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Şaban Eyisaraç
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Ferit Bayakır
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
| | - Fatih Özdoğan
- Health Sciences University, Kocaeli Derince Education and Research Hospital, Department of Otorhinolaryngology, Derince, Turkey
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GÜLER İSMAİL, BAKLACI DENİZ, KUZUCU İHSAN, KUM RAUFOĞUZHAN, ÖZCAN MÜGE. Miringoplastilerde Temporal Kas Fasyası ve Konkal Kıkırdak Greftlerinin Erken ve Geç Dönem Sonuçların Karşılaştırılması. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.559523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Assessment of the Factors That Affect the Anatomic and Functional Success of Cartilage Tympanoplasty in Children. J Craniofac Surg 2018; 28:e106-e110. [PMID: 27984431 DOI: 10.1097/scs.0000000000003162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Many factors may influence the surgical outcome of tympanoplasty in children, including age, the size and location of perforation, otorrhea, status of contralateral ear, surgical technique, and adenoid hypertrophy. This study aims to evaluate the outcomes of pediatric cartilage tympanoplasty and to assess the factors that affect the success of tympanoplasty in children. METHODS Children with chronic otitis media who underwent tympanoplasty using cartilage as graft material were evaluated retrospectively. Patient age, gender, size and site of the perforation, status of the contralateral ear, preoperative and postoperative hearing levels, surgical technique, and postoperative complications were noted. RESULTS Of the 72 patients included in the study, 27 were male and 35 were female. The average age was 13.22 ± 2.64 and mean follow-up time was 18.4 ± 8.62 months. Anatomic and functional success rates were 88.8% and 80.6%, respectively. Age, gender, and the status of the contralateral ear had no effect on surgical success rate. The mean preoperative and postoperative pure-tone averages were 33.2 6± 10.37 and 21.00 ± 13.25 dB, respectively. CONCLUSION Anatomic and functional outcomes of cartilage tympanoplasty are quite satisfactory in pediatric patients. Chronic otitis media should be treated surgically as early as when patient cooperation is possible.
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Cruz Toro P, Callejo Castillo Á, Moya Martínez R, Domenech Juan I. Inlay Butterfly Miringoplasty. Our Experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cruz Toro P, Callejo Castillo Á, Moya Martínez R, Juan ID. Inlay butterfly miringoplasty. Our experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:30-34. [PMID: 28807323 DOI: 10.1016/j.otorri.2017.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/23/2017] [Accepted: 04/02/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Multiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference. METHODS We performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results. RESULTS Surgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17dB preoperatively to 7dB after the intervention. CONCLUSIONS The modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children.
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Affiliation(s)
- Paula Cruz Toro
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España.
| | - Ángela Callejo Castillo
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España
| | - Rafael Moya Martínez
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España
| | - Iván Domenech Juan
- (AMiQ) Agrupació Mèdica i Quirúrgica, Unidad Funcional de Otorrinolaringología y Alergia, Hospital Universitari Dexeus, Barcelona, España
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Arora N, Passey JC, Agarwal AK, Bansal R. Type 1 Tympanoplasty by Cartilage Palisade and Temporalis Fascia Technique: A Comparison. Indian J Otolaryngol Head Neck Surg 2017; 69:380-384. [PMID: 28929072 DOI: 10.1007/s12070-017-1137-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/22/2017] [Indexed: 11/24/2022] Open
Abstract
(1) To compare graft take up of type-1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. (2) To compare hearing results of type 1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. A prospective clinical study. It consisted of 60 patients divided into two groups of 30 patients each. After randomization 30 patients underwent type 1 tympanoplasty using cartilage palisade technique and 30 underwent type 1 tympanoplasty using autotemporalis fascia. In follow up, pure tone audiogram were carried out at 2nd, 4th and 6th month. Clinical assessment was done at 2nd 4th and 6th month. The graft uptake rate between the group 1 and group 2 are 93.33 and 90% respectively. As p value was greater than 0.05 so statistically there is no significant difference between the two group. The post operative air bone gap of the two groups were compared using student t test. The pre op mean of group 1 was 32.5 db and pre op mean of group 2 was 30.66 db. The post op mean of group 1 was 21.33, with standard deviation of 3.6984 and standard error of 0.67523. The post op mean of group 2 was 21.09 with standard deviation of 3.29 and standard error of 0.58261. t value was 0.1357. Analysis was done using student t test and p value was found to be greater than 0.05. p value is greater than 0.05 which shows that there is no statistical difference between the two groups. This study establishes the fact that hearing results after performing type 1 tympanoplasty by autotemporalis fascia when compared with type 1 tympanoplasty performed by cartilage palisade technique showed similar hearing gain and post operatively graft take up rate was also similar in two groups. The disadvantage of reducing the mechanical vibration of the tympanic membrane was overcome by the palisade reconstruction of the tympanic membrane. This study definitely emphasizes upon usage of new grafting materials in reconstruction of tympanic membrane, with similar, if not better functional results, without compromising the acoustic transfer characteristics.
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Affiliation(s)
- Nikhil Arora
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| | - J C Passey
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| | - A K Agarwal
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| | - R Bansal
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
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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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Heo KW. Outcomes of type I tympanoplasty using a cartilage shield graft in patients with poor prognostic factors. Auris Nasus Larynx 2016; 44:517-521. [PMID: 27955869 DOI: 10.1016/j.anl.2016.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/18/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although fascia is widely used as the grafting material in tympanoplasty (TP), unsatisfactory outcomes can result in patients with poor prognostic factors. Recently, cartilage has emerged as a graft material in TP. This study examined the operative outcomes of type I TP using a cartilage shield graft (CSG) in patients with poor prognostic factors. METHODS This study reviewed the medical records of patients who underwent type I TP using CSG performed by the same surgeon, with over 24 months of follow-up. RESULTS There were 94 patients (mean age 46 years). Preoperatively, 39 patients had near-total perforation, 29 had a previous TP or myringoplasty, 14 had adhesive otitis media, and 12 had a marginal perforation covering ≥50% of the tympanic membrane area. The mean postoperative air-bone gap was significantly (p<0.0001) reduced compared to preoperative measurements. Postoperatively, tympanic membrane perforation occurred in 2.1% and otorrhea in 6.4%. There were no cases of retraction, adhesion, or lateralization. One subject complained of autophonia and ear fullness. CONCLUSION Type I TP using CSG has excellent surgical results and minimal complications, even in patients with poor prognostic factors, and should thus be considered in those patients.
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Affiliation(s)
- Kyung Wook Heo
- Department of Otorhinolaryngology-Head & Neck Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea.
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Vadiya S, Parikh V, Shah S, Pandya P, Kansara A. Comparison of Modified Cartilage Shield Tympanoplasty with Tympanoplasty Using Temporalis Fascia Only: Retrospective Analysis of 142 Cases. SCIENTIFICA 2016; 2016:8092328. [PMID: 27559489 PMCID: PMC4983392 DOI: 10.1155/2016/8092328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
The current study compares outcomes of modified cartilage shield tympanoplasty (CST) with temporalis fascia tympanoplasty in type I procedures in Indian patients. Graft uptake rates are better with the CST technique and hearing results are almost equivalent with both techniques except at 8000 Hz where improvement in hearing was found better with the use of temporalis fascia alone. The CST technique used in the study is unique.
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Affiliation(s)
- Sohil Vadiya
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Vibhuti Parikh
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Saumya Shah
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Parita Pandya
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
| | - Anuj Kansara
- Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat 388325, India
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Lyons SA, Su T, Vissers LET, Peters JPM, Smit AL, Grolman W. Fascia compared to one-piece composite cartilage-perichondrium grafting for tympanoplasty. Laryngoscope 2015; 126:1662-70. [PMID: 26542167 DOI: 10.1002/lary.25772] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of type 1 tympanoplasty with one-piece composite cartilage-perichondrium (CCP) grafts compared to temporalis fascia (TF) grafts for tympanic membrane (TM) closure and hearing improvement in adult patients with a subtotal TM perforation and chronic otitis media (COM). DATA SOURCES PubMed, Embase, Cochrane Library. REVIEW METHODS A systematic search was conducted. Relevance and validity of selected articles were assessed. Studies that scored moderate or high on relevance were included, and relevant data for both outcomes were extracted. For the outcome of TM closure, absolute risk differences (RD), relative risks, and number needed to treat with their respective 95% confidence intervals were calculated when possible. RESULTS We retrieved 3,783 unique studies. Ten studies satisfied the eligibility criteria. Four studies of moderate validity showed RD ranging from 0.08 to 0.13 in favor of the CCP graft compared to the TF graft for TM closure 1 year or more postoperatively, but this was not statistically significant. Five studies of moderate to high validity showed no clinically relevant difference in hearing improvement between both intervention groups at a minimum follow-up of 3 months. The relative air-bone gap closure ranged from 5.7 to 11.5 dB in the TF group and from 8.9 to 12.7 dB in the CCP group. CONCLUSIONS There is no evidence of superiority of one-piece CCP grafting over TF grafting in type 1 tympanoplasty regarding complete closure of a subtotal perforated TM 1 year or more postoperatively or hearing improvement at a minimum of 3 months follow-up. Laryngoscope, 126:1662-1670, 2016.
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Affiliation(s)
- Sarah A Lyons
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tanly Su
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Linda E T Vissers
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen P M Peters
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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16
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Bakshi SS. Letter to the Editor. Int J Pediatr Otorhinolaryngol 2015; 79:1966. [PMID: 26342568 DOI: 10.1016/j.ijporl.2015.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Satvinder Singh Bakshi
- Department of ENT and Head & Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry 607402, India.
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Iacovou E, Vlastarakos PV, Papacharalampous G, Kyrodimos E, Nikolopoulos TP. Is cartilage better than temporalis muscle fascia in type I tympanoplasty? Implications for current surgical practice. Eur Arch Otorhinolaryngol 2013; 270:2803-13. [PMID: 23321796 DOI: 10.1007/s00405-012-2329-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare the hearing results and graft integration rates in patients undergoing myringoplasty for the reconstruction of the tympanic membrane, with the use of either cartilage or temporalis muscle fascia (TMF). A systematic literature review in Medline and other database sources up to February 2012 was carried out, and the pooled data were meta-analyzed. Twelve studies were systematically analyzed. One represented level I, one level II and ten level III evidence. The total number of treated patients was 1,286. Cartilage reconstruction was used in 536, TMF in 750 cases. Two level III studies showed a significant difference between the pre- and postoperative air-bone gap closure, in favor of cartilage grafting. The mean graft integration rate was 92.4 % in the cartilage group and 84.3 % in the TMF group (p < 0.05). The rates of re-perforations were 7.6 and 15.5 %, respectively (p < 0.05). Among the other complications of type I tympanoplasty, retraction pockets, otitis media with effusion, anterior blunting, and graft lateralization were usually surgically managed, whereas most of the rest were minor and could be dealt with conservatively. The graft integration rate in myringoplasty is higher after using cartilage, in comparison with fascia reconstructions (grade C strength of recommendation), and the rate of re-perforation is significantly lower. Although cartilage is primarily used as grafting material in cases of Eustachian tube dysfunction, adhesive otitis media, and subtotal perforation in everyday surgical practice, a wider utilization for the reconstruction of the tympanic membrane in myringoplasties can be recommended.
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Affiliation(s)
- Emily Iacovou
- ENT Department, General Hospital of Larnaca, Larnaca, Cyprus
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Abstract
The use of cartilage grafts in tympanoplasties is recommended in cases with a higher probability of failure. Many grafting techniques have been reported, including palisade, cartilage island, and cartilage shield grafts. Cartilage minimizes the inflammatory tissue reaction, ensures resistance against infection during the recovery process, and provides good support against the retraction by virtue of its rigidity.This study compared the anatomic and functional results of conchal cartilage, tragal cartilage, and temporal muscle fascia grafts in primary type 1 tympanoplasty. Between January 2007 and January 2011, 79 patients with subtotal dry tympanic membrane perforation and an intact ossicular chain underwent primary type 1 tympanoplasty in our clinic. The postoperative perforation closure ratios, air and bone pure tone averages, and mean air-bone gap (ABG) in the 3 groups were compared with the preoperative values. The improvement in the mean ABG was assessed.The perforation closure ratio was 80.6%, 100%, and 88.5% in the muscle fascia, conchal cartilage, and tragal cartilage groups, respectively, and the mean increase in the ABG was 5.7, 8.9, and 9.7 dB, respectively.The island graft with cartilage perichondrium, which has recently become popular, can be also used in type 1 tympanoplasty. Because it does not require a second incision, conchal cartilage can be used routinely in tympanoplasties performed via a postauricular approach.
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Callioglu EE, Ceylan BT, Kuran G, Demirci S, Tulaci KG, Caylan R. Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological results). Eur Arch Otorhinolaryngol 2012; 270:2833-7. [PMID: 23266869 DOI: 10.1007/s00405-012-2238-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9 ± 3.7 (5-17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4 kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p < 0.001). However, no significant difference was seen in ABG gain values (p = 0.608), which was 10.1 ± 7.00 dB in cartilage group and 10.8 ± 5.38 dB in fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.
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Affiliation(s)
- Elif Ersoy Callioglu
- Department of Otolaryngology, Etlik Ihtisas Training and Research Hospital, Ankara, Turkey,
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Is Cartilage Tympanoplasty More Effective Than Fascia Tympanoplasty? A Systematic Review. Otol Neurotol 2012; 33:699-705. [DOI: 10.1097/mao.0b013e318254fbc2] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Yung M, Vivekanandan S, Smith P. Randomized study comparing fascia and cartilage grafts in myringoplasty. Ann Otol Rhinol Laryngol 2011; 120:535-41. [PMID: 21922978 DOI: 10.1177/000348941112000808] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study compares the medium-term outcomes of myringoplasty procedures using fascia and cartilage grafts. METHODS Patients with chronic otitis media with perforations larger than 50% of the size of the tympanic membrane were included in a randomized, controlled, prospective clinical trial. The perforations were repaired with either temporalis fascia (20 ears) or cartilage (18 ears) grafts selected randomly. A search of the literature was performed to look for other randomized studies comparing fascia and cartilage. RESULTS The graft take rates of fascia and cartilage grafts at 24 months were 84.2% and 80%, respectively. The postoperative air-bone gaps and hearing gains at 24 months were 16.97 dB and 13.63 dB, respectively, in the fascia group and 20.63 dB and 12.60 dB, respectively, in the cartilage group. There was no significant difference in the graft take rates or postoperative hearing between the two groups. The literature search identified one other randomized study comparing fascia and cartilage grafts in the repair of large perforations. The pooled data from the two studies did not show a difference in the graft take rates or hearing gains between cartilage and fascia. CONCLUSIONS There was no statistical difference in the outcomes of fascia and cartilage grafts in the repair of large perforations.
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Affiliation(s)
- Matthew Yung
- Department of Otolaryngology, The Ipswich Hospital National Health Service Trust, Ipswich, England
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