Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium

Dabholkar, Jyothi P.; Vora, Krishna; Sikdar, Abhik

doi:10.1007/s12070-007-0035-0

Cited by 56 publications

(60 citation statements)

References 6 publications

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“…Temporalis fascia has its own advantages like a common incision for approach, large amount of graft material is available and more so that its basal metabolic rate is low, its thickness is similar to normal tympanic membrane and embryo logically it develops from mesoderm which is same as normal tympanic membrane [6,17,18]. But temporalis fascia can suffer atrophy or vascularisation, causing posterior shrinkage or sinking in middle ear, ultimately causing failure of closure of the perforation in such cases [19,20]. Cartilage has been used with great success to reconstruct TM.…”

Section: Discussionmentioning

confidence: 99%

“…Subtotal perforation with very small anterior remnant of tympanic membrane and anterior bony overhang are more prone to failure after tympanoplasty [7]. Though various methods are practiced for placement of graft in tympanoplasty for Subtotal perforation, failure of perforation to close is seen in 10 % of cases [7,19]. The reasons of residual perforations are poor adaptation of graft, displacement of graft which may sink medially or may shift posteriorly or may shrink.…”

Section: Introductionmentioning

confidence: 99%

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Cartilage Support for Fascia Graft in Type I Tympanoplasty

Kulkarni

Burse

et al. 2014

Indian J Otolaryngol Head Neck Surg

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To evaluate the success rate, in terms of anatomical and functional results, in our technique of cartilage support for fascia graft in type I tympanoplasty. Retrospective study of tragal cartilage support for fascia graft in tympanoplasty for large central perforation in 748 patients was carried at an academic institution during January 2004 to March 2012. Patients' age ranged from 11 to 65 years. 325 (43.4 %) male and 423 (56.6 %) female patients were operated and mean post-operative follow up was of 24 months (range 6-48 months). The inclusion criteria were large central or subtotal perforation, anterior quadrant perforation, anterior tympanosclerotic patch with perforation and revision myringoplasty. Small central perforation, posterior perforations, traumatic perforations and Ossiculplasty were excluded from this study. In this technique, a piece of tragal cartilage carved in semi lunar shape is inserted medial to anterior remnant of tympanic membrane. Temporalis fascia graft is sandwiched between cartilage and anterior remnant of tympanic membrane. Post-operative closure of perforation was noted. Pure-tone average pre and post-operative air-bone gap in dB at 250, 500, 1000, 2000, and 4,000 Hz were compared. The overall success rate of our technique was 98.3 % in terms of graft uptake and within 13.35 ± 5.22 dB of air bone gap closure in terms of hearing improvement. This study reveals that cartilage support for fascia graft in type I tympanoplasty is a highly reliable technique and gives significant improvement in graft take-up and hearing status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cartilage Support for Fascia Graft in Type I Tympanoplasty

Kulkarni

Burse

et al. 2014

Indian J Otolaryngol Head Neck Surg

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“…Retroauricular approach was used in cases where temporalis fascia was required and in one case where the anterior perforation margin could not be viewed through the ear canal. The Underlay technique was used in all cases, as incidence of intratympanic cholesteatoma is less than 1% [7]. The worse-hearing ear was operated first.…”

Section: Surgical Procedures and Follow-upmentioning

confidence: 99%

Bilateral Type 1 Tympanoplasty in Chronic Otitis Media

Mane

Patil

Mohite

et al. 2011

Indian J Otolaryngol Head Neck Surg

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A theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance to perform bilateral tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 14 patients (28 ears). Fourteen patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral tympanoplasty type I (28 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 37.5 years. There were seven males and seven females in our study. All but five ears were operated through an endaural or endomeatal approach, and five ears operated by postaural approach. The Underlay technique was used in all cases. Total ten cases operated using Fascia Lata and four cases operated using Temporalis fascia as graft material. Follow-up examination and hearing tests (pure tone audiometry) were performed up to 20 months after surgery. The graft take rate was 96%, with no retraction pockets or displaced grafts observed during follow-up. One patient had small residual perforation which healed at the end of 3 months. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur. We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.

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“…In our study, closure rate of ABG within 10dB was found in 12(30%) cases which is comparable to Singh et.al (63%), Herman and Tang (75%) and Dabholkar et.al (76%), Strahan et.al (82%) and Gupta and Mishra (92%). [8][9][10][11][12] ABG closure between 11-20dB was found in 24 (60%) cases.…”

Section: Discussionmentioning

confidence: 99%

Merits and demerits of endoscopic tympanoplasty

Ambani

Bhavya

Vakharia

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONMyringoplasty is a surgical procedure which is confined to the drum head without manipulation of the ossicles or middle ear. Tympanoplasty is the surgical procedure which includes the manipulation of tympanic membrane and eradication of disease from the middle ear if present, if it is done in conjunction with manipulation of the ossicles it is known as tympanoossiculoplasty. Surgery that includes manipulation of mastoid along with tympanoplasty is known as tympanomastoidectomy. The development of tympanoplasty techniques led by incidental and inspirational contribution from surgeons all over the world. Specialized instruments like the ocular magnifying loops and the operating microscope opened up a new dimension to otology surgery. The newest technique of performing tympanoplasty is the endoscopic tympanoplasty. Initially endoscopes were used for diagnostic and teaching purpose of tympanic membrane and ear canal. Mer and colleagues introduced middle ear endoscopy in 1967.1 From then, endoscopes are increasingly used for various middle ear surgeries. In recent years, many surgeons have adopted it for middle ear surgery as opposed to microscope assisted ear surgery. Transcanal endoscopic approaches of middle ear provide wide angled view for inspecting the anatomy of the middle ear and redefining of the ossicles, which allows a better understanding of the ligaments and folds of the middle ear and help to understand the physiology of different spaces.2 The aim of otology surgeons at ABSTRACTBackground: Aim of the study was to evaluate the merits and demerits of endoscopic tympanoplasty compared to conventional microscopic tympanoplasty.Methods: This prospective comparative study was carried out between October 2015 to September 2016 in our otolaryngology department, for a period of 12 months. Total of 40 patients who fit into inclusion criteria, underwent endoscopic tympanoplasty under local anaesthesia with sedation. All laboratory preoperative testing was done; hearing evaluation was done with audiometry. Postoperative follow up was done at 2 nd and 3 rd month's period, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded. Results: Out of 40 patients, 16 (40%) were males, and 24 (60%) were females, there were 21 (52.5%) cases had moderate perforation, 15 (37.5%) cases had large perforation and 4 (10%) cases had subtotal perforation. Average time taken was of around 1hour and 30minutes, range was (70-140min.). All patients were evaluated for graft status, hearing gain and cosmetic results. Out of 40 patients, 35 (87.5%) patients had successful graft uptake, 2 (5%) patients had graft infection and 3 (7.5%) patients had residual perforation seen postoperatively. Conclusions: Use of endoscope not only serves as a great teaching tool, but also helps to visualize the middle ear anatomy and pathology intraoperatively with minimal soft tissue manipulation better cosmesis and reduced postoperative morbi...

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Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium

Cited by 56 publications

References 6 publications

Cartilage Support for Fascia Graft in Type I Tympanoplasty

Cartilage Support for Fascia Graft in Type I Tympanoplasty

Bilateral Type 1 Tympanoplasty in Chronic Otitis Media

Merits and demerits of endoscopic tympanoplasty

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