Comparison of Temporalis Fascia and Transcanal Composite Chondroperichondrial Tympanoplasty Techniques

Abstract

The purpose of this study was to compare the success rates and hearing outcomes of transcanal composite chondroperichondrial cartilage graft with that of underlay temporal muscle fascia (TMF) graft for myringoplasty. In this retrospective study, the medical records of patients who underwent type 1 myringoplasty between September 2015 and February 2018 at Otorhinolaryngology Department of Erzurum Ataturk University were reviewed. Demographic properties, preoperative otological findings, preoperative pure ton audiogram findings, postoperative pure ton audiogram findings, and duration of surgeries were reviewed from medical records. The patients with lack of one or more of these information at medical records or lost to at least 3 months of follow-up were excluded from the study. According to the graft material used in the operation, the patients were divided into 2 groups. The patients operated with cartilage graft by transcanal composite chondropericondrial cartilage graft myringoplasty (TCM) technique was regarded as first group, while patients operated with temporal fascia was regarded as the second group (TMF). Both groups were compared according to preoperative and postoperative air–bone gap (ABG), graft acceptance rate, and duration of operation using SPSS version 20.0 software. A total of 113 patients whose medical records met the inclusion criteria were included in the study. Of these, 59 underwent TCM and 54 underwent TMF myringoplasty. Tympanic membrane perforation closure success rate was higher in the cartilage group (94.9%) than in the fascia group (83.3%; P = .046). In the former, preoperative and postoperative ABG was 19.5 ± 5 and 10.8 ± 4.8 dB, respectively. In the latter, the corresponding values were 20.7 ± 5.4 and 11.5 ± 5.4 dB, respectively ( P < .05). Duration of surgery was 29.5 ± 3.4 minutes in the TCM group and 61.5 ± 6.0 minutes in the TMF group ( P < .05). Transcanal cartilage myringoplasty could be considered as an appropriate surgical option because of its simplicity, shorter operation time, and rapid patient recovery, with no significant difference in terms of hearing outcomes compared to temporal fascia.

Hearing assessment and status of tympanic membrane pre and post-operated tympanoplasty in cases of CSOM.

“…Pre-operative AB-gap was 19.5 + 5dB and postop. AB-gap was19.8 + 4.8dB 9 , this study corelate with our study.…”

Shifting from postauricular to transcanal microscopic tympanoplasty may have similar frequency-specific improvements with better air-bone-gap closure at low frequencies and a minimal learning-curve effect

“…Similar results of no significant postoperative hearing difference were reported between fascia and perichondrium [6]. Although cartilage tympanoplasty might show a worse air-bone gap closure at high frequencies due to the graft's stiffness or mass effect [4], several studies had reported comparable hearing outcomes between fascia and cartilage [30][31][32][33].…”

Endoscopic Fascia-Cartilage Composite Grafting in Chronic Suppurative Otitis Media

“…Tympanic membrane closure rate and air bone-bone gap closure rates were statistically better in composite fascia cartilage grafting compared to fascia alone grafts. 16 In a prospective case series of 31 patients who used composite fascia cartilage graft using an endoscopic approach, Lou et al achieved a 90% tympanic membrane perforation closure rate and better air-bone gap closure rates when compared with post-operative audiometry findings. 17 Shekharappa et al in a study of 30 patients, achieved a perforation closure rate of 93 % and an airbone gap closure rate of 90% using cartilage-only grafting.…”