Graft uptake and post-operative hearing outcome with type-I tympanoplasty in dry versus wet ear: a comparative study

Abstract

<p class="abstract"><strong>Background:</strong> The discharging ear presents the otologist with the dilemma of operating on it or not. This study is being undertaken to study and compare the results of type I tympanoplasty in dry ear (no ear discharge at the time of surgery) and wet ear (culture negative consistent ear discharge at the time of surgery).</p><p class="abstract"><strong>Methods:</strong> 50 patients of either sex aged between 18 to 50 years undergoing type-I tympanoplasty were included in the study on the basis of pre-determined clinical criteria. Type I tympanoplasty was performed using temporalis fascia graft by underlay technique. Post-operative data regarding graft uptake and hearing improvement was recorded in the follow up period of three months. </p><p class="abstract"><strong>Results:</strong> The complete graft uptake was there in 88% of the patients in group 1 and 84% patients in group 2. The difference in the two groups was statistically insignificant (p>0.05). The mean pre-operative pure tone average in group 1 was 30.57±7.80 dB while post-operative pure tone average was 20.68±8.22 dB with a mean hearing gain of 9.89 dB. The mean pre-operative pure tone average in group 2 was 35.21±5.98 dB while the post-operative pure tone average was 27.07±9.25 dB with a mean hearing gain of 8.12 dB. There was marked hearing improvement in both the groups post operatively (p<0.001 i.e., highly significant). When hearing improvement was compared between two groups there was no significant statistical difference (p>0.05).</p><p class="abstract"><strong>Conclusions:</strong> The outcome is equally good for type 1 tympanoplasty in dry and wet ear in safe (mucosal) type of chronic suppurative otitis media with respect to graft uptake and hearing improvement.</p>

Audit of middle-ear surgery outcomes in a tertiary referral Australian teaching hospital

“…Andersen et al, 13 in their prospective ear surgery database, mention an 88 per cent graft uptake rate in primary surgery and an 80 per cent graft uptake rate in revision cases. Similar graft uptake rates using temporalis fascia are reported in the literature by Dangol et al, 14 Singh et al 15 and Sandhu et al 16 (83.1 per cent, 85 per cent and 88 per cent, respectively).…”

“…The data gleaned from our middle-ear surgery audit shows outcomes consistent with benchmark data set by international audits. Complete graft uptake in tympanoplasty was seen in 86.9 per cent of cases in our study, compared with benchmark rates ranging from 83-88 per cent, 5,[13][14][15][16] using similar temporalis fascia grafting techniques. The dry ear rate following canal wall down mastoidectomy for cholesteatoma is 77 per cent, superior to rates reported from the UK Royal College of Surgeons audit 2 (ranging from 60 per cent (open cavity) to 67 per cent (closed cavity)) and superior to the rates reported for endoscopic cholesteatoma surgery in the study by Diale et al 24 Air-bone gap closure of less than 10 dB occurred in the majority of stapedotomy cases (60 per cent) and almost half of tympanoplasty cases (46.6 per cent).…”