Hearing Results After Primary Cartilage Tympanoplasty

Abstract

Objectives/Hypothesis: Cartilage-perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties. Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia. Study Design: A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed. Methods: Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma. Pre-and postoperative speech reception thresholds and air-bone gaps at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz were compared. Results: Eleven patients comprised the cartilage study group, and there were 11 age-and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air-bone gap closures between the two groups. Conclusions: These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after temporalis fascia tympanoplasty. Therefore, when indicated, a cartilage-perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing.

The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty

“…A novel study using Doppler interferometer and cadaver cartilage by Zahnert et al [26] confirms that a cartilage thickness of 0.5 mm to be a good compromise between sufficient mechanical stability and low acoustic transfer loss. The rate of re-retractions after cartilage tympanoplasty is reported to be low and would reflect our one ear (2 %) reretraction rate [20].…”

“…The previously held notion that cartilage tympanoplasty diminishes acoustic transfer does not seem to be a dilemma when examining reported literature [20]. Dornhoffer [24] compared the hearing results of patients after cartilage perichondrial grafting versus perichondrium alone and found no statistical difference.…”

“…Cartilage has been used as an effective graft material for nearly 50 years. A number of studies have demonstrated its resilience to retraction without affecting hearing [20]. A significant disadvantage with using cartilage is that it obscures keratin pearls behind the graft and therefore either second look surgery or high resolution computed tomography (CT) of the middle ear must be performed for follow up.…”

Timpanoplastia com plugue de cartilagem na infância

“…Notwithstanding, it was only after 1944, with the beginning of antibiotics and with the improvement in surgical techniques that other materials were used as grafts in tympanoplasties 1,2 . After this time, in 1952, Zollner and Wullstein published their methods, using retroauricular skin grafts; however they did not succeed in treating tympanic membrane perforations 1,2,4,5,6 .…”

“…The most commonly used techniques for graft placement on the tympanic membrane are the "underlay" (medial) and "onlay" (lateral), and the most used types of graft are the temporal muscle fascia and perichondrium, with similar success rates (approximately 90%) 4,5 . Among children, these rates vary between 66 and 93.5% with the use of temporal fascia graft 10 .…”