Is cartilage- perichondrium composite graft tympanoplasty the ideal treatment for revision tympanoplasty

Abstract

INTRODUCTIONTympanoplasty has undergone tremendous evolution since it was first described by by Wullstein in 1952 andZoellner in 1955. 1,2 Over the decades various autologus (temporalis fascia, fascia lata, periosteum, perichondrium, cartilage with or without peri-chondrium, veins, fatty tissue, and skin) and homologus (dura mater, pericardium, cartilage, amniotic membrane, skin, cornea, peritoneum, veins, and aortic valve) grafting materials and techniques were used in tympanoplasty operations.3 Temporalis fascia remains the most commonly used material for tympanic membrane reconstruction, with a success rate of 93% to 97% in primary tympanoplasties. 4 In high risk situations such as the subtotal perforation, atelectatic ear, cholestetoma, and revision tympanoplasty, the results have not been found to be commendable. In these situations, fascia and perichondrium have shown to undergo atrophy and subsequent failure in post-operative period.5 Heerman claimed to have used the cartilage palisade technique for middle ear and mastoid cavity reconstruction since 1960, in over 13,000 cases. Reconstruction of tympanic membrane with cartilage counteracts the tendency to retraction of soft autologus materials like temporalis fascia or perichondrium. Because of its low turn-over rate, cartilage is more resistant to infection. 6 METHODS55 patients who underwent revision tympanoplasty were taken from the department of Otorhinolaryngology, Harsh ENT Hospital, Ghaziabad. Data were collected from the record section and analysed in various aspects. A retrospective chart review was performed of all patients who underwent cartilage composite graft revision tympanoplasty. All the cases were thoroughly examined and investigated before taking them for surgery, findings ABSTRACT Background: The objective of the study was to evaluate the anatomical and audiological outcomes of cartilageperichondrium composite graft tympanoplasty by underlay technique in revision tympanoplasties. Methods: A series of 55 patients who underwent revision tympanoplasty with cartilage-perichondrium composite Island graft, at the department of Otorhinolaryngology, Harsh ENT Hospital, Ghaziabad. Tympanoplasty with cartilage-perichondrium composite island graft was done using underlay technique after slicing the cartilage with help of slicer. Ossiculoplasty was performed as and when needed. Results: Graft uptake rate was found to be 96.36% (53 of the 55 cases) in our study without any serious complications. Audiological outcomes with closure of 94.55% air bone gap within 0 to 30 dB was achieved (p <0.05). Conclusions: Nearly 97% success rate can be achieved with cartilage-perichondrium composite graft tympanoplasty for Revision tympanoplasty.