Long-Term, High-Frequency Tympanometry and Audiometry Results after Cartilage and Fascia Tympanoplasty

Abstract

Objective: Fascia or cartilage can be used as grafts in tympanoplasty; however, the disadvantage of cartilage is that it causes stiffness and rigidity in the newly formed tympanic membrane. The aim of this study was to compare the long-term high-frequency tympanometry and audiometry outcomes of tympanoplasty using cartilage and fascia.Methods: Forty patients in whom tragal cartilage was used in type 1 tympanoplasty and 40 patients in whom temporal muscle fascia was used were included in the study. The preoperative and postoperative audiometries of the two groups were compared. Postoperative highfrequency tympanometry (224, 668, 800, and 1000 Hz) and air volume, compliance, and pressure differences of the two groups were also compared. Results:The mean age of the patients was 31.3±4.5 year. The success rates were 96% in the cartilage group and 92% in the fascia group. In the fascia group, the preoperative mean air bone gap was 27.9±97 decibels (dB), and the postoperative mean air bone gap was 19.1±7.6 dB. The postoperative mean air bone gap improvement was 8.8±9.9 dB; the difference was statistically significant. In the cartilage group, the preoperative mean air bone gap was 28.2±9.6 dB, and the postoperative mean air bone gap was 17.2±10.5 dB. The postoperative mean air bone gap improvement was 10.9±10.3 dB; the difference was statistically significant. When postoperative mean air bone gap improvement was compared, there was no statistical difference between the two groups. When high-frequency tympanogram values were compared, there were no significant differences between the two groups at 224, 668, 800, or 1000 Hz frequencies in terms of air volume, compliance, or pressure values. Conclusion:The use of temporal muscle fascia and cartilage in tympanoplasty is statistically similar when compared in terms of tympanic membrane repair, hearing gain, air volume, pressure, and compliance. For this reason, cartilage graft can easily be preferred in tympanoplasty, especially in revision cases and adhesive otitis media, without fear of stiffness or rigidity effects.

Tympanoplasty Type I using Tragal Cartilage as graft: Our experience.

“…Cartilage graft was taken in 43 cases (97.7%) in this study, which is comparable to other studies as listed in table below (Table-III) [1][2][3]7,[10][11][12][13][14][15][16][17][18]. …”

“…The commonly used autologous graft materials are vein, fat, fascia lata, temporalis fascia, tragal perichondrium and cartilages. 3 Temporalis facia and tragal perichondrium are most commonly used due to their anatomic proximity, compliance and translucency. To get closure of perforation and restore hearing caused by chronic suppurative otitis media, several trials were carried out since the 1600s.…”

“…Later Heermann et al, introduced cartilage palisade graft for tympanoplasty labeled as Simmering Technique. 3 using tragal cartilage with intact perichondrium on both side with good results. In the literature reported success rate of temporalis facia is 93 -97%.…”

Comparative Outcome of Temporal Fascia and Tragal Cartilage Graft in Type 1 Tympanoplasty

“…They also compared the middle ear pressure, air volume and compliance of tympanic membrane in both groups. They concluded that no statistical differences were observed in air volume, pressure or compliance values at any frequency in audiometry and tympanometry in the cartilage and fascia groups [22] . In our study, the graft take up rate in cartilage perichondria composite graft and temporalis fascia graft was 84.85% and 85% (statistically significant) respectively.…”