Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological result
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OTOLOGY
Cartilage graft or fascia in tympanoplasty in patients with low middle ear risk index (anatomical and audological results) Elif Ersoy Callioglu • B. Tijen Ceylan • Gokhan Kuran Sule Demirci • Kamil Gokce Tulaci • Refik Caylan
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Received: 13 July 2012 / Accepted: 18 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9 ± 3.7 (5–17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4 kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p \ 0.001). However, no significant difference was seen in ABG gain values (p = 0.608), which was 10.1 ± 7.00 dB in cartilage group and 10.8 ± 5.38 dB in fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.
E. E. Callioglu (&) B. Tijen Ceylan G. Kuran S. Demirci K. G. Tulaci R. Caylan Department of Otolaryngology, Etlik Ihtisas Training and Research Hospital, Ankara, Turkey e-mail: [email protected]
Keywords Cartilage Hearing Masteidectomy Tympanoplasty
Introduction Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and also hearing. Ever since it was first described by Zollner [23] and Wullstein [20] in 1952, various kinds of graft materials and techniques have been employed. At present, the most frequently used technique is temporal muscle fascia graft with underlay approach. Recently, cartilage has started to replace fascia in the reconstruction of the tympanic membrane. In the literature, success rates varying between 82 and 100 % have been reported for cartilage tympanoplasty operations [3, 6]. Variation in rates depends on the size of the perforation and the severity of middle ear pathology (chronic tubal dysfunction, atelectatic tympane membrane, and scutum defect); it was shown that fascia leads to shape changes and retraction in the fibrous connective tissue containing elastic fibrils with irregular
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