Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media
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ORIGINAL ARTICLE
Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media Ajay M. Bhandarkar1
•
Neethu V. Krishnan1 • Neethu Mary Mathew1
Received: 17 August 2020 / Accepted: 14 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract To study the efficacy of interlay cartilage rim augmented fascia tympanoplasty in mucosal chronic otitis media. A retrospective, observational study was conducted in a tertiary care hospital including charts of patients spanning a duration of one year, where 15 patients diagnosed with chronic otitis media-mucosal disease with large and subtotal perforations (with or without ossicular erosion), and had undergone interlay cartilage rim augmented fascia tympanoplasty, were analysed for morphological and functional improvement following surgery. Pre- and postoperative otomicroscopic examination and pure tone audiometry findings were the parameters considered. 86.6% had a well-healed, non-retracted, undisplaced mobile neotympanum, 6.7% who underwent a type III (minor columella) tympanoplasty had a medialised neotympanum and 1 subject (6.7%) who underwent a type I tympanoplasty had a residual pinpoint perforation which healed with conservative management. The overall morphological success rate was 93.3%. The mean hearing gain following surgery was 20.84 dB with a minimum gain of 10 dB and a maximum gain of 30 dB. The mean air–bone gap closure gain achieved was 19.2 dB with a minimum gain of 6.4 dB and a maximum gain of 30 dB. The interlay cartilage-fascia rim augmentation tympanoplasty is a novel, effective graft model suggested for large and subtotal central perforations. Future randomized studies with a larger sample size could be performed with longer followup to assess the outcome of this technique.
& Ajay M. Bhandarkar [email protected] 1
Department of Otorhinolaryngology-Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
Keywords Tympanoplasty Cartilage Fascia Hearing Tympanic membrane perforation
Introduction Chronic otitis media is a major cause of acquired hearing loss in developing countries [1]. The global burden of chronic otitis media is 65–330 million individuals, 60% of whom suffer from hearing loss [2]. The morphological and functional implications produced by chronic otitis media can be corrected by the reconstruction of the tympanic membrane and ossicles [3]. Innumerable graft materials have been used in reconstruction, however, temporalis fascia grafts have stood the test of time due to its accessibility, site, availability, negligible basal metabolic rate and thickness which is equivalent to that of the tympanic membrane, with excellent uptake rates in normally ventilated middle ear clefts [4, 5]. Temporalis fascia, however, fails to obtain desired results in revision tympanic membrane reconstruction, Eustachian tube dysfunction, adhesive otitis media, subtotal to total perforations, and tympanic fibrosis [6]. Use of cartilage
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