A Study on the Outcome of Myringoplasty in Small to Medium Sized Perforations Using Collagen Sheet as Graft Material.

Abstract

Chronic Otitis Media is a global health problem causing significant morbidity of life. Various medical and surgical treatment modalities are being used for the treatment of Chronic Otitis Media. Surgical treatment is the definitive option which includes different surgical procedures, all of which have been designed to attain the same goals of eradicating disease and achieve a safe and dry ear with closure of tympanic membrane perforations. Various graft materials are being used for the closure of tympanic membrane perforations like autografts, isografts, allografts and xenografts, each having its own advantages and limitations. The trend towards increasingly less invasive medical procedures, with shorter hospitalisation stay has led to demand for materials to replace autologous grafts, one such material being the collagen. The purpose of this study is to evaluate the outcome of myringoplasty in small to medium sized perforations using collagen sheet as the graft material. In the period from November 2018 to May 2020, 50 patients after fulfilling the inclusion and exclusion criteria were taken up for myringoplasty. They underwent myringoplasty using transcanal approach and collagen sheet was used to close the tympanic membrane perforation. Post-operatively, patients were treated with antibiotics and regularly followed up. Otoendoscopy was done at the end of 1st month and 3rd month. At the end of 3months, patients were evaluated for graft uptake and pure tone audiometry repeated to evaluate the post-operative hearing gain. In this study, we examined a total of 50 patients with 25 males and 25 females (50%). The mean age of our patients was 29.42years, ranging from 18 to 60years; with almost 66% between 21 and 40years. Treatment was considered successful if there was complete closure of tympanic membrane perforations. Of the 50 patients that were included; graft uptake was noted in 46 patients i.e. in 92%, closure was achieved at the end of 3months. Four failures in our study were due to infections. In this study, the graft uptake following myringoplasty was analyzed with statistically significant objective parameters like age, gender, size of perforation, laterality of disease, etiology of CSOM that affect the success of tympanoplasty. It was observed that small sized perforations had more chances of graft uptake. Post-operative hearing outcomes were also evaluated and was found to be statistically significant. Collagen sheet provided promising results as a graft material for myringoplasty and the graft uptake rates were comparable to the success rates of other conventional autologous grafts. Post operatively, significant improvement in hearing was also noted.