Outcome of Myringoplasty with Temporalis Fascia and Perichondrial-Cartilage Composite Graft in High Risk Perforations

KK Shrestha,S Maharjan,Anup Dhungana,AS Rijal,RR Joshi

doi:10.3126/nmcj.v21i1.24855

KK Shrestha, S Maharjan + Show 3 more

Open Access

https://doi.org/10.3126/nmcj.v21i1.24855

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Abstract

The objective of this study was to compare the graft uptake results and postoperative hearing of myringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high risk perforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal type with high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/ eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement cases were included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80 cases were included for myringoplasty which were randomly allocated by lottery method with 40 cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptake results were assessed after 6 weeks and postoperative hearing was evaluated and compared within and between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrial composite graft group was 90% and 92.5%, respectively with no significance difference in the graft uptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalis fascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and 33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001) showing improvement in the hearing after surgery in both groups. The mean air bone gain were 14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectively with no significant difference between the groups (p=0.469). The graft uptake rate and hearing results after cartilage perichondrial composite graft are comparable to those of temporalis fascia graft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it is more resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend the use of cartilage perichondrial composite graft for tympanic membrane reconstruction in high risk perforation without concern about affecting audiometric results.

Highlights

Patients aged 13 years and above diagnosed with COM mucosal type with high risk perforation willing to undergo myringoplasty in the hospital were included in the study
Total number of patients enrolled for the study was 84. These patients were randomized into two groups temporalis fascia group (Group A) and perichondrial-cartilage composite graft (Group B) by lottery method, each group containing 42 patients
There was no significant difference in the graft uptake rates or postoperative hearing between the two groups

Summary

Introduction

It is one of the common surgery done in otology for the treatment of Chronic Suppurative Otitis MediaTubotympanic Type(CSOM-TT).[1]. In 1952, Wullstein[2] and Zollner[3] first described tympanoplasty as the mainstay for tympanic membrane reconstruction. Various grafting materials have been used for reconstruction like mesenchymal tissues, including vein, fascia, perichondrium and periosteum.[4,5,6,7,8,9,10] Nowadays most frequently used graft material is temporalis muscle fascia.[11]. Cartilage was first used by Jansen[12] in 1958 for ossicular chain reconstruction. In 1963, Salen[13] and Jansen[14] used cartilage composite grafts for tympanic membrane reconstruction

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