Prolonged Middle Ear Ventilation by Cartilage-Grommet Tympanoplasty

Kartik Parelkar,Reshma Hanwate,Anoop Attakil,Rajanala Nataraj,Madhavi Pandare,Smita Nagle,Poonam Khairnar,Rajesh Kar,Vandana Thorawade,Mohan Jagade

doi:10.4236/ijohns.2015.41003

Kartik Parelkar, Reshma Hanwate + Show 8 more

Open Access

https://doi.org/10.4236/ijohns.2015.41003

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Abstract

In 1994, the American Otological Society reported favourable experience with composite cartilage shield tympanoplasty. The tragal cartilage with a grommet inserted in it was used for tympanoplasty in our patient with unilateral CSOM, supposedly because of severe chronic eustachian tube dysfunction. The marriage of cartilage tympanoplasty with grommet insertion was aimed to add the advantages and abolish the disadvantages of both the procedures. In 1990 Lary Hall first introduced the “long term ventilation of the middle ear” with a T-tube placed in the tragal cartilage perichondrium composite island graft. T-tube insertion in the cartilage has been described. But insertion of the Indian Sheperds grommet (ventilation tube) in the cartilage graft as described in this case and its technique are possibly the first of its kinds in literature. The report is aimed to ignite innovation of newer and better techniques of cartilage tympanoplasty.

Highlights

The aim of tympanoplasty is to reconstruct the tympanic membrane and the sound conducting mechanism
Chronic severe eustachian tube dysfunction is the main indication of cartilage shield T-tube tympanoplasty; such a situation most often is present in craniofacial abnormalities, downs syndrome, nasopharyngeal adenoid cystic carcinoma, previous head neck cancers involving the nasopharynx
Tympanomeatal flap was elevated and the cartilage-grommet graft placed in an underlay fashion (Figure 4), while the perichondrium over the lateral aspect was spread in an overlay manner except in the region of the grommet

Summary

Introduction

The aim of tympanoplasty is to reconstruct the tympanic membrane and the sound conducting mechanism. In 1990 Lary Hall first introduced the technique of cartilage T-tube tympanoplasty, the goal of placement of the permanent tube is to prevent repeated insertions of ventilating tubes, especially in children with severe and chronic secretory otitis media. Chronic severe eustachian tube dysfunction is the main indication of cartilage shield T-tube tympanoplasty; such a situation most often is present in craniofacial abnormalities, downs syndrome, nasopharyngeal adenoid cystic carcinoma, previous head neck cancers involving the nasopharynx. (2015) Prolonged Middle Ear Ventilation by Cartilage-Grommet Tympanoplasty. This technique can be used in cases with recurrences of chronic otitis media and history of multiple surgeries with chronic eustachian tube dysfunction as the possible eitiolgy. Prolonged middle ear ventilation is possible when a ventilation tube is inserted in the cartilage graft. The possibility of grommet migration and displacement due to proliferation of the epithelial layer of tympanic membrane are reduced in this technique. We would like to report our experience of cartilage-grommet tympanoplasty in this case

Case Report

Discussion

Conclusions