TYPE III TYMPANOPLASTY: A COMPARATIVE STUDY BETWEEN AUTOLOGOUS INCUS AND TRAGAL CARTILAGE AS OSSICULOPLASTY MATERIAL – OUR EXPERIENCE

Abstract

Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement in patients who underwent type III tympanoplasty using autologous incus and tragal cartilage as ossiculoplasty material. Method: A retrospective chart review of 30 patients who underwent type III tympanoplasty at medical college Srinagar Pauri Garhwal from January 2019 to December 2019 was done. In 10 patients autologous incus and in 20 tragal cartilage was used for ossiculoplasty. Those patients who required wall down were excluded from the study and only patient with limited atticotomy and complete mastoidectomy requiring type III tympanoplasty were included in the study. Pure tone audiograms done after 3 months were compared with the pre operative audiogram. Result: 10 patients who underwent type three tympanoplsty with use of autologous incus for ossiculoplasty had a mean hearing gain of 17.08dB and 20 pateint underwent type three tympanoplasty with use of tragal cartilage for ossiculoplasty had mean hearing gain of 18.26 dB at 3 months after surgery. Hearing gain was similar in both groups irrespective of the material used. The tragal cartilage was used as strut extending from stapes head to the anteroinferior part of annulus supporting the graft throughout and additionally helping in maintaining the middle ear space. Conclusion: The post-operative hearing gain with autologous incus and tragal cartilage as middle ear prosthesis are similar but the additional role of cartilage supporting the graft and maintaining the middle ear space overrule the use of tragal cartilage for ossiculoplasty in type three tympanoplasty. So by this study we recommend the use of tragal cartilage as ossiculoplasty material for type III tympanoplasty over other material.