Butterfly Cartilage Tympanoplasty Research Articles

Butterfly Cartilage Tympanoplasty as an Alternative to Conventional Surgery for Tympanic Membrane Perforations: A Systematic Review and Meta-Analysis.

To compare the effectiveness of butterfly cartilage tympanoplasty (BCT) with that of conventional surgical approaches in the treatment of tympanic membrane perforations. A systematic search was performed by screening the PubMed, Embase, and Cochrane Library databases up to October 31, 2020. Two coauthors independently identified studies in accordance with the selection criteria. Data were pooled and analyzed via Review Manager version 5.3 and Stata version 12.0 software. The postoperative outcomes were measured and expressed as odds ratios (ORs) and standardized mean differences (SMDs). Additionally, heterogeneity was assessed through the I2 statistic. A total of 15 articles were eligible for final inclusion. The OR values for the graft uptake rate, compared to conventional tympanoplasty, were 1.12 (95%CI: 0.56-2.22, I2 = 52%, P = .75) and 1.22 (95%CI: 0.58-2.59, I2 = 0%, P = .60), and the OR compared to fat plug myringoplasty was 3.02 (95%CI: 1.04-8.77, I2 = 0%, P = .04). The qualitative analysis of the hearing results reflected significant postoperative auditory gains with no significant differences between the BCT and control groups, indicating satisfactory and similar postoperative hearing improvement. Moreover, the operation time was shortened (SMD = -2.19, 95%CI: -2.79 to -1.59, I2 = 82%, P < .05), and the postoperative pain was less with the BCT approach. Butterfly cartilage tympanoplasty has satisfactory efficacy in terms of anatomical and functional results in small to medium perforations. It reduces operation time and postoperative pain. However, the effectiveness on large perforation requires further assessment by well-designed studies.

Endoscopic Cartilage Butterfly Tympanoplasty: A Two-Handed Technique with Endoscope Holder.

The aim of the study was to evaluate and report the short-term results of two-handed endoscopic cartilage butterfly tympanoplasty using endoscope holders. The efficacy of the operative technique was evaluated and assessed by comparing the air-bone-gap on pure tone audiometry preoperatively and on follow-up at 6months and 1-year post operatively. Patients with uncomplicated otitis media and healthy middle ear status with no ossicular involvement underwent endoscopic transcanal cartilage butterfly tympanoplasty. Small and medium sized tympanic membrane perforations were included in the study. Pre- and postoperative air-bone gaps and presence for any residual perforation was noted. A total 69 patients consisting of 45 males and 24 females with a mean age of 24.45years were included in the study group. Small perforations involving only one quadrant were 39 in number while the medium sized perforations involving two quadrants were 26 in number and the ones involving three quadrants were 4 in number. At the end of the follow-up period of 6months and 1year, successful closure occurred in 67 of 69 patients with a success rate of 97.1%. The mean preoperative Air-Bone gap was 34 ± 3.45dB which showed a steady decline on follow-up at 6months 13 ± 4.53 and 15.34 ± 3.39dB at 1year following surgery. Recurrent perforation was noted in two patients involving three quadrants of the tympanic membrane. Endoscopic two-handed butterfly cartilage tympanoplasty can be safely performed in small and medium sized perforations with no middle ear disease/ossicular involvement. The hearing outcomes and successful closure rate are similar to those of other surgical methods. Our study uses the endoscope which provides superior image quality and the use of an endoscope holder makes the technique a two handed one, thereby making the manoeuvring of the microear instruments easier. Moreover, it can be performed under local anaesthesia with low complication rates and quick recovery. Level of Evidence Level 4.

Microscopic versus Endoscopic Inlay Butterfly Cartilage Tympanoplasty.

Background and ObjectivesInlay butterfly cartilage tympanoplasty makes the graft easy, and reduces operating time. The present study aimed to investigate the outcomes of microscopic versus endoscopic inlay butterfly cartilage tympanoplasty.Subjects and MethodsIn this retrospective study, the outcomes of 63 patients who underwent inlay butterfly cartilage tympanoplasty with small to medium chronic tympanic membrane perforation were evaluated. Twenty-four patients underwent conventional microscopic tympanoplasty and 39 underwent endoscopic tympanoplasty. The outcomes were analyzed in terms of the hearing gain and graft success rate.ResultsThe surgical success rate was 95.8% in the patients who underwent conventional microscopic tympanoplasty and 92.3% in those who underwent endoscopic tympanoplasty. In both groups of patients, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values in either group.ConclusionsEndoscopic inlay tympanoplasty using the butterfly cartilage technique appears to be an effective alternative to microscopic tympanoplasty and results in excellent hearing.

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations

A hospital based prospective study to compare and evaluate the efficacy and convenience of various office procedures like chemical cauterization, fat plug myringoplasty and butterfly cartilage tympanoplasty. This interventional, prospective, longitudinal study carried out on 300 patients in the ENT department of a tertiary care medical college hospital in central India between January 2009 and January 2015. The success rate was found to be 94.54, 91.12 and 97% in chemical cauterization, fat plug and butterfly cartilage tympanoplasty respectively (p value 0.246). In all the groups there were significant improvement in terms of hearing in decibels and AB gap postoperatively. No statistically significant association was found in between the failure rates in all the groups. From this study we conclude that all the procedures were simple, rapid, reliable, cost effective, takes less time and minimum hospital stay (day care) than conventional tympanoplasty. We strongly recommend these procedures in place of tympanoplasty in small to medium size central tympanic membrane perforations according to condition and convenience of the patients.

Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

PurposeIn 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort. Materials and methodsButterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap. ResultsThe reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%–100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB. ConclusionsThe butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.

Butterfly Cartilage Tympanoplasty Long-term Results: Excellent Treatment Method in Small and Medium Sized Perforations.

Objectives The aim of this study was to evaluate and report the long-term results of the butterfly cartilage tympanoplasty. Short-term and long-term hearing outcomes were compared according to age and perforation location as well.Methods Ninety-three patients who were diagnosed with noncomplicated chronic otitis media and underwent microscopic transcanal butterfly cartilage tympanoplasty due to anterior, posterior, and central tympanic membrane perforation were included. Age, gender, follow-up time, pre- and postoperative pure tone audiometry thresholds (both air and bone conduction), pre- and postoperative air-bone gaps (ABGs), if any residual perforation was noted.Results At the end of the follow-up period, successful closure occurred in 88 of 93 patients and success rate is 94.6%. In all patients, including those with residual perforations, the mean preoperative bone conduction threshold was 15.9 dB (range, 5 to 50 dB) among all groups whereas mean air conduction threshold was 36.4±15.1 dB (range, 10 to 90 dB) preoperatively and 28.8±14.3 dB in 6th month follow-up and 24.9±14.1 dB 24th month follow-up. Preoperative mean ABG was 22.1±7.1 dB (range, 5 to 40 dB) whereas 13.3±5.9 dB 6 months after surgery and 11.9±5.5 dB 24 months after surgery. There was a significant difference between pre- and postoperative ABG in both 6th and 24th month follow-up (P6 mo-24 mo<0.05). Furthermore, preoperative mean air conduction differed significantly from postoperative 6th and 24th month follow-up mean air conduction thresholds (P<0.05).Conclusion We suggested that butterfly cartilage tympanoplasty can be safely performed in small, moderate, and even large perforations, as the hearing outcomes and successful closure rate are similar to those of other surgical methods. Moreover, it can be performed under local anaesthesia and it has low complication rates.

Inlay butterfly cartilage tympanoplasty for large central perforations

Objective. The aim of this study is to evaluate the results of inlay butterfly tympanoplasty technique in large central tympanic membrane perforations. Methods . The files of the patients who underwent inlay butterfly cartilage tympanoplasty for large central tympanic membrane perforations were reviewed. Patients were followed with otoscopy and audiometry. Preoperative and postoperative pure-tone audiometry results were calculated and analyzed to evaluate the hearing gain. The grafting procedure was considered successful if no perforations were observed during postoperative microscopic or endoscopic evaluation during the follow-up period. Results . Twenty-nine patients with large central tympanic membrane perforation who were operated by inlay butterfly tympanoplasty technique were included in the study. Twenty-one (72.4%) ears were operated with endoscope and 8 (27.6%) under microscope. The mean duration of surgery was 30.5±3.77 minutes. The mean follow-up time was 69.6±21.6 (range; 24-112 weeks). Graft take rate was 89.7% (26/29). Conclusion. Inlay butterfly cartilage tympanoplasty is a minimal invasive and effective technique for repairing large central tympanic membrane perforations.

Butterfly cartilage tympanoplasty: an alternative new technique instead of conventional surgery method.

Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small- and medium-sized perforations. There are some difficulties with application of conventional butterfly technique and it affects our success rate of graft healing. With some modifications of graft preparation we can make better success rates. The aim of this study was to present the new renovation of conventional method, describe about what kind of changes we made and its technical facilities about the procedure. The study design is a prospective case series. This study was carried out on 18 patients who underwent inlay butterfly cartilage tympanoplasty with the new technique for anterior and inferior perforations at an otolaryngology department of a tertiary medical center between November 2015 and August 2016. Patients were followed with otoscopy and audiometry, and graft healing's success. Anatomic closure at 6th month after tympanoplasty was found in all 18 patients. There was no incidence of cartilage graft rejection or displacement. Preoperative mean PTA was 27.7dB, which improved 6months after surgery to 10.5dB (the average value of hearing thresholds at 0.5, 1, 2 and 4kHz). Butterfly cartilage tympanoplasty technique is safe and efficient in terms of both anatomical closure of the defect and improvement in hearing. We believe with this new technique, we facilitate this procedure in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.

Inlay Butterfly Cartilage Tympanoplasty: Anatomic and Functional Results.

To evaluate anatomic/functional results of inlay butterfly cartilage tympanoplasty and compare those with the results of over-underlay perichondrium-cartilage island or temporalis fascia tympanoplasties. Patients who operated for primary type 1 tympanoplasty (n=78) with inlay butterfly cartilage (n=25), over-underlay perichondrium-cartilage island (n=36) or over-underlay temporalis fascia (n=17) graft from January 2005 to January 2015 were included in the study. Age, gender, pre-/postoperative otoscopy findings/audiograms, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap on pure tone audiogram at four frequencies (0.5, 1, 2, 4kHz) and complications were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane. Anatomic integrity rates of the tympanic membrane was 92.00% for inlay butterfly cartilage tympanoplasty, 91.67% over-underlay perichondrium cartilage island tympanoplasty and 88.2% over-underlay fascia tympanoplasty. The mean gains of air bone gap on pure tone audiogram for the inlay butterfly cartilage, over-underlay perichondrium cartilage island and over-underlay fascia graft group were 11.28, 12.84 and 12.66dB respectively. Inlay butterfly cartilage tympanoplasty is a reliable and simple technique with satisfactory outcomes in selected cases. The anatomic and functional results after inlay butterfly cartilage tympanoplasty are parallel to the results of over-underlay perichondrium-cartilage island or temporalis fascia tympanoplasties.

Butterfly-cartilage tympanoplasty in children: A 28-case series and literature review

ObjectiveThis study presents results for a pediatric series of tympanoplasty using the butterfly-cartilage technique, with comparison to literature reports. MethodsA retrospective study included patients aged between 2 and 12 years receiving tympanoplasty performed by a single senior surgeon in our department between 2003 and 2012, for whom pre- and postoperative tympanum imaging was complete. Results were analyzed at a minimum 10 months’ follow-up in terms of graft healing and auditory data, with pre- and postoperative audiograms and calculation of mean hearing loss. ResultsTwenty-eight tympanoplasties were performed in 27 children: 16 males, 11 females; in 1 case, perforation was bilateral. Perforation location was inferior or antero-inferior in 14 cases (50%), antero-superior in 9 (32.1%) and anterior in 5 (17.9%). Perforation size on otoscopy ranged from 11.1% to 36.4% of tympanum area (mean, 26.3%). Mean follow-up was 25 months. Closure of the perforation was achieved in 87.7% of cases. Mean hearing loss was 20.2dB (range, 10–31.25dB) preoperatively and 14dB (range, 5–31.25dB) postoperatively. DiscussionWe analyze our results and compare them with the international literature to refine indications for this technique of tympanic repair. ConclusionTympanoplasty using the butterfly-cartilage technique was reliable and easy to perform. It should be included in the therapeutic armamentarium for moderate non-marginal tympanic perforation. In the present series, the technique was reserved to perforations involving less than 40% of tympanum area.

The effect of inlay butterfly cartilage tympanoplasty technique on compliance

Conclusion: IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results. Objective: The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters. Methods: Overall, 25 patients that underwent an operation between August 2010–May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4 kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared. Results: The graft survival rate in patients was found to be 92%. Mean pre-operative air–bone gap (ABG) was 16.4 ± 5.4 in patients, while mean post-operative ABG was 10.9 ± 5.8, with a statistically significant difference (p = 0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r = −0.025 and p = 0.936).

Butterfly cartilage tympanoplasty: An alternative approach for management of small- and medium-sized perforations

Objective: To evaluate the efficacy of butterfly cartilage tympanoplasty for small- and medium-sized central perforations and compare it with temporalis fascia tympanoplasty. Materials and Methods: A prospective, comparative study was conducted on 110 patients, divided into two groups. Patients of tubotympanic type of chronic suppurative otitis media with 2–6 mm size perforation were included in the study. Fifty-five patients were operated by temporalis fascia Type I tympanoplasty and rest 55 by butterfly cartilage tympanoplasty (transcanal technique) under local anesthesia. Results were compared in terms of pre- and post-operative air-bone gap improvement and success rates. Results: In our study, in terms of outcomes, both techniques had similar results. The success rate was 93.7% in butterfly cartilage tympanoplasty and 96.3% in temporalis fascia group. However, in terms of time taken, butterfly cartilage tympanoplasty took less time (about 30 min) than temporalis fascia (about 55 min). Conclusion: Transcanal butterfly cartilage tympanoplasty is a very good alternative in small- and medium-sized perforations for conventional temporalis fascia tympanoplasty as it is simple, takes less time, day care procedure, on table hearing improvement, cosmetically no postoperative scar, no need of post aural preparation, and patient can go home within hours.

Functional and Practical Outcomes of Inlay Butterfly Cartilage Tympanoplasty

For tympanoplasty, the most common grafting materials are the temporalis fascia or perichondrium; however, both require incision of the canal skin, which carries a risk of morbidity and the need for postoperative care. Inlay butterfly cartilage tympanoplasty, by which the perforation edges are refreshed and a cartilage is inserted through the perforation without canal incision, makes the graft easy, and reduces operating and recovery time. We analyze the outcome of inlay butterfly cartilage tympanoplasty. This study included 112 patients who underwent tympanoplasty from January 2011 to August 2012. Patients were divided into 2 groups: patients who underwent inlay butterfly cartilage tympanoplasty (Group I, n = 56) and patients who underwent conventional underlay tympanoplasty using the temporalis fascia (Group II, n = 56). Anatomic success was defined as an intact, repaired tympanic membrane, and functional success was defined as a significant decrease in the air-bone gap at the end of follow-up. Perioperative pain was analyzed using a visual analogue scale (VAS). Surgical success, functional success, perioperative pain, and operating time were evaluated and compared. The surgical success rate was 96.4% in Group I and 91.1% in Group II (p = 0.435). The mean air-bone gap decrease was 7.9 ± 2.2 dB in Group I and 8.9 ± 3.2 dB in Group II (p = 0.426). Group I showed a lower VAS score for pain (1.5 ± 1.2) and a shorter operation time (25.6 ± 8.5 min) compared with those of Group II (4.9 ± 1.7, 48.6 ± 19.5 min, respectively) (p < 0.01). Inlay butterfly cartilage tympanoplasty is compatible with the conventional underlay technique in both anatomic and functional success rates. Its simplicity, shorter operation time, and rapid recovery time could make it an attractive surgical option.

Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure

The aim of this study is to compare the inlay butterfly transcanal cartilage tympanoplasty with the conventional underlay tympanoplasty. Operation time, pre- and postoperative hearing levels, successful closure rate of tympanic membrane (take rate) and long-term re-perforation in dry perforated chronic otitis media were evaluated. The study design consists of case series with a chart review. The study settings are tertiary referral center. Of the 72 patients (age range 14-57years) with dry perforated chronic otitis media, 29 patients underwent inlay butterfly transcanal cartilage tympanoplasty (group 1) and 43 patients underwent conventional underlay tympanoplasty without mastoidectomy (group 2) between January 2010 and June 2012. The outcome measures were the duration of surgery, "take rate" at the 30th postoperative day and the audiometric results at the 45th postoperative day. Long-term re-perforation was evaluated at least postoperative 1year. The graft take rate was 96.5% in group 1 and 90.7% in group 2 at the 30th postoperative day (p>0.05). Mean air-bone gap was improved from 18.8±8.09 to 11.9±7.12dB in group 1 and from 21.9±7.32 to 11.6±8.43dB in group 2. The improvement of air-bone gap in both groups was statistically significant (p<0.05) but the improvement between the groups was not statistically significant (p>0.05). The average duration of the surgery was 29.9±5.38min for inlay tympanoplasty group and 58.9±12.1min for underlay tympanoplasty group (p<0.05). Two patients in group 2 had re-perforations after an initial take of the graft in 1-year follow-up period. Inlay butterfly transcanal cartilage tympanoplasty is a good choice in selected cases. Although this technique has the similar take rate and audiological results with conventional underlay tympanoplasty, it is a time-saving procedure.

Inlay “butterfly” cartilage tympanoplasty

ObjectivesThe aim of this study was to analyze the outcome of inlay “butterfly” cartilage tympanoplasty. MethodsThe files of 42 patients (24 were male, 18 were female) who underwent primary or revision inlay butterfly cartilage tympanoplasty in 2005 to 2011 at a tertiary medical center were reviewed. Patients were regularly observed by otoscopy and audiometry. ResultsThe mean patient age was 27 years (range, 14–75 years), and the mean duration of follow-up was 24 months (range, 3–36 months). The postoperative period was uneventful. The technical (anatomical) success rate was 92% at 1 year. There was a significant decrease in the mean air-bone gap in 32 patients (preoperatively, 49.6 dB; postoperatively, 26.2 dB; P = .006). Results were suboptimal in 3 patients with persistent small perforations of the operated ear. ConclusionInlay butterfly cartilage tympanoplasty appears to be effective in terms of defect closure and improved hearing, comparable with temporalis fascia graft tympanoplasty. Follow-up is necessary for at least 1 year when some perforation may reappear.

Inlay Butterfly Cartilage Tympanoplasty in Children

To assess the results of inlay butterfly cartilage tympanoplasty in children. Before-and-after trial; follow-up duration, 26.6 +/- 19.9 months (mean +/- standard deviation). Tertiary referral center. Fifty-nine pediatric cases of tympanic membrane perforation. Inlay butterfly cartilage tympanoplasty was performed under general anesthesia according to the technique originally described by Eavey and modified by Lubianca-Neto (i.e., without any associated split-thickness skin graft). Percentage of perforation closures, surgical complications, preoperative and postoperative puretone hearing thresholds; the results of inlay butterfly cartilage tympanoplasty were compared with those obtained in a retrospective series of 29 underlay fascia temporalis myringoplasties. The 71% "take rate" of inlay butterfly cartilage tympanoplasty was not significantly different from the 83% take rate obtained with underlay fascia temporalis tympanoplasty (p = 0.23, chi test). The anatomic results were improved when the graft diameter was at least 2 mm larger than the size of the perforation (81% take rate) (p = 0.009, chi test). No iatrogenic cholesteatoma was observed. Pure-tone hearing thresholds were improved at 0.5, 1, and 2 kHz, and stable at 4 kHz. Hearing levels were not different from those obtained with underlay fascia temporalis tympanoplasty. Inlay butterfly cartilage tympanoplasty is a safe, efficient, time-saving, and easy technique of tympanoplasty in children. Anatomic results may be improved by associating a split-thickness skin graft and/or by trimming a tragal graft much larger than the size of the perforation.