Inlay Butterfly Cartilage Tympanoplasty Research Articles

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.

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.

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.

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).

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

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.