Palisade Cartilage Tympanoplasty Research Articles

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120dB which was improved to 13.387 ± 5.253dB postoperatively at 12weeks which was statistically significant. The mean postoperative ABG closure was 8.700dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Palisade Cartilage Tympanoplasty, an Alternative Surgical Approach for CSOM.

Introduction:The hearing outcome and graft take in patients of CSOM with sclerotic mastoids were studied using the novel technique of palisade cartilage tympanoplasty. Besides, it was compared with tympanoplasty type-1 above and over the cortical mastoidectomy in both groups. Materials and Methods:Out of 313 patients of CSOM, 125 had sclerotic mastoid and were included in the study. Palisade cartilage group patients were subjected to palisade cartilage tympanoplasty type-1. While as in the Temporalis fascia group patients, type-1 tympanoplasty was done using temporalis fascia as graft material. These procedures were performed in addition to cortical mastoidectomy done in all cases. Results:Statistically significant (P<0.001) mean postoperative hearing gain was achieved (> 20 dB) in both the groups with a reduction of AB gap to 13.3 & 11.79 dB, respectively. However, the post-surgery hearing outcomes achieved were similar in both groups (P=0.09). The overall graft take rate of 86% was seen in the Palisade cartilage group. The remaining 14% had graft take failure. The primary graft failure rate was 10% (5/50), and the secondary failure rate within six months of follow-up was 4% (2/50). The Temporalis fascia group graft take rate was higher (92%) than the Palisade cartilage group, with only 4 % (3/75) of cases having a primary graft failure rate. However, these findings (92% vs. 86%) were not statistically significant (P=0.2830). Conclusions:As the hearing outcomes and graft take rates were comparable in the two groups, the present study highlighted the use of palisade cartilage tympanoplasty in patients of CSOM with sclerotic mastoids as an alternative method to tympanoplasty.

An Exposition on Endoscopic Broad Palisade Cartilage Tympanoplasty: Procedural Illustrations and Connotations in Context of Audiological and Morphological Outcomes.

The objective of this study was to evaluate graft take up rate and hearing improvement in type I and type III endoscopic tympanoplasty using broad palisade cartilage graft and to compare the results with other studies who have used single piece cartilage as graft. This retrospective observational descriptive study was done in a tertiary care hospital. This study included 64 cases, who met the inclusion criteria, which were operated over 2years and were followed for 3years. The results were evaluated using graft uptake rates and hearing improvement comparing the preoperative and postoperative air conduction threshold (ACT) and air bone gap closure (ABG). The graft take rate was 92.1% and 87.5% at the end of 1year and 3years respectively. The preoperative and post-operative air conduction threshold were 35 ± 6.0dB HL and 17.5 ± 2.7dB HL in type I tympanoplasty respectively (p value <0.0001) while in type III tympanoplasty, preoperative and post-operative air conduction threshold (ACT) were 43.3 ± 8.6dB HL and 23.1 ± 4.2dB HL respectively (p value <0.0001). The preoperative and postoperative air bone gap (ABG) were 29.0 ± 5.6dB HL and 14.4 ± 4.20dB HL in type I tympanoplasty respectively (p value <0.0001). In type III preoperative and post-operative air bone gap were 36. 1 ± 7.5dB HL and 16.4 ± 3.3dB HL respectively (p value < 0.0001). Endoscopic broad palisade cartilage tympanoplasty has similar outcomes in morphological and audio logical perspectives as single piece cartilage tympanoplasty. Further studies with long term follow up period are required to corroborate the result of this study.

T-tubes Through Cartilage Tympanoplasty: Is It Worth the Perforation Risk?

To review a single surgeon's experience with T-tube placement through cartilage tympanoplasty versus native tympanic membrane for long-term ventilation of the chronic ear and residual perforation rates following tube removal. Retrospective chart review. Two tertiary referral centers. One hundred sixteen patients (4-71 yr of age) who underwent either total island cartilage tympanoplasty or posterior palisade cartilage tympanoplasty with T-tube placement primarily or secondarily from 1998 to 2016. Long-term outcome of each T-tube was recorded with respect to retention and patency, and tympanic membrane status following either tube removal or extrusion. Audiometric data, age, sex, diagnosis, and procedure(s) performed were considered. There were 116 patients (122 total ears and 139 total T-tubes) included: 57 ears underwent total island cartilage tympanoplasty with tube placed through cartilage and 65 ears underwent posterior island graft with tube placed through native tympanic membrane. Sixty-eight T-tubes were placed in the total island cartilage group with three (4.4%) residual perforations following removal. Seventy-one T-tubes were placed in the posterior palisade graft group with six residual perforations (8.5%) following removal or extrusion. The mean retention rate for the T-tubes was 3.93 years for the total island tympanoplasty group and 3.58 years for the posterior palisade tympanoplasty group. The mean follow-up for total island tympanoplasty and posterior palisade tympanoplasty was 5.36 and 5.66 years, respectively. Our data suggest that T-tube placement through cartilage tympanoplasty is worthwhile providing long-term ventilation to the middle ear and portends no higher risk for residual perforation than T-tube placement through native tympanic membrane.

Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study.

The endoscopic approach to tympanoplasty is gaining popularity, but its adoption for the palisade tympanoplasty technique is unstudied. The aim of the present study was to evaluate the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations. Retrospective study of 42 adult patients who underwent endoscopic tympanoplasty for a subtotal perforation in a university tertiary referral center from January 2018 to June 2019. Patients underwent transcanal tympanoplasty either with cartilage palisade grafts or with one-piece composite cartilage-perichondrium grafts. Both techniques were compared for graft take rate and audiometric results. Twenty palisade and 22 single-piece tympanoplasties were analyzed. No statistically significant differences between groups were found in terms of tympanic membrane closure (85% vs. 86.3%, p = 0.5) or hearing improvement. The results of the present study suggest that similar results can be obtained with palisade cartilage grafts compared to the one-piece composite cartilage-perichondrium technique for endoscopic tympanic membrane closure. Further studies with long-term results will be needed to confirm these findings.

Palisade cartilage fascia tympanoplasty: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cartilage tympanoplasty is one of the procedures performed for treatment of tympanic membrane perforation, more so in those cases associated with eustachian tube dysfunction, or failed previous temporalis fascia type 1 tympanoplasty. Palisade cartilage tympanoplasty, initially described by Heerman utilizes strips of conchal cartilage to reconstruct the tympanic membrane.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study which was presented with 64 patients who underwent palisade cartilage- fascia type I tympanoplasty and compared their hearing outcome after three years of post-operative period. Indication to perform a cartilage-fascia tympanoplasty was either an atelectatic middle ear or large perforation of the drum or residual or recurrent perforation following previous temporalis fascia myringoplasty. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average pre-operative hearing loss was 37.38±15.04 dB, while post-operative hearing loss was 20.47±8.85 dB, giving an average gain of 17.03 dB. Of 64 patients, 93.7% patients had fully healed neotympanum.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Palisade cartilage fascia tympanoplasty is an effective method to ensure graft uptake and at the same time achieve competitive hearing gain. The reliability of this technique lies in its use for recurrent and residual perforations of the tympanic membrane as well as in cases associated with eustachian tube dysfunction.&lt;/p&gt;

A Short Term Comparison of Cartilage with Temporalis Fascia Graft Tympanoplasty in Paediatric and Adolescent Population.

To compare the anatomic and functional outcomes of the cartilage and temporalis fascia graft materials in type 1 tympanoplasty in paediatric and adolescent population. A total of 55 patients aged <18years who required type 1 tympanoplasty were selected. 30 patients underwent cartilage palisade tympanoplasty and 25 using temporalis fascia grafts. The age, the side of the operated ear, the operative technique, pre- and post operative pure tone and impedance audiological results, and the status of the graft were noted. Graft was considered taken up if there was successful closure of tympanic membrane perforation. At the end of 6months, the graft take rate for cartilage was 90% and for temporalis fascia it was 80% (p>0.05). ABG closure ratio in cartilage group was 58.54±23.10% and in temporalis fascia group was 56.46±27.4% (p>0.05). Pre operatively all patients had type B tympanogram in both the groups. While post operatively either type A or C curve was seen in 80% patients of cartilage and 68% patients of temporalis fascia group. Hearing outcomes and graft success rates were high in both fascia and cartilage graft groups but not significantly different.

Retraction: A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique

Retraction: A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique

Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes

ABSTRACT Objectives To evaluate the anatomical (an intact tympanic membrane without atelectasis or lateralization) and audiological outcomes of type 1 cartilage palisade tympanoplasty. Methods The prospective study was done at a tertiary referral institute included 30 patients with mucosal type chronic otitis media requiring type 1 tympanoplasty including subtotal or total perforations and revision cases. The tympanic membrane reconstruction was done using full thickness broad cartilage palisades harvested from the tragus or concha with attached perichondrium laterally. Patients were assessed at 1st, 3rd and 6th postoperative months for assessment of graft uptake, healing of tympanic membrane and hearing evaluation using pure tone audiometry. Results Total 27 out of 30 patients had fully epithelized completely healed grafts postoperatively at 1 month (success rate of 90%) while three patients had small defect. One out of these three patients showed complete healing of graft while remaining two had persistent defect at 3rd and 6th months postoperatively. The mean pure tone air bone gap considerably reduced from 33.27 ± 4.29 dB preoperatively to 12.67 ± 5.68 dB postoperatively at 6 months. Conclusion Tympanic membrane reconstruction using full thickness palisades of cartilage provides good anatomical and audiological results with significant improvement of hearing specially in cases of subtotal or total perforations, revision surgery, atelectasis and Eustachian tube disorders where healing of tympanic membrane has much poorer prognosis irrespective of the surgical technique used. How to cite this article Gupta S, Lade H, Verma D, Malik NUD. Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):117-120.

A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique

Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study. Materials and Methods: The study population included 54 patients who were operated on in two groups (palisade technique and temporalis fascia technique) with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area), an intact ossicular chain, at least 1 month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre and postoperative audiograms were compared. The follow-up time was 6 months. Results: Graft acceptance was achieved in all patients (100%) in the palisade cartilage tympanoplasty group and in 25 patients (92.5%) in the temporalis fascia group. This difference was not statistically significant ( P = 0.15). Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.

Cartilage palisade tympanoplasty in children and adults: Long term results

ObjectiveTo show long-term anatomic and functional results of full thickness cartilage palisade tympanoplasty in children and adults. MethodsIn 51 patients (56 ears); 9 children (12 ears) and 42 adults (44 ears) full thickness cartilage palisade tympanoplasty and interposition with malleus head autograft was performed. On average 11 years after the tympanoplasty, an otomicroscopy and a tonal audiogram were done to assess anatomic and functional results. ResultsAnatomic results of 56 ears: 40 (71.43%) tympanic membranes have no anatomic irregularities; 14 (25.00%) have cartilage resorption (11 of them minor and 3 major resorptions), 2 (3.57%) have secondary perforation. In the group of children all ears tympanic membrane were with no or minor resorption and no perforations.Functional results (51 audiograms performed: in children 12 and in adults 39): pre- and post-operative average pure tone average air-bone gaps were 27.29±10.26 and 10.73±7.90dB, respectively.In the group of children pre- and post-operative average pure tone average air-bone gaps were 29.44±10.30 and 6.81±3.47dB, respectively. In the group of adults pre- and post-operative pure tone average air-bone gaps were 26.63±10.30 and 11.93±8.50dB, respectively. The differences between the two groups preoperatively (z=0.733; p=0.463) and postoperatively are irrelevant (z=1.723; p=0.085). The hearing gain is bigger in children (F=4.788; p=0.033). ConclusionThe full thickness cartilage palisade tympanoplasty with malleus autograft interposition is also nowadays a successful method in solving of an advanced ear pathology also in children.

A Short-term Comparison Between Result of Palisade Cartilage Tympanoplasty and Temporalis Fascia Technique.

The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Prospective study. The study population included 54 patients who were operated on in two groups (palisade technique & temporalis fascia technique) with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area), an intact ossicular chain, at least a one month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre- and post-operative audiograms were compared. The follow-up time was six months. Graft acceptance was achieved in all patients (100%) in the palisade cartilage tympanoplasty group and in 25 patients (92.5%) in the temporalis fascia group. This difference was not statistically significant (P= 0.15). Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.

Long-Term Results of Palisade Cartilage Tympanoplasty

Evaluation of morphologic and functional long-term results of palisade cartilage tympanoplasty (PCT) combined with titanium ossicular replacement prostheses. Retrospective review of tympanoplasties. Tertiary referral center. Twenty-nine patients (12 women and 17 men; mean age, 39 yr; range, 17-72 yr) operated on more than 9 years ago (mean follow up, 9.1 yr) because of cholesteatoma, adhesive otitis, chronic otitis media, subtotal tympanic membrane defects, and tympanic fibrosis requiring tympanoplasty. Tympanoplasty, applying the PCT. For ossiculoplasty, total or partial titanium ossicular replacement prostheses were used. Questionnaire on postoperative course, otoscopic findings, and hearing results using a 4-frequency pure-tone average air-bone gap. A recurrent defect was not observed. The graft take rate was 100%. There was one case of prosthesis protrusion which required revision surgery and insertion of a shorter prosthesis. A pure-tone average air-bone gap of 0 to 10 dB was seen preoperatively in 1 ear, 11 to 30 dB in 16 ears, and 31 to 59 dB in 12 ears. Postoperatively, the corresponding numbers were 10, 15, and 4 ears. The PCT is a reliable surgical method to manage difficult middle ear pathology on a long-term (>9 yr) basis. It offers satisfactory morphologic and functional results in combination with titanium prosthesis ossiculoplasty.

Efficacy of Cartilage Palisade Tympanoplasty

To calculate the efficacy (evaluating both morphologic and functional results) of cartilage palisade tympanoplasty (CPT) in comparison with tympanoplasty involving a temporalis muscle fascia (FT) graft. Randomized controlled trial. General Hospital. One hundred twenty-three patients with chronic otitis media who were recruited for the study between the years 1997 and 2002. Sixty-four patients were randomly allocated to the group receiving CPT and the remaining 59 to the group undergoing tympanoplasty with FT. The primary endpoint was defined as "morphological success," a composite variable that includes the absence of perforation, atelectasis, atrophy, lateralization, otorrhea, and blunting. The secondary endpoints were defined as functional hearing results. Both treatment groups were homogeneous with regard to the main baseline characteristics studied. Morphologic success at 24 months in the CPT group was 51 of 62 (82.26%), whereas in the FT group, it was 38 of 58 (64.41%; p = 0.03; relative risk = 1.28; 95% confidence interval (CI) = 1.02-1.60). The relative risk for morphologic success, adjusted for a multivariate model, was 1.36 (95% CI = 1.11-1.38), whereas the adjusted NNT was 5 (95% CI = 4-15). No statistically significant differences were found between the functional results of both treatment groups. Cartilage palisade tympanoplasty is a more effective technique for reconstructing the tympanic membrane than FT for the population studied.

Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears

The purpose of this study was to analyze the anatomic and functional results of cartilage tympanoplasty performed on atelectatic ears using the palisade technique and to assess the long-term efficacy of cartilage palisades in preventing recurrent retractions. The records of 54 patients (56 ears) who underwent surgery for atelectasis with or without mastoidectomy from January 2000 to August 2005 were retrospectively evaluated. A successful outcome was defined as complete and intact healing of the graft without perforation, retraction, or lateralization for at least 36 months after the operation, in addition to improvement of hearing indicated by a pure-tone average air-bone gap (PTA-ABG) of less than 20 dB. The mean follow-up period was 44.5 +/- 8.0 months (range, 36-68 months). Closure of the tympanic membrane was achieved in 91% of ears. Otomicroscopic evaluation revealed nine (16%) mild and five (8%) moderate retractions, but none of the retractions was deep enough to necessitate tube placement. Postoperative PTA-ABG was less than 20 dB in 71% of ears. The average preoperative and postoperative ABG values, including all types of tympanoplasty operations (Type I, II and III), were 28.4 +/- 5.8 and 16.9 +/- 6.7 dB, respectively (p < 0.001). No significant difference in the change in PTA-ABG was found between the groups with or without mastoidectomy (p > 0.05). Palisade cartilage tympanoplasty is an effective technique for tympanic membrane closure and hearing improvement in atelectatic ears. Mastoidectomy does not change the anatomic or audiologic findings in these types of ears. We recommend this technique to other otologic surgeons.

癒着性中耳炎に対するｃａｒｔｉｌａｇｅ ｐａｌｉｓａｄｅ ｔｙｍｐａｎｏｐｌａｓｔｙの経験

We evaluated the clinical utility of cartilage palisade tympanoplasty (CRPT) in adhesive otitis media, a condition known to recur frequently with poor success in hearing gain. Specimens were 9 ears having adhesive otitis media and undergoing CPT in January 2006 and December 2007. Cases of pars tensa cholesteatoma were excluded. Mean subject age was 35.2 years. Seven had total drum adhesion and 2 posterior half-adhesion. Preoperative pure-tone hearing averaged 20-102 dB (mean: 56 dB). A small piece of cartilage harvested from the cymba was obliquely sectioned to yield wide, thin cartilage strips. Strips were overlapped slightly anteriorly to posteriorly parallel to the malleus handle when present. Tympanoplasty type 1 was conducted in 2 cases, type 3c in 6, and type 4c in 1. No ears undergoing CPT produced recurrent adhesion or perforation although 2 suffered transient partial erosion healed easily in topical management. An air-bone gap of <15 dB was achieved in 3 ears, a hearing gain exceeding 15 dB in 5, and a hearing level of less than 30 dB in 3. Conditions falling in at least 1 of the above categories are considered successful based on Japan Otological Society criteria. Seven of the 9 (78%) were regarded as audiologically successful. CPT conducted for adhesive otitis media appears worthwhile, given the present better-than-expected results in our cases, although further study is needed to confirm this conclusion.

Les perforations tympaniques et les greffes de tympan

Objectives To report anatomic and physiologic characteristics of the tympanic membrane, to discuss the etiology and pathogenesis of tympanic perforation, and to discuss its management. Material and methods After a review of the literature, different surgical techniques and the postoperative results were evaluated. Results The rate of tympanic membrane closure is greater than 90% for the majority of authors. Age, mucosa inflammation, pathological contralateral ear (perforation, otitis media, cholesteatoma), and surgical experience influence this result. Discussion Even if surgical results are good, abstention must always be proposed and all complications must be explained. Conclusion Palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closures.

A Comparison of Cartilage Palisades and Fascia in Type 1 Tympanoplasty in Children

To assess the anatomic and functional results of primary Type1 cartilage tympanoplasty performed with the palisade technique and to compare them with the results of primary Type 1 tympanoplasty performed with temporalis fascia in children. Retrospective case review. Tertiary referral center. The records of 45 children with intact ossicular chain and no history of mastoidectomy or tympanic perforations occupying more than 50% of the membrane area were evaluated. Patients with similar age and middle ear pathologic findings were selected in an effort to make the groups as homogeneous as possible. Of those, 21 children were included in the cartilage study group, and 24 patients were included in the fascia group. An over-under tympanoplasty technique using either a palisaded tragal cartilage or temporalis muscle fascia. Successful outcome was defined as full, intact healing of the graft without perforation, retraction, or lateralization for at least 12 months after the operation and with improvement of hearing. Postoperative speech reception thresholds and postoperative air-bone gap were compared with preoperative levels within and between the groups. Tympanoplasty with the palisade cartilage technique resulted in a significantly higher graft acceptance rate (100%) than with the fascia technique (70.2%; p = 0.008). Speech reception threshold levels, pure-tone average, and air-bone gaps improved significantly with surgery in both the palisade and fascia groups (p < 0.001). Comparison of audiologic results between the groups did not reveal any statistically significant difference (p > 0.05). Palisade tympanoplasty in children yielded good anatomic and functional results. The anatomic results obtained using this technique were superior to those obtained using temporalis muscle fascia. Children who underwent Type 1 tympanoplasty with palisaded cartilage had equivalent postoperative audiometric results compared with children who underwent Type 1 tympanoplasty with temporalis fascia. Thus, palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closure and hearing improvement in children.

Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique

The use of cartilage as a grafting material has been advocated in cases at high risk for failure, such as subtotal perforations, adhesive processes, tympanosclerosis and residual defects after primary tympanoplasties. The cartilage palisade technique, in which the TM is fully reconstructed with palisade-shaped cartilage pieces, was first described by Heermann. Cartilage material has been criticized because of concerns regarding hearing results, however, large cartilage plates with thicknesses <or=0.5 mm have been suggested as an acceptable comprise and the graft take of this technique has been reported to be excellent. The purpose of this study was to compare the graft take rates and hearing results of primary type I cartilage tympanoplasty operations with palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. retrospective chart review. tertiary medical center. The study population included 51 patients who were operated between January 2000 and 2006 at the Department of Otorhinolaryngology of Ataturk Training and Research Hospital, Izmir, Turkey. Primary tympanoplasty cases with pure subtotal perforations (perforation >50% of the whole TM area), intact ossicular chain, at least more than 1 month dry period and normal middle ear mucosa were included in the study. Palisade cartilage tympanoplasty group included 23 cases, whereas 28 patients were were in the fascia group. therapeutic. Graft take rates were noted in 51 patients and pre- and post operative audiograms were compared using the chi-square test with Yates' continuity correction, Fisher's exact test, t test and repeated measures ANOVA. Graft take was achieved in 22 patients (95.7%) in palisade cartilage group and in 21 patients (75%) in temporalis fascia group (P = 0.059). Mean speech reception threshold, air-bone gap and pure-tone average scores comparing the gain between both techniques showed no significant changes in the threshold (P > 0.05). However the functional success was achieved with the palisade cartilage technique postoperatively, regarding to mean air-bone gap and speech reception threshold changes. Our experience with palisade cartilage technique demonstrates that subtotal or total perforations at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the TM with reasonable hearing can be achieved.

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results

The combined Heermann and Tos (CHAT) technique is the combination of Heermann's 'cartilage palisade tympanoplasty' and Tos's 'modified combined approach tympanoplasty = modified intact canal wall mastoidectomy'. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14-57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7-30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.