Tympanoplasty Type Research Articles

Endoscopic malleus button hole myringoplasty

<p class="abstract"><strong>Background:</strong> Myringoplasty or type-1 tympanoplasty is surgical procedure that is used for repair of the tympanic membrane. The result outcome of myringoplasty depends on several variables such as method of tympanoplasty taken whether endoscopic and microscopic, of size of perforation, bony overhang, eustachian tube function, state of the middle ear mucosa, degree of pneumatization of mastoid and technique of graft placement.</p><p class="abstract"><strong>Methods:</strong> Our study was conducted at G.G.S. Medical College, Faridkot from January 2017 to April 2018. Patients were taken for endoscopic tympanoplasty and graft was placed with buttonhole technique. Results were compared in form of preoperative audiometry and post-operative audiometry done after 3 months. </p><p class="abstract"><strong>Results:</strong> In our study patients done with endoscopic tympanoplasty with buttonhole technique graft placement showed postoperative audiometry with decreased air bone gap till 10 db in maximum number of patients and 97% patents with graft uptake.</p><p class="abstract"><strong>Conclusions:</strong> The use of endoscopes has brought a new perspective to ear surgery. The use of endoscopes along with different technique as mentioned of placing graft to prevent all the complications.</p>

Comparison of half-thickness tragal cartilage graft to temporalis fascia graft Tympanoplasty Type I: A randomized control trial.

To compare half-thickness tragal cartilage graft with temporalis fascia graft in terms of graft take-up and acoustic outcomes in type-I tympanoplasty. The randomised control trial was conducted at Lady Reading Hospital, Peshawar, Pakistan, from January to December 2017, and comprised patients aged 16-60 years undergoing tympanoplasty. The patients were divided into two equal groups using systemic random sampling method. In Group A, tympanoplasty type-I was done using half-thickness tragal cartilage graft, while in Group B, it was done using temporalis fascia graft. Data was analysed using SPSS20. Of the 40 patients, there were 20(50%) in each of the two groups. Overall, there were 24(50%) males and 16(40%) females. The mean age of Group A was 28.57±8.00 years, and in Group B it was 27.14±6.18 years. The graft success rate in Group A was 19(95%) and in Group B it was 18(90%) (p>0.05). The graft success rates for half-thickness tragal cartilage and temporalis fascia were statistically non-significant.

Comparative study of use of dry and wet temporalis fascia Graft in type-1 Tympanoplasty

Comparative study of use of dry and wet temporalis fascia Graft in type-1 Tympanoplasty

Tympanoplasty Type I using Tragal Cartilage as graft: Our experience.

Objectives: To determine the efficacy of tragal cartilage graft in tympanoplasty type I. Study Design: Quasi-experimental study. Setting: Department of ENT, Head and Neck Surgery, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, Pakistan. Period: From Jan. 2017 to Dec. 2017 (One Year). Material & Methods: A total of forty four patient fulfilling inclusion criteria were included in this study. All the patients were assessed in terms of detail history, thorough examination focusing on ENT findings. Pure Tone Audiometry (PTA) was performed pre-operative and post-operative at 3 and 6 months interval for the frequencies of 0.5, 1, 2,4 Hz. Data were analyzed using SPSS (version 16). Paired sample t-test of significance was used. The confidence interval was set to 95% and P-value <0.05 was considered significant. Results: Out of 44 patients males were 24 (54.54%), female 20 (45.45%) with Male: Female ratio of 1.2:1. Mean age of the patients was 28. 47 + SD 7.26 Years. There was statistically significant difference between the pre and post-op air conduction (p<.001), and pre-op and post-op air bone gap (p<.001).There was subjectively significant hearing improvement in 31 patients (70.5%). Cartilage graft was taken in 43 patients with success rate of 97.7%. Conclusion: Tragal cartilage is an effective graft material, which yields good results in terms of graft take up, hearing improvement and minimum complication, postoperative healing and acoustic properties.

Impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes: a retrospective analysis in patients with tympanic membrane perforation due to chronic otitis media.

To evaluate the impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes. Patients who underwent tympanoplasty type 1 surgery were randomised into temporal fascia graft alone (n = 55) and temporal fascia graft plus platelet-rich fibrin therapy (n = 36) groups. Graft survival and hearing outcomes were recorded. Graft survival rates were significantly higher in the temporal fascia graft plus platelet-rich fibrin therapy group than in the temporal fascia graft alone group at one (100.0 vs 85.5 per cent, p = 0.020), three (97.2 vs 80.0 per cent, p = 0.024) and six months post-operatively (94.4 vs 74.5 per cent, p = 0.031). The difference in hearing gain between groups was not significant. Our findings revealed that the use of a platelet-rich fibrin plus temporal fascia graft for type 1 tympanoplasty was associated with more favourable post-operative outcomes than the use of temporal fascia alone, both in terms of tympanic membrane healing and graft survival; hearing restoration outcomes were similar.

Hearing results in modified radical mastoidectomy with type III tympanoplasty

<p class="abstract" style="display: inline !important;"><strong>Background:</strong> The objective of the study was to hear the results in patients with atticoantral-chronic otitis media who undergone canal wall down mastoidectomy with different types of tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> 86 cases of CSOM-AA were included. Patients were divided in 3 groups according to intra-operative ossicular chain status and reconstruction. Group A were patients having intact stapes superstructure and the graft kept over the stapes head covering middle ear and mastoid cavity. Group B patients were with intact superstructure of stapes and graft kept over cartilage graft kept on mobile stapes head. Group C patients were with absent superstructure of stapes with intact, mobile footplate and graft kept over autologous or homologous cartilage kept on footplate of stapes. On 10<sup>th</sup> week and 24<sup>th</sup> week after surgery, PTA was carried out to compare pre and post-operative hearing status. The study was conducted at SMIMER Hospital, Surat (a tertiary health care hospital) fromSeptember 2016 to September 2017. </p><p class="abstract"><strong>Results:</strong> In 86 patients, average mean preoperative AC threshold was 48.16 (±15.15) dB, mean pre-operative BC was 8.96 (±7.85) dB and mean pre-operative air bone gap was 40.11 (±12.92) dB. The mean post-operative AC threshold was 43.17 (±13.72) dB, mean post-operative BC was 11.34 (±9.44) dB and postoperative air bone gap was 32.06 (±11.62) dB. The mean air bone gap closure was 8.76 (±11.86). This hearing gain was statistically highly significant (p<0.001). Among 86 patients, cartilage was used in total 60 patients. Mean ABG was 8.6 dB, 11.05 dB and 8.43 dB respectively for tragal, conchal and homologous septal cartilage. </p><p class="abstract"><strong>Conclusions:</strong> Hearing improvement can be achieved with appropriate reconstruction in CWD mastoidectomy.</p>

Numerical modelling and vibration analysis of human middle ear for application in sound conduction reconstruction

In this paper, we introduce a new numerical approach for estimating the hearing restoration eect prior to the tympanoplasty operation using the nite element harmonic vibration analysis. This kind of approach makes it possible to propose a new medical treatment for the recovery of conductive or cochlear hearing loss. First of all, precise geometric models of the middle ear, including healthy type model and tympanoplasty type models, are constructed on the basis of the computerized tomography (CT) scanning data. Then, frequency response characteristics of the stapes displacement in sound conduction are claried using the three-dimensional nite element harmonic vibration analysis. Based on the investigation results, we propose that the hearing restoration eect can be estimated by a comparison of the dierences in the stapes displacement between the reconstruction model and the healthy subject.

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome. MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests. ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies. ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.

Perichondrium - An Autologous Substitute for Temporalis Fascia in Type I Tympanoplasty: A Comparative Study

Introduction 
 Temporalis fascia is the commonly used graft material for tympanic membrane reconstruction. Tragal perichondrium share with the fascia the quality of being mesenchymal tissue. In our study we compared perichondrium and temporalis fascia in terms of graft uptake and hearing improvement.
 Materials and Methods
 All patients presenting with discharge from ear and decreased hearing were subjected to clinical examination and investigation. Patients satisfying inclusion criteria were included in study with total of 40 patients. Twenty underwent type1 tympanoplasty with temporalis fascia (TF) and another 20 patients with tragal perichondrium (TP). To evaluate success patients are evaluated at end of 6 months for graft uptake and 3 months for hearing results in audiological gain of 10 dB in two consecutive frequencies.
 Results
 Mean Pre-op AC Threshold in TF group was 30.75 dB±5.16 and Post-op AC Threshold was 14.15 dB±8.05. Mean Pre-op AC Threshold in TP group was 32.2 dB±4.81 and Post-op AC Threshold was 20.95 dB±7.14. Mean post-op AC Threshold, Mean Post-Op AB Gap and Mean Audiological Gain was statistically significant among 2 groups p=0.0075, p=0.0013, p=0.0294 respectively. Temporalis fascia was better than Tragal Perichondrium. Graft uptake in 2 groups was not significant (p=0.6325).
 Conclusion
 From the present study we may conclude that temporalis fascia, tragal perichondrium free grafts provide viable autograft material for tympanoplasty. Both achieve good hearing restoration but the improvement in hearing or audiological gain is better in temporalis fascia graft than in tragal perichondrium graft.

Clinical study on type 1 tympanoplasty: anatomical and functional outcomes

<p class="abstract"><strong>Background:</strong> Tympanoplasty is operation to eradicate disease in middle ear and to reconstruct the hearing mechanism. Present study aims at assessment of success rate and hearing improvement following type I tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> 50 patients with chronic suppurative otitis media, tubotympanic type attending department of ENT are taken up for study screened with clinical history and examination. Type I tympanoplasty performed in all patients. Simple mastoidectomy with type I tympanoplasty performed in 8 patients. Patients are followed after surgery on 7<sup>th</sup>, 14th days and end of 3 months. Anatomical outcome is assessed in terms of graft uptake. Pure tone audiometry was performed at 3 months and air bone gap is considered to assess outcome. </p><p class="abstract"><strong>Results:</strong> Out of 50 cases, 43 cases (86%) showed good success rate by means of graft uptake. Remaining 5 cases showed residual perforation and 3 cases medialization of graft. In 42 patients type1 tympanoplasty is performed, success rate was 80.95% and in cases with where type1 tympanoplasty with cortical Mastoidectomy was done and the success rate was 100%. In the present study mean pre op AB gap was 27.65 dB and mean post op AB gap was 19.07 dB. The difference between the two, i.e., AB gap closure was 8.52 dB which is statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Type-1 tympanoplasty using temporalis fascia with underlay technique have good surgical success rate with excellent improvement of hearing. Cortical mastoidectomy can be planned depending on the status of the middle ear mucosa.</p>

Evaluation of middle ear risk index in patients undergoing tympanoplasty.

Tympanoplasty is a standard surgical procedure for the treatment of chronic otitis media. In this study, we aimed to determine the effect of the predictive factors of middle ear risk index (MERI) in patients undergoing tympanoplasty. A total of 200 patients who underwent tympanoplasty surgery from 2008 to 2018 at Khalili hospital in Shiraz were evaluated. In this study, variables such as age, sex, systemic diseases (diabetes mellitus, hypertension), location and size of tympanic membrane perforation (TMP), health of the opposite ear, dryness duration of the ear, presence or absence of myringosclerosis during surgery, type of operation and the risk of MERI were evaluated. The success rate for a 6-month follow-up of patients was 88%. Results showed that there was a significant difference between the MERI scores and the three types of operation of intact canal wall (ICW), canal wall down (CWD) and non mastoidectomy (P < 0.001). The longer the dryness duration of the ear, the MERI score was lower. When MERI score is low, the patient doesn't need mastoidectomy. Also, the worse the opposite ear, the higher the MERI score was. The highest MERI score was in patients undergoing CWD, and the lowest MERI score was in patients undergoing simple tympanoplasty. MERI score is a useful tool for predicting the success rate of tympanoplasty and helps the surgeon planning the type of tympanoplasty.

Outcomes of Endoscopic Assisted Versus Microscopic Assisted Type1 Tympanoplasty for Inactive Chronic Otitis Media

Background and objectives: The objectives of this study is to assess the outcomes of the endoscope as compared to the microscope in type 1 tympanoplasty surgery for cases with inactive chronic otitis media. Methods: Prospective comparative study was conducted from October 2016 to October 2017, forty patients underwent myringoplasty, twenty were endoscope assisted and twenty were microscope assisted. Results of surgery were compared at the end of six months post-operation. Results: In the endoscope group 85% while in the microscope group 90% of patients had a successful outcome. Average time taken in microscopic myringoplasty was 103.75 minutes range (75 -150 minutes) while time taken in the endoscopic myringoplasty group was 82.25 minutes range (60 -120 minutes). Average hearing gain was 12.25 dB for microscope assisted group and 11 dB for endoscope assisted group. Conclusions: The surgical result of endoscope assisted myringoplasty was similar to the microscope assisted myringoplasty although the graft taken and postoperative hearing gain in microscopic group was better than endoscopic group, but the operation dura-tion in endoscope group was shorter.

COMPARATIVE STUDY OF ENDOSCOPIC AND MICROSCOPIC ASSISTED MYRINGOPLASTY IN TIRUMALA HOSPITALS, KADAPA

Objective: The main aim of the study is to assess the operative time, graft uptake and audiological gain and post-operative scar in the group of the patients undergoing the endoscope assisted and the microscope assisted myringoplasty in Tirumala Hospital, Kadapa.&#x0D; Material and Methods: Myringoplasty or type-1 tympanoplasty was performed by either the endoscope or the microscope assistance. Postaural approach was undertaken for microscope assisted myringoplasty. Underlay technique of myringoplasty was performed using temporalis fascia graft in all the patients suffering from the inactive mucosal chronic otitis media. Post operative evaluation was done in terms of operative time, graft uptake and audiological gain. The patients were followed up for a period of 6 months. The study was longitudinal in nature and comprised of 100 patients suffering from the chronic otitis media inactive mucosal disease. The patients are divided into two groups consisting of 50 in each group. One group of patients have undergone microscopic assisted myringoplasty one group undergone endoscopic assisted myringoplasty and were followed up regularly. Study period is one year from January 2016 to December 2016 attending outpatient otolaryngology department were included in the study.&#x0D; Results: The operative time in the patients undergoing the endoscope assisted myringoplasty(EAM) was 45minutes whereas it was 60 minutes in the patients undergoing the microscope assisted myringoplasty(MAM). The tympanic membrane graft uptake and audiological gain was assessed at 1 month, 3months and 6 months post operatively. The successful closure of the tympanic membrane perforation was higher with the endoscope assisted myringoplasty as compared to the microscope assisted myringoplasty at 1 month, 3 months and 6 months of follow up. The mean audiological gain following myringoplasty with both the techniques used was noted. The mean audiological gain was found to be marginally better with the endoscope assisted myringoplasty at follow up of 1, 3 and 6 months as compared to the microscope assisted myringoplasty.&#x0D; Conclusion: The operative time was less in the endoscope assisted technique as compared to the microscope assisted technique. The post operative morbidity (evaluated in terms of post operative scar) was less in the group of patients undergoing the Transcanal endoscope assisted as compared to microscope assisted myringoplasty. There was no significant difference in either graft uptake or post-operative audiological gain in the patients undergoing myringoplasty by endoscope assisted and microscope assisted technique. The endoscope assisted myringoplasty has advantages of better assessment of ossicular chain and in the patients with canal overhang it improves the visualisation of the margins of the perforation thus obviating the need for canalplasty. Thus the endoscope assisted myringoplasty can be used as a preferred alternative to the conventional microscope assisted myringoplasty, with better post operative results and reduced operating time and morbidity of the surgical procedure.&#x0D; Keywords: Chronic otitis media (COM); Myringoplasty; Endoscope assisted myringoplasty; Microscope assisted myringoplasty.

Analysis of hearing improvement in patients with chronic mucosal otitis media after type-1 tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic mucosal otitis media implies a permanent abnormality of the pars tensa. It can be active, where there is pus formation and inflammation or it can be inactive, where there is no inflammation and pus formation. It may occur due to many etiological factors like recurrent Upper respiratory tract infection leading to Eustachian tube blockage, sequelae to unresolved acute otitis media etc. Patient is most commonly presented with pus discharge from ears and decreased hearing.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was carried out in 44 patients, above the age of 18 years, with unilateral chronic mucosal otitis media. All patients underwent type 1 tympanoplasty. Pre and post treatment hearing was measured by pure tone audiometry. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The result shows that most patients were in the age group of 20-30 years of age. Most common symptom patients presented with was hearing loss and pus discharge. The pre treatment mean air bone gap was 34 db and the post treatment mean air bone gap was 14 db.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most common age group was between 20-30 years. Patients presented with mostly hearing loss and discharge from the ear which was chronic in nature and mostly mucoid. All patients benefitted in hearing postoperatively after type 1 tympanoplasty was done. It shows that type 1 tympanoplasty is still one of the most used methods and produces effective results in patients with chronic mucosal otitis media.&lt;/p&gt;

Evaluation of Type III Tympanoplasty Using Cartilage Ossiculoplasty in Cholesteatoma Ear Surgery.

This prospective observational study evaluates the role of tympanoplasty type III in cholesteatoma ear disease during same sitting with mastoid surgery using cartilage ossiculoplasty. Forty patients of chronic suppurative otitis media-cholesteatoma disease were recruited in the study. All the patients had extensive cholesteatoma and underwent canal wall down mastoid surgery. Tympanoplasty type III, that is, stapes columella, minor columella, or major columella, was done in each case along with mastoid surgery depending upon the remnant ossicular status. Conchal cartilage graft was used for ossiculoplasty along with temporalis fascia graft. Hearing and graft uptake results were evaluated at the end of 6 months postoperatively. Of the 40 cases, 3 cases failed tympanoplasty. In the remaining 37 cases, a statistically significant hearing improvement (air-bone gap of 33 dB) was observed postoperatively. Seven cases underwent stapes columella, 13 cases underwent minor columella, and 17 cases underwent major columella tympanoplasty type III. Although a hearing improvement was recorded in all these subgroups, a statistically significant hearing gain was present only in tympanoplasty type III minor columella cases thereby underlying the importance of intact stapes. However, it is difficult to discern the type of tympanoplasty type III that the patient would undergo prior to the ear surgery.

Comparative Study Between Microscopic and Endoscopic Tympanoplasty Type I.

Tympanoplasty is surgical reconstruction of tympano-ossicular system and includes-Canalplasty, Meatoplasty, Myringoplasty and Ossiculoplasty. To analyse and compare the intraoperative and postoperative aspects and the outcomes of conventional postauricular microscopic tympanoplasty and permeatal endoscopic tympanoplastythis study was conducted on 50 patients undergoing type I tympanoplasty (25 patients divided into two groups; group A-microscopic tympanoplasty and group B-endoscopic tympanoplasty). Advantages, disadvantages and results were compared between the two groups. Success rates and hearing improvement were comparable in both groups while intraoperative ease, postoperative morbidity and operative time was seen superior in endoscopic group. Although, endoscopic technique being minimally invasive yet has disadvantages such as single handed difficult instrumentation, frequent cleaning of scope and thus a steep learning curve. In conclusion permeatal endoscopic tympanoplasty can be considered as a good alternative to the conventional microscopic tympanoplasty.

Temporal Fascia Versus Tragal Perichondrial Graft in Myringoplasty and Tympanoplasty

The objective of this study is to compare the results of tympanoplastywith underlay technique with respect to graft uptake, hearing improvement and complications. Thestudy was conducted between January 2006 & January 2018 at Haider clinic, Kulsum international Hospital Islamabad, MaroofInternational Hospital, Social security Hospital Islamabad and PAF hospital Islamabad. Sampling was done by non-probability convenient sampling type by random selection. Total of 1677 patients were selected had Tympanoplasty type 1. All had dry central perforations of different sizes for more than 3 months and conductive hearing loss of less than 40dB with patent Eustachian tube. Informed consent was taken from patients andethical committee. Patients with sensorineural hearing loss and with severe nasal pathology were excluded. Patients were divided into 2 groups, A and B, were subjected totympanoplasty by underlay technique by the same group of surgeons. In group A, temporalis fascia graft and in group B tragalperichondrial graft was used. Postoperative audiometry was done after 3 months in each case to calculate air bone gap. In our study there were 62% males and 38% females, mean age was 32.5. In Group A, 689 patients hadtympanoplasty with temporalis fascia and in group B 988 patients with chondro-perichondrial graft. Medialization was seen in 30(4.3%) patients in Group A and in 10(1%) in group B. Persistent Perforations happened in 32(4.6%) patients in group A and in 8(0.8%) patients group B. Graft uptake success rate using temporalis fascia was 85.9% and was 97.4% with Chondro-perichondrial graft. Hearing improvement was seen in 627(91%) patients in group A and 970(98%) patients in group B. Statistical analysis of the data was done using SPSS 16. Temporalis fascia and tragal perichondrium both are excellent material to repair tympanic membrane. Graft uptake rate and hearing improvement are better in perichondrial graft.

Comparison of Grafting Success Rate and Hearing Outcomes between Primary and Revision Tympanoplasties.

There are a few studies that compare the outcomes between primary and revision tympanoplasties. The purpose of the present study was to compare the results of type I tympanoplasty (i.e., synonymous to myringoplasty) and revision myringoplasty based on the closure of tympanic membrane perforation and hearing improvement. This prospective single-blind study was carried out on a total of 240 patients with tympanic membrane perforation at a tertiary referral center. The subjects underwent primary or revision myringoplasty. Grafting success rate and hearing results were measured and the comparison between the primary and revision groups was drawn. Grafting success rate was reported as 96.6% (112 out of 116 cases) for myringoplasty, while in revision myringoplasty the success rate of 78.2% (97 out of 124 patients) was achieved (P=0.001). Speech reception threshold was 23.1±9.2 dB and 24.9±13.1 dB in the primary and revision groups, respectively (P>0.05). However, the percentage of air-bone gap on audiometry≤20 dB were 83.8% and 76% in the primary and revision groups, respectively (P=0.26). The findings of the present study have shown that although grafting success was reported significantly better in myringoplasty (tympanoplasty type 1), compared to that in revision myringoplasty, it did not reveal any superiority over revision tympanoplasty regarding the hearing outcomes. No consensus was achieved due to a great number of controversies in the literature.

COMPARISON OF CARTILAGE TYPE IIIA AND IIIB TYMPANOPLASTY IN INDIAN PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA

Objective: This prospective comparative study determined the efficacy of type III tympanoplasty using homologous septal spur cartilage in patients with chronic otitis medis (COM).Methods: We selected patients by random sampling. Complete otolaryngologica examination including otological examination, tuning fork tests, pure tone audiometry (PTA), and relevant investigations was done. Post-tympanoplasty residual air-bone gap (ABG) was graded. Type III tympanoplasty was done for all and followed up until month 6.Results: Of 50 patients, 70.0% were men. Mean age was 27.72±10.81 years, 24 and 26 patients underwent type IIIA and IIIB tympanoplasty, respectively. Pre-operative mean PTA and ABG was 50.08 dB and 38.27 dB, respectively. Pre-operative ABG of 31–60 dB was seen in 41 patients while nine had an ABG of 0–30 dB. Overall, pre- and post-operative PTA was 50.24 dB and 28.54 dB, respectively. Overall, pre- and post-operative ABG was 38.32 dB and 16.40 dB (III A 36.92 dB and 14.79 dB; III B 39.62 dB and 17.88 dB). Mean overall hearing gain postoperatively in PTA was 21.70 dB (type III A 22.33 dB, III B −21.115 dB). Overall, ABG closure was 23.53 dB (type III A 22.333 dB, III B −21.115 dB). None had failure (&gt;30 dB). Good ABG of 10–20 dB was seen in 72% and 78% of patients at month 3 and 6, respectively.Conclusion: Significant post-operative hearing improvement was seen in both types of tympanoplasty using homologous cartilage graft for ossicular reconstruction. Type III A is better than type IIIB as the stapes superstructure is vital for hearing.

Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients

ObjectiveTo investigate the success rates and hearing outcomes of temporalis fascia and tragal cartilage grafts used for type-1 tympanoplasty in the elderly (³65 years) MethodsThe medical records of 73 elderly patients who underwent type-1 tympanoplasty at our center between January 2010 and June 2017 were retrospectively reviewed for age, gender, perforation side, presence of contralateral perforation, type and location of perforation, graft material types, preoperative and postoperative hearing levels, and length of follow-up. ResultsThe graft success rate was 83.5% (61 patients) for the entire group, 76.2% (32 patients) for the fascia group, and 93.5% (29 patients) for the cartilage group. The success rate for the cartilage group was significantly higher than that for the fascia group (P=0.048). The mean hearing gain was 12.5±7.6 and 8.9±6.1dB in the fascia and cartilage groups, respectively, and postoperative ABG was 10 dB or better in 29 (69.0%) and 19 (61.3%) patients, respectively. The mean hearing gain was significantly higher in the fascia group than in the cartilage group (P=0.028), whereas the mean ABG was significantly higher in the cartilage group than in the fascia group (P=0.009). The functional success rates were similar in both groups (P=0.490). ConclusionTympanoplasty is a safe and effective procedure in elderly patients with a 83.5% of graft success rate. Tragal cartilage may be the first choice of graft material due to its high success rates. The functional outcomes did not show significant differences between the fascia and cartilage groups.