The Effect of Perforation Size and Site on Graft Success and Hearing in Cartilage Tympanoplasty with Mastoidectomy

Year 2020, Volume: 6 Issue: 3, 364 - 368, 31.12.2020

Mehmet Fatih Karakuş , Süleyman Emre Karakurt , Mustafa Çolak , Haci Hüseyin Dere

https://doi.org/10.19127/mbsjohs.801416

Cited By: 1

Abstract

Objective: Chronic otitis media (COM) treatment aims to obtain a dry middle ear mucosa as much as possible with medical treatment and to closure the perforation in the tympanic membrane with the help of various graft materials after the eradication of the disease. In the presence of perforation, the surface area of the tympanic membrane is decreases, which causes a decrease in the sound pressure in the middle ear and adversely affect hearing. At present, there is no globally accepted standardization of factors affecting anatomical success of the graft and hearing outcomes. In this study, the effect of perforation size and site in the tympanic membrane on anatomic success and hearing was investigated in cases where autogenic composite tragal cartilage graft material was used.
Methods: The patients were classified in groups with respect to the perforation site (central or marginal) and size (large if the perforation comprised more than 50% of the membrane area, and small if it comprised less) in the tympanic membrane. Anatomical success and preoperative–postoperative mean air bone gap pure tone average (ABG PTA) values of the graft were separately calculated for each group, and the ratios were compared.
Results: In 69 patients who underwent Type 1 tympanoplasty with mastoidectomy, 48 tympanic membrane perforations were central, 21 were marginal, 46 were small, and 23 were large. Graft anatomic success rates were 91.7% in the central group, 66.7% in the marginal group, 89.1% in the small group, and 73.9% in the large group. The anatomical success of the central group was found to be significantly higher than that of the marginal group. No difference was found between the small and large groups. When the effect on hearing was calculated, the postoperative hearing levels were significantly better in the central group.
Conclusion: Perforation size had no effect on the anatomical success and hearing level of the graft, while the perforation site affected both the anatomical success of the graft and the hearing level.

Keywords

tympanoplasty, cartilage, hearing, tympanic membrane perforation, mastoidectomy

References

• Alsarhan HE, Dawood MR, Jwery AAK, Khammas AH, Hamad AK. Assessment of hearing loss in tympanic membrane perforation. Adv Arab Acad Audio-Vestibul Journal 2016; 3: 16-9.
• Dawood MR. Hearing evaluation after successful myringoplasty. Journal of Otology 2017; 12 (4): 192-7.
• Gamra OB, Mbarek C, Khammassi K, Methlouthi N, Ouni H, Hariga I, et al. Cartilage graft in type I tympanoplasty: audiological and otological outcome. Eur Arch Otorhinolaryngol 2008; 265(7): 739-42.
• Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies. Laryngoscope 2017; 127(9): 2139-48.
• Kamath MP, Sreedharan S, Rao AR, Raj V, Raju K. Success of myringoplasty: our experience. Indian J Otolaryngol Head Neck Surg 2013; 65(4): 358-62.
• Karela M, Sandeep B, Watkins A, Phillipps JJ. Myringoplasty: surgical outcomes and hearing improvement: is it worth performing to improve hearing? Eur Arch Otorhinolaryngol 2008; 265(9): 1039-42.
• Kumar TVVV. Evaluation of various graft materials in myringoplasty. Int J Pharm Bio Sci 2015; 6(1): 700-23.
• Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope 1987; 97(9): 1069-74.
• McGrew BM, Jackson CG, Glasscock ME. Impact of mastoidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004; 114(3): 506-11.
• Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993; 103(12): 1352-6.
• Mishiro Y, Sakagami M, Takahashi Y, Kitahara T, Kajikawa H, Kubo T. Tympanoplasty with and without mastoidectomy for non-cholesteatomatous chronic otitis media. Eur Arch Otorhinolaryngol 2001; 258(1): 13-5.
• Oz I, Erbek SH, Erbek S, Ozlüoglu LN. Anatomic and functional results in tragal cartilage tympanoplasty in adults: Correlation with prognostic factors. Turkish Journal Of Ear Nose And Throat 2018; 28(2): 78-84.
• Rasha A, Ahmed SAO. Outcome of hearing improvement in myringoplasty a study of fifty one Sudanese patients. International Journal of Otorhinolaryngology 2015; 1(1): 5-8.
• Wasson JD, Papadimitriou CE, Pau H. Myringoplasty: impact of perforation size on closure and audiological improvement. J Laryngol Otol 2009; 123(9): 973-7.
• Westerberg J, Harder H, Magnuson B, Westerberg L, Hydén D. Ten-year myringoplasty series: does the cause of perforation affect the success rate? J Laryngol Otol 2011; 125(2): 126-32.
• Yilmaz S, Karaman E, Guclu E, Yaman H, Akkan N. Type 1 tympanoplasty results. Duzce Medical Journal 2009; 11(3): 33-6.
• Zhang ZG, Huang QH, Zheng YQ, Sun W, Chen YB, Si Y. Three autologous substitutes for myringoplasty: a comparative study. Otol Neurotol 2011; 32(8): 1234-8.