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Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results

Year 2010, Volume: 20 Issue: 1, 7 - 12, 10.01.2010

Abstract

Objectives: The aim of this study was to evaluate anatomic/audiologic outcomes of cartilage tympanoplasty with island technique and compare the results with the results of temporalis fascia tympanoplasty. Patients and Methods: The charts of 40 patients who underwent surgery for primary type 1 tympanoplasty either with perichondriumcartilage 12 males, 11 females; mean age 29.7 years; range 12 to 58 years or fascia graft 9 males, 8 females; mean age 32.4 years; range 13 to 61 years between January 2006 and January 2008 were retrospectively reviewed. Patients in whom the only pathology was subtotal tympanic membrane perforation with intact ossicular chain were included in the study. Pre- and postoperative audiograms, postoperative otoscopy findings and follow-up time were obtained from the patient’s chart in both groups. Reviewed parameters were the complete closure rates of the tympanic membrane perforation and the change in air bone gap at each of four frequencies 0.5, 1, 2, 4 kHz . Audiologic evaluation was made among the patients in whom complete ear drum closure was achieved in both groups. Results: Anatomic closure rates of the tympanic membrane perforation for perichondrium-cartilage and fascia group were 91.3% and 88.2%, respectively. Pre- and postoperative pure tone average air bone gap obtained at four frequencies for the perichondrium-cartilage and fascia group were 21.3±6.7 dB, 9.0±3.9 dB, and 21.2±6.9 dB, 8.5±4.4 dB, respectively. These findings revealed the overall gains of 12.3 dB for the cartilage-perichondrium group and 12.7 dB for the fascia group p>0.05 . Conclusion: The anatomic and audiologic results after cartilage tympanoplasty with island technique are comparable to those after temporalis fascia tympanoplasty. Furthermore, the cartilage is more resistant than the fascia to the anatomic deformation and necrosis. Therefore, we advise its use as a routine tympanic membrane reconstruction material without concern about effecting audiometric resuls.

References

  • Wullstein HL. Funktionelle operationen im Mittelohr mit. Hilfe des freien Spaltlappentransplantates. Arch Otorhinolaryngol 1952;161:422-35.
  • Zollner F. The principles of plastic surgery of the sound- conducting apparatus. J Laryngol Otol 1955;69:637-52.
  • Sheehy JL, Glasscock ME 3rd. Tympanic membrane grafting with temporalis fascia. Arch Otolaryngol 1967;86:391-402.
  • Tos M. Need for clinical research in cartilage tym- panoplasty. Trakya Univ Tip Fak Derg 2007;24:179-89.
  • Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope 2003;113:1844-56.
  • Uslu C, Tek A, Tatlipinar A, Kilicarslan Y, Durmus R, Ay Oğredik E, et al. Cartilage reinforcement tym- panoplasty: otological and audiological results. Acta Otolaryngol. 2009;1-9. [Epub ahead of print]
  • Cavaliere M, Mottola G, Rondinelli M, Iemma M. Tragal cartilage in tympanoplasty: anatomic and func- tional results in 306 cases. Acta Otorhinolaryngol Ital 2009;29:27-32.
  • Dornhoffer JL. Cartilage tympanoplasty. Otolaryngol Clin North Am 2006;39:1161-76.
  • Dornhoffer JL. Hearing results with cartilage tym- panoplasty. Laryngoscope 1997;107:1094-9.
  • Glasscock ME 3rd, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope 1982; 92:718-27.
  • Amedee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol 1989;10:447-50.
  • Adkins WY. Composite autograft for tympanoplasty and tympanomastoid surgery. Laryngoscope 1990; 100:244-7.
  • Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior mar- ginal and attic retraction pockets. Laryngoscope 1987; 97:1069-74.
  • Mürbe D, Zahnert T, Bornitz M, Hüttenbrink KB. Acoustic properties of different cartilage recon- struction techniques of the tympanic membrane. Laryngoscope 2002;112:1769-76.
  • Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993;103:1352-6.
  • Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope 2000;110:1994-9.
  • Kirazli T, Bilgen C, Midilli R, Ogüt F. Hearing results after primary cartilage tympanoplasty with island tech- nique. Otolaryngol Head Neck Surg 2005; 132:933-7.
  • Karaman E, Yılmaz S, Öğreden Ş, Acıoğlu E, Enver Ö. Tragal kıkırdak timpanoplasti sonuçlarımız. Cerrahpaşa Tıp Dergisi 2007;38:43-5.
  • Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ. Over-under tympanoplasty. Laryngoscope 2002; 112:802-7.

Kulak zarı perforasyonu onarımında ada tekniği ile kartilaj timpanoplastisi: Anatomik ve işitsel sonuçlar

Year 2010, Volume: 20 Issue: 1, 7 - 12, 10.01.2010

Abstract

Amaç: Ada tekniği ile yapılan kartilaj timpanoplastisinin anatomik/işitsel verileri değerlendirildi ve sonuçlar temporal fasya timpanoplastisi sonuçları ile kıyaslandı.Hastalar ve Yöntemler: Ocak 2006 - Ocak 2008 tarihleri arasında kliniğimizde perikondriyum kartilaj 12 erkek, 11 kadın; ort. yaş 29.7 yıl; dağılım 12-58 yıl ya da temporal fasya grefti 9 erkek, 8 kadın; ort. yaş 32.4 yıl; dağılım 13-61 yıl ile primer tip 1 timpanoplasti ameliyatı uygulanan 40 hastanın dosyası geriye dönük olarak incelendi. Çalışmaya, tek patolojisi sağlam kemikcik zinciri ile birlikte subtotal kulak zarı perforasyonu olan hastalar dahil edildi. Hasta dosyalarından, her iki grup için ameliyat öncesi ve sonrası odyogramlar, ameliyat sonrası otoskopi bulguları ve takip süreleri elde edildi. Değerlendirilen parametreler, kulak zarı perforasyonu kapanma yüzdeleri ve her dört frekans 0.5, 1, 2, 4 kHz için kemik hava yolu açıklığındaki değişikliklerdi. İşitsel değerlendirme, her iki grup için kulak zarında tam kapanma olan hastalar arasında yapıldı.Bulgular: Kulak zarı perforasyonunun anatomik kapanma oranları, perikondriyum kartilaj ve fasya gruplarında sırası ile %91.3 ve %88.2 idi. Dört frekans için ameliyat öncesi ve sonrası elde edilen pür ton ortalama hava kemik aralığı ise perikondriyum kartilaj ve fasya grupları için sırası ile 21.3±6.7 dB, 9.0±3.9 dB ve 21.2±6.9 dB, 8.5±4.4 dB olarak belirlendi. Bu sonuçlar, ortalama kazancın perikondriyum kartilaj grubunda 12.3 dB ve fasya grubunda ise 12.7 dB olduğunu gösterdi p>0.05 .Sonuç: Ada tekniği ile yapılan primer tip 1 kartilaj timpanoplastisi sonrası elde edilen anatomik ve işitsel sonuçları, primer tip 1 temporal kas fasya timpanoplastisi sonuçları ile kıyaslanabilirdir. Ayrıca kartilaj anatomik deformasyon ve nekroza karşı fasyadan daha dirençlidir. Bu nedenle işitsel sonuçları etkileme kaygısı olmadan kulak zarı onarımında rutin kullanımını öneriyoruz

References

  • Wullstein HL. Funktionelle operationen im Mittelohr mit. Hilfe des freien Spaltlappentransplantates. Arch Otorhinolaryngol 1952;161:422-35.
  • Zollner F. The principles of plastic surgery of the sound- conducting apparatus. J Laryngol Otol 1955;69:637-52.
  • Sheehy JL, Glasscock ME 3rd. Tympanic membrane grafting with temporalis fascia. Arch Otolaryngol 1967;86:391-402.
  • Tos M. Need for clinical research in cartilage tym- panoplasty. Trakya Univ Tip Fak Derg 2007;24:179-89.
  • Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope 2003;113:1844-56.
  • Uslu C, Tek A, Tatlipinar A, Kilicarslan Y, Durmus R, Ay Oğredik E, et al. Cartilage reinforcement tym- panoplasty: otological and audiological results. Acta Otolaryngol. 2009;1-9. [Epub ahead of print]
  • Cavaliere M, Mottola G, Rondinelli M, Iemma M. Tragal cartilage in tympanoplasty: anatomic and func- tional results in 306 cases. Acta Otorhinolaryngol Ital 2009;29:27-32.
  • Dornhoffer JL. Cartilage tympanoplasty. Otolaryngol Clin North Am 2006;39:1161-76.
  • Dornhoffer JL. Hearing results with cartilage tym- panoplasty. Laryngoscope 1997;107:1094-9.
  • Glasscock ME 3rd, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope 1982; 92:718-27.
  • Amedee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol 1989;10:447-50.
  • Adkins WY. Composite autograft for tympanoplasty and tympanomastoid surgery. Laryngoscope 1990; 100:244-7.
  • Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior mar- ginal and attic retraction pockets. Laryngoscope 1987; 97:1069-74.
  • Mürbe D, Zahnert T, Bornitz M, Hüttenbrink KB. Acoustic properties of different cartilage recon- struction techniques of the tympanic membrane. Laryngoscope 2002;112:1769-76.
  • Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993;103:1352-6.
  • Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope 2000;110:1994-9.
  • Kirazli T, Bilgen C, Midilli R, Ogüt F. Hearing results after primary cartilage tympanoplasty with island tech- nique. Otolaryngol Head Neck Surg 2005; 132:933-7.
  • Karaman E, Yılmaz S, Öğreden Ş, Acıoğlu E, Enver Ö. Tragal kıkırdak timpanoplasti sonuçlarımız. Cerrahpaşa Tıp Dergisi 2007;38:43-5.
  • Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ. Over-under tympanoplasty. Laryngoscope 2002; 112:802-7.
There are 19 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Çağatay Han Ülkü This is me

Publication Date January 10, 2010
Published in Issue Year 2010 Volume: 20 Issue: 1

Cite

APA Ülkü, Ç. H. (2010). Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. The Turkish Journal of Ear Nose and Throat, 20(1), 7-12.
AMA Ülkü ÇH. Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. Tr-ENT. January 2010;20(1):7-12.
Chicago Ülkü, Çağatay Han. “Cartilage Tympanoplasty With Island Technique for Reconstruction of Tympanic Membrane Perforation: Anatomic and Audiologic Results”. The Turkish Journal of Ear Nose and Throat 20, no. 1 (January 2010): 7-12.
EndNote Ülkü ÇH (January 1, 2010) Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. The Turkish Journal of Ear Nose and Throat 20 1 7–12.
IEEE Ç. H. Ülkü, “Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results”, Tr-ENT, vol. 20, no. 1, pp. 7–12, 2010.
ISNAD Ülkü, Çağatay Han. “Cartilage Tympanoplasty With Island Technique for Reconstruction of Tympanic Membrane Perforation: Anatomic and Audiologic Results”. The Turkish Journal of Ear Nose and Throat 20/1 (January 2010), 7-12.
JAMA Ülkü ÇH. Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. Tr-ENT. 2010;20:7–12.
MLA Ülkü, Çağatay Han. “Cartilage Tympanoplasty With Island Technique for Reconstruction of Tympanic Membrane Perforation: Anatomic and Audiologic Results”. The Turkish Journal of Ear Nose and Throat, vol. 20, no. 1, 2010, pp. 7-12.
Vancouver Ülkü ÇH. Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. Tr-ENT. 2010;20(1):7-12.