Anatomic and functional results in tragal cartilage tympanoplasty in adults: Correlation with prognostic factors

Year 2018, Volume: 28 Issue: 2, 78 - 84, 15.06.2018

Işılay Öz Seyra Hatice Erbek Selim Erbek Levent Naci Özlüoğlu

Abstract

Objectives: This study aims to evaluate the graft success and functional results of cartilage island graft tympanoplasties performed in adult patients. Patients and Methods: Medical records of patients operated on for chronic otitis media at our clinic were reviewed. One hundred and ninety-five patients 212 ears older than 16 years of age that had undergone tympanoplasty operation and that had been followed up for at least six months postoperatively, were included in the study. The prognostic factors that could have impact on graft success were analyzed. The pure-tone average and postoperative gain in air-bone gap ABG were recorded as the mean of 0.5, 1 and 2 kHz thresholds. Results: Graft success was achieved in 191 patients 90% , and graft perforation occurred in 21 patients 10% . When the risk factors that might lead to graft perforation were analyzed separately, the presence of cholesteatoma p=0.014 , and not performing mastoidectomy during tympanoplasty p=0.031 were significantly associated with graft perforation. The average preoperative ABG, including all types of tympanoplasty operations was 40.20±17.3 dB, and postoperative ABG was 30.14±19.21 dB p<0.05 . Conclusion: The presence of cholesteatoma and tympanoplasty without mastoidectomy were found to affect graft success negatively. Cartilage island graft is an effective technique for tympanic membrane closure and significant hearing improvement.

Keywords

Cartilage graft, chronic otitis media, tympanoplasty

References

• Zollner F. The principles of plastic surgery of the sound- conducting apparatus. J Laryngol Otol 1955;69:637-52.
• Wullstein HL. Functional Operations in the middle ear with split-thickness skin graft. Arch Otorhinolaryngol 1952;161:422-35.
• Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope 2003;113:1844-56.
• Onal K, Arslanoglu S, Oncel S, Songu M, Kopar A, Demiray U. Perichondrium/Cartilage island flap and temporalis muscle fascia in type I tympanoplasty. J Otolaryngol Head Neck Surg 2011;40:295-9.
• Aidonis I, Robertson TC, Sismanis A. Cartilage shield tympanoplasty: a reliable technique. Otol Neurotol 2005;26:838-41.
• Dornhoffer JL. Cartilage tympanoplasty. Otolaryngol Clin North Am 2006;39:1161-76.
• Kyrodimos E, Sismanis A, Santos D. Type III cartilage “shield” tympanoplasty: an effective procedure for hearing improvement. Otolaryngol Head Neck Surg 2007;136:982-5.
• Tos M. Cartilage Tympanoplasty. New York: Thieme; 2009.
• Yung M. Cartilage tympanoplasty: literature review. J Laryngol Otol 2008;122:663-72.
• Goodhill V. Tragal perichondrium and cartilage in tympanoplasty. Arch Otolaryngol 1967;85:480-91.
• Heermann J. Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction. Ear Nose Throat J 1992;71:344-9.
• Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg 2008;139:386-90.
• Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. AmericanAcademy of Otolaryngology- Head and Neck Surgery Ffoundation, Inc. Otolaryngol Head Neck Surg 1995;113:186-7.
• Kerr AG, Byrne JE, Smyth GD. Cartilage homografts in the middle ear: a long-term histological study. J Laryngol Otol 1973;87:1193-9.
• Yamamoto E, Iwanaga M, Fukumoto M. Histologic study of homograft cartilages implanted in the middle ear. Otolaryngol Head Neck Surg 1988;98:546-51.
• Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope 1987;97:1069-74.
• Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Otorhinolaryngol 2011;268:471-4.
• Duckert LG, Müller J, Makielski KH, Helms J. Composite autograft "shield" reconstruction of remnant tympanic membranes. Am J Otol 1995;16:21-6.
• Uslu C, Tek A, Tatlipinar A, Kiliçarslan Y, Durmuş R, Ayöğredik E, et al. Cartilage reinforcement tympanoplasty: otological and audiological results. Acta Otolaryngol 2010;130:375-83.
• Austin DF. Reporting results in tympanoplasty. Am J Otol 1985;6:85-8.
• Ulkü CH. Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results. Kulak Burun Bogaz Ihtis Derg 2010;20:7-12.
• De Seta E, Covelli E, De Seta D, Mancini P, Filipo R. Cartilage tympanoplasty: how to reduce surgery time. J Laryngol Otol 2010;124:784-5.
• Zhang ZG, Huang QH, Zheng YQ, Sun W, Chen YB, Si Y. Three autologous substitutes for myringoplasty: a comparative study. Otol Neurotol 2011;32:1234-8.
• Poe DS, Gadre AK. Cartilage tympanoplasty for management of retraction pockets and cholesteatomas. Laryngoscope 1993;103:614-8.
• Jonathan D. The predictive value of eustachian tube function (measured with sonotubometry) in the successful outcome of myringoplasty. Clin Otolaryngol Allied Sci 1990;15:431-4.
• Takahashi H, Sato H, Nakamura H, Naito Y, Umeki H. Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty. Auris Nasus Larynx 2007;34:173-6.
• Sadé J, Luntz M, Levy D. Middle ear gas composition and middle ear aeration. Ann Otol Rhinol Laryngol 1995;104:369-73.
• De Vos C, Gersdorff M, Gérard JM. Prognostic factors in ossiculoplasty. Otol Neurotol 2007;28:61-7.
• Vartiainen E, Nuutinen J. Success and pitfalls in myringoplasty: follow-up study of 404 cases. Am J Otol 1993;14:301-5.
• Sperling NM, Kay D. Diagnosis and management of the lateralized tympanic membrane. Laryngoscope 2000;110:1987-93.
• Merenda D, Koike K, Shafiei M, Ramadan H. Tympanometric volume: a predictor of success of tympanoplasty in children. Otolaryngol Head Neck Surg 2007;136:189-92.
• Kos MI, Castrillon R, Montandon P, Guyot JP. Anatomic and functional long-term results of canal wall-down mastoidectomy. Ann Otol Rhinol Laryngol 2004;113:872-6.
• Aktaş D, Özturan O, Çokkeser Y, Miman MC, Öncel S, Kalcıoğlu T ve ark. Açık kavite timpanoplasti erken dönem sonuçlarımız. Otoskop Dergisi 2002;3:70-4.
• McGrew BM, Jackson CG, Glasscock ME. Impact of mastoidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004;114:506-11.
• Sadé J, Fuchs C, Luntz M. Shrapnell membrane and mastoid pneumatization. Shrapnell membrane and mastoid pneumatization. Arch Otolaryngol Head Neck Surg 1997;123:584-8.
• 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;258:13-5.
• Ozbek C, Ciftçi O, Ozdem C. Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears. Eur Arch Otorhinolaryngol 2010;267:507-13.