Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-06-06T18:38:10.432Z Has data issue: false hasContentIssue false
  • English
  • Français

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

Published online by Cambridge University Press:  06 October 2020

I D Erbele ,
M R Fink ,
G Mankekar ,
L S Son ,
R Mehta  and
M A Arriaga
I D Erbele
Affiliation:
Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
M R Fink
Affiliation:
Medical School, Louisiana State University Health Sciences Center, New Orleans, USA
G Mankekar
Affiliation:
Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, USA
L S Son
Affiliation:
Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
R Mehta
Affiliation:
Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA
M A Arriaga*
Affiliation:
Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA Our Lady of the Lake Hearing and Balance Center, Baton Rouge, USA Culicchia Neurological Clinic, New Orleans, USA
*
Author for correspondence: Dr Moisés A Arriaga, Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, 1111 Medical Center Blvd, Suite 630; Marrero, LA 70072, Baton Rouge70808, USA E-mail: maa@neurotologic.com Fax: +1 225 765 1023
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications.

Method

This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained.

Results

Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3–71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4–9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring.

Conclusion

Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

Keywords

TympanoplastyTympanic Membrane PerforationHearing
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 10 , October 2020 , pp. 875 - 881
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr M A Arriaga takes responsibility for the integrity of the content of the paper

References

Dornhoffer, J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. Laryngoscope 2003;113:1844–56CrossRefGoogle Scholar
Kirazli, T, Bilgen, C, Midilli, R, Ogut, F. Hearing results after primary cartilage tympanoplasty with island technique. Otolaryngol Head Neck Surg 2005;132:933–7CrossRefGoogle ScholarPubMed
Mohanty, S, Manimaran, V, Umamaheswaran, P, Jeyabalakrishnan, S, Chelladurai, S. Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations - A prospective study in a tertiary care hospital. Auris Nasus Larynx 2018;45:936–42CrossRefGoogle ScholarPubMed
Solmaz, F, Akduman, D, Haksever, M, Gundogdu, E, Yanilmaz, M, Mescioglu, A. The audiological and take results of perichondrium attached cartilage island graft in tympanoplasty: PACIT. Acta Otorhinolaryngol Ital 2016;36:275–81Google ScholarPubMed
Genc, S. A different cartilage graft technique: perichondrium-preserved palisade island graft in tympanoplasty. J Craniofac Surg 2016;27:e166–70CrossRefGoogle ScholarPubMed
Bedri, EH, Korra, B, Redleaf, M, Worku, A. Double-layer tympanic membrane graft in type I tympanoplasty. Ann Otol Rhinol Laryngol 2019;128:795–801CrossRefGoogle ScholarPubMed
Jeffery, CC, Shillington, C, Andrews, C, Ho, A. The palisade cartilage tympanoplasty technique: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2017;46:48CrossRefGoogle ScholarPubMed
Salviz, M, Bayram, O, Bayram, AA, Balikci, HH, Chatzi, T, Paltura, C et al. Prognostic factors in type I tympanoplasty. Auris Nasus Larynx 2015;42:20–3CrossRefGoogle ScholarPubMed
Yurttas, V, Yakut, F, Kutluhan, A, Bozdemir, K. Preparation and placement of cartilage island graft in tympanoplasty. Braz J Otorhinolaryngol 2014;80:522–6CrossRefGoogle ScholarPubMed
Balci, MK, Islek, A, Ciger, E. Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques. Eur Arch Otorhinolaryngol 2019;276:673–7CrossRefGoogle ScholarPubMed
Ciger, E, Balci, MK, Islek, A, Onal, K. The wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia for type 1 tympanoplasty: a prospective, randomized study. Eur Arch Otorhinolaryngol 2018;275:2975–81CrossRefGoogle ScholarPubMed
Karaman, E, Duman, C, Isildak, H, Enver, O. Composite cartilage island grafts in type 1 tympanoplasty: audiological and otological outcomes. J Craniofac Surg 2010;21:37–9CrossRefGoogle ScholarPubMed
Parelkar, K, Thorawade, V, Marfatia, H, Shere, D. Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft. Braz J Otorhinolaryngol 2020;86:308–14CrossRefGoogle ScholarPubMed
Ulku, CH. Inlay butterfly cartilage tympanoplasty: anatomic and functional results. Indian J Otolaryngol Head Neck Surg 2018;70:235–9CrossRefGoogle ScholarPubMed
Ozdemir, D, Ozgur, A, Akgul, G, Celebi, M, Mehel, DM, Yemis, T. Outcomes of endoscopic transcanal type 1 cartilage tympanoplasty. Eur Arch Otorhinolaryngol 2019;276:3295–9CrossRefGoogle ScholarPubMed
Gurgel, RK, Popelka, GR, Oghalai, JS, Blevins, NH, Chang, KW, Jackler, RK. Is it valid to calculate the 3-kilohertz threshold by averaging 2 and 4 kilohertz? Otolaryngol Head Neck Surg 2012;147:102–4CrossRefGoogle ScholarPubMed
Monsell, EM, Balkany, TA, Gates, GA, Goldenberg, RA, Meyerhoff, WL, House, JW. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of Otolaryngology-Head and Neck Surgery Foundation ,. Otolaryngol Head Neck Surg 1995;113:186–7Google Scholar
McShefferty, D, Whitmer, WM, Akeroyd, MA. The just-noticeable difference in speech-to-noise ratio. Trends Hear 2015;19:1–9Google ScholarPubMed
Oghalai, JS, Jackler, RK. New web-based tool for generating scattergrams to report hearing results. Otolaryngol Head Neck Surg 2016;154:981CrossRefGoogle ScholarPubMed
Kartush, JM, Michaelides, EM, Becvarovski, Z, LaRouere, MJ. Over-under tympanoplasty. Laryngoscope 2002;112:802–7CrossRefGoogle ScholarPubMed
Babu, S, Luryi, AL, Schutt, CA. Over-under versus medial tympanoplasty: comparison of benefit, success, and hearing results. Laryngoscope 2019;129:1206–10CrossRefGoogle ScholarPubMed
Yigit, O, Alkan, S, Topuz, E, Uslu, B, Unsal, O, Dadas, B. Short-term evaluation of over-under myringoplasty technique. Eur Arch Otorhinolaryngol 2005;262:400–3CrossRefGoogle ScholarPubMed
Yawn, RJ, Carlson, ML, Haynes, DS, Rivas, A. Lateral-to-malleus underlay tympanoplasty: surgical technique and outcomes. Otol Neurotol 2014;35:1809–12CrossRefGoogle ScholarPubMed
Kazikdas, KC, Onal, K, Yildirim, N. Sensorineural hearing loss after ossicular manipulation and drill-generated acoustic trauma in type I tympanoplasty with and without mastoidectomy: a series of 51 cases. Ear Nose Throat J 2015;94:378–98Google ScholarPubMed
Domenech, J, Carulla, M, Traserra, J. Sensorineural high-frequency hearing loss after drill-generated acoustic trauma in tympanoplasty. Arch Otorhinolaryngol 1989;246:280–2CrossRefGoogle ScholarPubMed
Eldaebes, MMAS, Landry, TG, Bance, ML. Repair of subtotal tympanic membrane perforations: a temporal bone study of several tympanoplasty materials. PloS one 2019;14:e0222728–eCrossRefGoogle ScholarPubMed
Eldaebes, M, Landry, TG, Bance, ML. Effects of cartilage overlay on the tympanic membrane: lessons from a temporal bone study for cartilage tympanoplasty. Otol Neurotol 2018;39:995–1004CrossRefGoogle ScholarPubMed
Morrison, DR, O'Connell, B, Lambert, PR. The impact of canalplasty on outcomes of medial graft tympanoplasty. Otol Neurotol 2019;40:761–6CrossRefGoogle ScholarPubMed
Kim, MB, Park, JA, Suh, MJ, Song, CI. Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty. Auris Nasus Larynx 2019;46:167–71CrossRefGoogle ScholarPubMed
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;268:471–4CrossRefGoogle ScholarPubMed
Guler, I, Baklaci, D, Kuzucu, I, Kum, RO, Ozcan, M. Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients. Auris Nasus Larynx 2019;46:319–23CrossRefGoogle ScholarPubMed
Kolethekkat, AA, Al Abri, R, Al Zaabi, K, Al Marhoobi, N, Jose, S, Pillai, S et al. Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty. J Laryngol Otol 2018;132:497–504CrossRefGoogle ScholarPubMed
Khan, MM, Parab, SR. Comparative study of sliced tragal cartilage and temporalis fascia in type I tympanoplasty. J Laryngol Otol 2015;129:16–22CrossRefGoogle ScholarPubMed
Ozdamar, K, Sen, A. Comparison of temporal muscle fascia and tragal cartilage perichondrium in endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap. Braz J Otorhinolaryngol 2019Google ScholarPubMed
Sen, A, Ozdamar, K. Which graft should be used for the pediatric transcanal endoscopic type 1 tympanoplasty? A comparative clinical study. Int J Pediatr Otorhinolaryngol 2019;121:76–80CrossRefGoogle ScholarPubMed
Vashishth, A, Mathur, NN, Choudhary, SR, Bhardwaj, A. Clinical advantages of cartilage palisades over temporalis fascia in type I tympanoplasty. Auris Nasus Larynx 2014;41:422–7CrossRefGoogle ScholarPubMed
Shishegar, M, Faramarzi, A, Taraghi, A. A short-term comparison between result of palisade cartilage tympanoplasty and temporalis fascia technique. Iran J Otorhinolaryngol 2012;24:105–12Google ScholarPubMed
Vadiya, S, Parikh, V, Shah, S, Pandya, P, Kansara, A. Comparison of modified cartilage shield tympanoplasty with tympanoplasty using temporalis fascia only: retrospective analysis of 142 cases. Scientifica (Cairo) 2016;2016:1–4CrossRefGoogle ScholarPubMed
Gurgel, RK, Jackler, RK, Dobie, RA, Popelka, GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012;147:803–7CrossRefGoogle ScholarPubMed
American Academy of Otolaryngology and the American Council of Otolaryngology. Guide for the evaluation of hearing handicap. JAMA 1979;241:2055–9CrossRefGoogle Scholar
Kim, HJ. Classification and hearing result reporting guideline in chronic otitis media surgery. Korean Journal of Otorhinolaryngology-Head and Neck Surgery 2006;49:2–6Google Scholar
Dobie, RA. The AMA method of estimation of hearing disability: a validation study. Ear Hear 2011;32:732–40CrossRefGoogle ScholarPubMed
Monson, BB, Hunter, EJ, Lotto, AJ, Story, BH. The perceptual significance of high-frequency energy in the human voice. Front Psychol 2014;5:587CrossRefGoogle ScholarPubMed
Levy, SC, Freed, DJ, Nilsson, M, Moore, BC, Puria, S. Extended high-frequency bandwidth improves speech reception in the presence of spatially separated masking speech. Ear Hear 2015;36:e214–24CrossRefGoogle ScholarPubMed
Supplementary material: File

Erbele et al. supplementary material

Erbele et al. supplementary material

Download Erbele et al. supplementary material(File)
File 225.2 MB