Authors
Department of Otorhinolaryngology, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: To compare two methods of tympanic membrane (TM) grafting when graft materials medial or lateral to malleus, this study have been done.
Materials and Methods: In this clinical trial which was conducted in Alzahra and Kashani hospitals, between June 2010 and February 2012, 56 patients with chronic otitis media and perforated TM entered the study in two groups. The inclusion criteria consisted of patients who were at least 15-years-old without history of smoking, diabetes mellitus or autoimmune disease. Exclusion criteria of the study: No compliance for follow up, post-surgical ear trauma or any infective pathology that directly affects the ear. In Group A patients, the graft material is pierced in near central part of the graft and they lodged so that the malleus handle projects through the graft perforation. Group B had grafting in the lateral side of the malleus. Three month after surgery both groups examined and tested by audiometry. Success of surgery is defined as complete repair of TM, without lateralization, atelectasis, blunting or retraction pocket.
Results: This study contained 28 patients in Group A and 28 in Group B. Overall success rate was 94.64% that was 96.42% in Group A, and 92.85% in Group B. Differences of air-bone gap in each group before and after surgery was 16.10 (±4.89) in Group A, and 15.78 (±3.40) in Group B. Improvement of hearing level was not significant between two surgical methods (P = 0.442).
Conclusions: Both techniques (medial and lateral to malleus handle) of TM grafting are effective with success rates 96.42% and 92.85% respectively.
Keywords
1. | Meredith EA, Hussam KE. Tympanoplasty and ossiculoplasty. In: Cummings otolaryngology head and neck surgery. Philadelphia: Mosby Elsevier Publication; 2010. p. 1999-2008. |
2. | Merchant SN, Rosowski JJ, Shelton C. Reconstruction of the middle ear. In: Snow JB, Wackym PA, Ballenger JJ, Editors. Ballenger's otorhinolaryngology head and neck surgery. United States: People's Medical Publishing House; 2009. p. 239-45. |
3. | Hydén D. Ear drum perforations in children after ventilation tube treatment. Int J Pediatr Otorhinolaryngol 1994;29:93-100. |
4. | Pribitkin EA, Handler SD, Tom LW, Potsic WP, Wetmore RF. Ventilation tube removal. Indications for paper patch myringoplasty. Arch Otolaryngol Head Neck Surg 1992;118:495-7. [PUBMED] |
5. | Te GO, Rizer FM, Schuring AG. Pediatric tympanoplasty of iatrogenic perforations from ventilation tube therapy. Am J Otol 1998;19:301-5. [PUBMED] |
6. | Merchant SN. Ossiculoplasty and tympanoplasty in chronic otitis media. In: Nadol JB, McKenna MJ. Surgery of the Ear and Temporal Bone. 2 nd ed. USA: Lippincott Williams and Wilkins; 2005. p. 306-25. |
7. | Spiros M. Closure of tympanic membrane perforation. In: Glasscocok MA, Gulya AJ, editors. Glasscock-Shambough surgery of the ear. Ontario: BC Decker Incorporation; 2003. p. 400-22. |
8. | Zollner F. Panel of myringoplasty. Second workshop on reconstructive middle ear surgery. Arch Otol 1963;78:301. |
9. | Heermann H. Tympanic membrane plastic with temporal fascia. Hals-Nasen-Ohrenh 1960;9:136. |
10. | Shea JJ Jr. Vein graft closure of eardrum perforations. J Laryngol Otol 1960;74:358-62. [PUBMED] |
11. | Tabb HG. Closure of perforations of the tympanic membrane by vein grafts. A preliminary report of twenty cases. Laryngoscope. 1960;70:271-86. |
12. | Tabb HG. Experience with transcanal and postauricular myringoplasty. Trans Pac Coast Otoophthalmol Soc Annu Meet 1968;52:121-5. [PUBMED] |
13. | Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ. Over-under tympanoplasty. Laryngoscope 2002;112:802-7. [PUBMED] |
14. | Luetje CM II. Reconstruction of the tympanic membrane and ossicular chain. In: Byron JB, Jonas TJ, Shawn D, editors. Head and neck Surgery - Otolaryngology. 4 th ed., Vol. 2. USA Lippincott Williams and Wilkins; 2006. p. 2114-23. |
15. | Adams ME, El-Kashlan HK. Tympanoplasty and ossiculoplasty. In: Flint PW, Haughery BH, Lund VJ, editors. Cummings otolaryngology head and neck surgery. 5 th ed. China: Mosby; 2010. p. 2003-4. |
16. | Yigit O, Alkan S, Topuz E, Uslu B, Unsal O, Dadas B. Short-term evaluation of over-under myringoplasty technique. Eur Arch Otorhinolaryngol 2005;262:400-3. [PUBMED] |
17. | Fiorino F, Barbieri F. 'Over-under' myringoplasty with umbus-anchored graft. J Laryngol Otol 2008;122:854-7. [PUBMED] |
18. | Ryan JE, Briggs RJ. Outcomes of the overlay graft technique in tympanoplasty. ANZ J Surg 2010;80:624-9. [PUBMED] |
19. | Jung T, Kim YH, Kim YH, Park SK, Martin D. Medial or medio-lateral graft tympanoplasty for repair of tympanic membrane perforation. Int J Pediatr Otorhinolaryngol 2009;73:941-3 |