A Comparative Study of Cartilage Versus Temporalis Fascia in Bilateral Simultaneous Myringoplasty

Lavanya, B T (2013) A Comparative Study of Cartilage Versus Temporalis Fascia in Bilateral Simultaneous Myringoplasty. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Myringoplasty is technique where the tympanic membrane defect is reconstructed aimed at creating an air filled middle ear cleft, prevent re infections for the external surroundings and help in reconstructing the hearing2. Since the publication of Miodoński, Zollner and Wullstein different methods and grafting materials have been promoted. Temporalis fascia has stood the test of time as an ideal graft material for tympanic membrane reconstruction. The past few years has seen the emergence of cartilage as an alternate or in fact more effective graft material. Various cartilage grafting techniques have been proposed. Palisade graft, island graft, cartilage shield and butter fly graft. This is attributed to its increased stability, resistance to re perforation and retraction. The rigidity of the cartilage raises doubts with regard to its ability to conduct sound. But thin the cartilage may improve sound conduction. It was suggested that cartilage grafts are stable, reliable and post operative hearing results are as good as or even better than the fascia. In this study I aim to compare the clinical and audiological outcomes of bilateral simultaneous myringoplasty done using cartilage versus bilateral simultaneous myringoplasty using temporalis fascia as graft materials. MATERIALS AND METHODS: STUDY PLACE : Rajiv Gandhi Govt General Hospital, Chennai. STUDY DESIGN : Prospective study. STUDY PERIOD : September 2010 to December 2012. SAMPLE SIZE : 30. AIM : To compare the outcome of bilateral simultaneous myringoplasty done using temporalis fascia versus cartilage and to compare the results in term of graft uptake, hearing improvement and the various factors influencing the same. INCLUSION CRITERIA: 1. Age : above 12 years, 2. Sex : both male and female are equally included, 3. Chronis suppurative otitis media tubo tympanic disease, 4. Bilaterally diseased ears, 5. Dry ear for at least 6 weeks, 6. Pure tone audiometary evidence of conductive hearing loss, 7. Treated / controlled nose and para nasal sinus disease. EXCLUSION CRITERIA : 1. Age : below 12 years, 2. Chronic suppurative otitis media attico antral disease, 3. Unilateral CSOM, 4. Actively discharging ears, 5. Pure tone audiogram evidence of mixed or sensori neural hearing loss, 6. Other external or middle ear disease, 7. Active nose and par nasal sinus disease, 8. Ear disease requiring any other procedure apart from myringoplasty. CONCLUSION 1. This study found that bilateral simultaneous myringoplasty can offer results equal in terms of healing and hearing like that of unilateral myringoplasty and at the same time help to conserve money and resources. 2. The graft take up rates were superior with cartilage than compared to temporalis fascia. 3 . Though several studies prove 90% and above success rates while using temporalis fascia for closure of tympanic membrane perforation in unilateral disease my study found only a 50 % success rate. Thus according to my study while dealing with bilateral disease the success rates are very much lower, so for a bilateral perforation which is quoted as a high risk perforation by Dornhoffer temporalis fascia may not be the material of choice. 4. Rates of residual perforation were drastically reduced at the end of 12 weeks in the ear using cartilage as graft material, were by the cartilage was found have successfully overcome the various factors influencing the outcome of a successful myringoplasty, to become integrated in the neotympamic membrane and thus withstanding the test of time. 5. The uptake of cartilage is not influenced by the status of the middle ear or status of the Eustachian tube.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cartilage, Temporalis Fascia, Bilateral Simultaneous Myringoplasty, Comparative study.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 25 Mar 2020 17:13
Last Modified: 25 Mar 2020 17:15
URI: http://repository-tnmgrmu.ac.in/id/eprint/12465

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