Cartilage Myringoplasty: An Ideal Grafting Technique for Complex Perforations MC06-MC08
Dr. Munish Kambatatti Shekharappa,
Associate Professor, Department of Ear, Nose and Throat, SSIMS and RC, Jnanashankara, NH-4 by-Pass Road,
Davangere-577005, Karnataka, India.
Introduction: Tympanoplasty is one of routinely performed surgeries in ENT practice. Using cartilage-perichondrium composite graft in selective cases gives better outcome.
Aim: To study the outcome and feasibility of cartilage-perichondrium composite graft in repair of complex tympanic membrane perforations.
Materials and Methods: This cross-sectional, intervention study was conducted at SSIMS and RC, Tertiary Care Teaching Hospital, Davangere, Karnataka, Southern India. Study sample consisted of 30 patients with chronic otitis media- tubo tympanic type in inactive stage. Patients were randomly selected and evaluated between January 2015 to June 2016. A detailed history, clinical examination, diagnostic nasal endoscopy, otoendoscopy were done for all patients preoperatively and postoperatively at three weeks, three months and six months. Audiological evaluation was done at six months postsurgery. Cartilage-perichondrium composite graft from tragal and conchal cartilage was used for the repair of tympanic membrane in all the cases. The data were presented in proportions, percentages.
Results: Of 30 cases who underwent surgery, 24 patients (80%) had large central and subtotal perforations. Only one patient had a total perforation. The remnant tympanic membrane showed atrophic changes in 16 cases (53%) and sclerotic plaque was seen in 14 cases (46%). In our study, tragal cartilage was used in 17 and conchal cartilage in 13 cases. All the patients underwent type-1 tympanoplasty. Successful graft uptake was seen in 28 cases (93%) by six months. Two patients (7%) had a residual perforation at three months and in four cases (13%), the neotympanum showed anterior blunting by the end of six months. With respect to hearing, maximum air bone gap closure achieved in our study was 21db in one patient and minimum was 3db. Average air bone gap closure achieved was 10.1db.
Conclusion: Cartilage-perichondrium composite graft can be considered a good choice in repair of tympanic membrane perforations with specific selective indications.