A newly introduced modified cartilage tympanoplasty vs traditional

A newly introduced modified cartilage tympanoplasty vs traditional
temporalis fascia tympanoplasty, a comparative analytical study
Khalid Al-Zaabi1, Arif Ali Kolethakkat2, Rashid K. Al-Abri2
1 Oman Medical Specialty Board (OMSB)
2 ENT Division, Surgery Department, College of Medicine

Background: Since its original description by Zollner in 1995 and Wullstein in 2952 many approaches, technique and grafting materials for tympanoplsty have been popularized and supported by various authors. Over the last decade there has been a growing interest in using the cartilage and the perichondrium owing to its rigidity,
low metabolic rate but mainly contributed to its nutrition by way of diffusion and resistance power to pressure variation. However the cartilage due to its thickness,
the concern over the obstruction of free ossicular mobility and potential hiding of a residual cholesteatoma ignited innumerable modifications in cartilage
tympanoplasties recently. A systemic review in 2012 by Scwan et al has reported a general conclusion of a better morphological and statistically significant hearing
outcomes for cartilage as graft material.

Objective: To compare the outcome of a newly introduced modified cartilage tympanoplasty technique with traditional temporalis fascia tympanoplasty

Methods: We did a retrospective study (with a prospective intent) in our tertiary care hospital – Sultan Qaboos University hospital since 2009 over period of five years
and the data were analysed statistically

Results: A total of 115 patients were evaluated for morphological assessment, 58 from temporalis fascia group (TFT) and 57 from Cartilage fascia (CFT). Out of 115
patients 54.8% were male and 45.2% were females. The mean age was 31.8 years with an average follow up of the cases was 11.1 months. In TFT group 70 percentages had normal closure whereas in cartilage group 94.7 % of cases showed healed uptake of graft. Those who had normal mobile ossicular the closure rate in TFT and CFT were 74.7 and 94.1 % respectively. In ossicular defective cases it was 72.7 and 95.6 percentage respectively. Out of total 80 patients counted for functional evaluation, 40 were TFT group and 40 were CFT group. In TFT group 33 patients had normal mobile ossicular status whereas in seven patients the ossicular status was abnormal. In CFT group it was 27 and 13 respectively. Those who had normal mobile intact ossciles, In TFT group in 69.7% cases ABG closed at or less than 20 dB but in CFT group ABG closure of less than 20 dB attained in 92.6% of cases, the difference was statistically significant. In those with ossciular defects,in TFT group out of 7 cases five cases showed necrosis of long process of incus, one case with absence of both malleus and incus and one case with absence of stapes.
In CFT group in 10 cases long process of incus was absent, two cases with absence of incus and stapes and two cases with extensive fixation of ossicles with absent
mobility. In TFT group based on Kartush protocol in 57.1 % cases ABG closed at or less than 20 dB but in CFT group ABG closure of less than 20 dB attained in 76.9% of cases, the difference was not statistically significant. Overall in TFT group based on Kartush protocol 67.5% cases ABG closed at or less than 20 dB but in CFT group ABG closure of less than 20 dB attained in 87.5 percentages of cases but the difference was statistically significant.

Conclusions: The cartilage fascia tympanoplsty with our own modification is reliable technique on morphological and functional perspectives over the traditional temporalis fascia grafting as revealed in our study. The technique and the statistical figures were reviewed with literature.