Publication:

The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

Background The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.

Methods This prospective non-controlled, non-randomized  study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups:  revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears .  Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and p<0.05 was considered statistically significant for the hearing outcomes.

Results Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (p<0.05). Best take up rates were observed in atelectatic and tympanosclerotic group i.e., 100% and 96.55% respectively.

Conclusions This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.