Elsevier

American Journal of Otolaryngology

Volume 32, Issue 5, September–October 2011, Pages 381-387
American Journal of Otolaryngology

Original contribution
Primary cartilage tympanoplasty: our technique and results

https://doi.org/10.1016/j.amjoto.2010.07.010Get rights and content

Abstract

Cartilage has shown to be a promising graft material to close tympanic membrane perforations. However, due to its rigid quality, doubts are raised regarding its sound conduction properties. It has been suggested that acoustic benefit may be obtained by thinning the cartilage. We describe our innovative method for harvesting tragal cartilage from the same endaural incision and also describe preparation of the graft by slicing it. We present our 3-year experience of shield cartilage type 1 tympanoplasty using sliced tragal cartilage–perichondrium composite graft.

Aim

The aim of this study was to prove the success rate of our technique of shield cartilage tympanoplasty using sliced tragal cartilage graft in terms of functional and anatomic results.

Study design

Retrospective analysis of type 1 cartilage tympanoplasties using sliced tragal cartilage was carried out in MIMER Medical College and Sushrut ENT Hospital during May 2005 to January 2008 with a minimum follow-up of 2 years.

Method and materials

A total of 223 ears were operated by our technique.

Results

The overall success rate of our technique was 98.20% in terms of perforation closure and air bone gap closure within 7.06 ± 3.39 dB. The success rates in the various age group are as follows: 11 to 20 years, 97.67%; 21 to 40 years, 99.12%; and 41 to 60 years, 96.96%.

Conclusion

Our technique of type 1 cartilage tympanoplasty achieves good anatomic and functional results.

Introduction

Temporalis fascia remains the most frequently used graft material with closure of the tympanic membrane in 70% to 90% of primary tympanoplasties in different hands. However, in some situations such as advanced middle ear pathology, retraction pockets, and atelectatic ears, temporalis fascia tends to undergo atrophy in the subsequent postoperative period regardless of placement techniques [1]. Our dissatisfaction with the temporalis fascia with a higher incidence of recurrent perforations compelled us to use a tougher material that would not only prevent reperforation but also prevent retractions. Cartilage has shown to be a promising graft material to close perforations in the tympanic membrane. Although it is similar to temporalis fascia, its more rigid quality tends to resist resorption, retraction, and reperforation, even in the milieu of continuous eustachian tube dysfunction [2].

Of the 23 well-defined cartilage tympanoplasty methods, Tos [3] has classified them into 6 groups:

  • 1.

    Underlay palisade method of Heermann

  • 2.

    Onlay palisade method

  • 3.

    Method of broad palisades

  • 4.

    Method of underlay stripes

  • 5.

    Method of onlay stripes

  • 6.

    Dornhoffer mosaic cartilage tympanoplasty

The tragal cartilage is yellow fibroelastic cartilage. The cartilage is a relatively avascular tissue. The presence of cartilage canals through which blood vessels may enter cartilage is well documented. Each canal contains a small artery surrounded by numerous venules and capillaries. Cartilage cells receive their nutrition by diffusions from vessels. Cartilage cells–chondrocytes lie in spaces (lacunae) present in matrix. Ground substance is made of complex molecules containing proteins and carbohydrates (proteoglycans). These molecules form a meshwork that is filled by water and dissolved salts. The carbohydrates are chemically glycosaminoglycans including chondroitin sulfate, keratan sulfate, and hyaluronic acid. The core protein is aggrecan. The proteoglycan molecules are tightly bound. Along with the water content, these molecules form a firm gel that gives cartilage its firm consistency [4].

This rigidity of the cartilage that prevents reperforations is, however, considered to interfere with the sound conduction properties of the tympanic membrane. We describe our innovative method for harvesting tragal cartilage from the same endaural incision and also describe the preparation of the graft by slicing it so as to obtain acoustic benefits.

Section snippets

Materials and methods

A retrospective study of type 1 cartilage tympanoplasties operated by both the authors in MIMER Medical College and Sushrut ENT Hospital from May 2005 to January 2008 was carried out.

Results

The data of the operated patients are tabulated in Table 1, Table 2, Table 3.

Discussion

It has been shown in both experimental and clinical studies that cartilage is well tolerated by middle ear, and long-term survival is the norm [5], [6], [7], [8]. The greatest advantage of the cartilage graft has been thought to be its very low metabolic rate. However, in addition, it can receive its nutrients by diffusion; it is very easy to work with because it is pliable and resists deformation from pressure variations and becomes well incorporated in the tympanic membrane [9]. Human and

Conclusion

Our technique of type 1 cartilage tympanoplasty gives good anatomic and functional results. The highlight of our technique is the harvesting of the graft via the same endaural incision. By slicing the cartilage, desired acoustic benefit is obtained. We recommend using sliced cartilage as a first choice for tympanic membrane reconstruction.

References (14)

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This study was not financially supported by external sources.

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