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With large number of grafts available for ossiculoplasty, choice becomes difficult. An ideal graft should be safe, easily available, cost efficient, with good hearing results, uptake and low extrusion rates. The ear nose and throat surgeon is still facing the indecision over type of graft to be selected. A prospective study was conducted in Department of Otorhinolaryngology, Rajindra Hospital, Patiala (August 2012–2014) on 50 patients 15–60 years, of either sex with ABG > 40 dB. Operative procedure planned and type of graft decided intraoperatively. Autografts included remodelled malleus, remodelled incus and tragal cartilage grafts. Synthetic (Teflon) grafts were PORP and TORP. Graft uptake/failure was noted at 1 and 3 months. PTA done at 3 months postoperatively. Net hearing gain (change in ABG) was calculated for various grafts used and analysed. Mean age was 35.26 ± 13 yrs, male and female 1:1. Most common involved ossicle was incus (100%) followed by stapes (36%) and malleus (34%). Autografts, 23, uptake in 20 (86.95%), failure 3 (13.04%) cases. Synthetic grafts, 27, uptake 18 (66.66%) and failure 9 (33.33%). ‘p’value 0.09 (non significant). Mean hearing gain, autografts 14.47 ± 6.54 dB and synthetic grafts 14.57 ± 13.12 dB. ‘p’ value 0.976 (non significant). No significant difference seen in mean hearing gain and uptake/failure of autografts and synthetic grafts. Autografts being cost effective are preferred choice.

Objective To compare half-thickness tragal cartilage graft with temporalis fascia graft in terms of graft take-up and acoustic outcomes in type-I tympanoplasty. Methods The randomised control trial was conducted at Lady Reading Hospital, Peshawar, Pakistan, from January to December 2017, and comprised patients aged 16-60 years undergoing tympanoplasty. The patients were divided into two equal groups using systemic random sampling method. In Group A, tympanoplasty type-I was done using half-thickness tragal cartilage graft, while in Group B, it was done using temporalis fascia graft. Data was analysed using SPSS20. Results Of the 40 patients, there were 20(50%) in each of the two groups. Overall, there were 24(50%) males and 16(40%) females. The mean age of Group A was 28.57±8.00 years, and in Group B it was 27.14±6.18 years. The graft success rate in Group A was 19(95%) and in Group B it was 18(90%) (p>0.05). Conclusion The graft success rates for half-thickness tragal cartilage and temporalis fascia were statistically non-significant.

Background and objectives Patulous Eustachian tube (PET) causes troublesome autophony. We treated PET using tragal cartilage chip insertion to fill in the concavity within the tubal valve and evaluated the feasibility of this method. Subjects and methods This study used a prospective design. Eleven patients with PET disorder were included. Tragal cartilage chip insertion via a transcanal approach into the Eustachian tube (ET) was performed in 14 ears of those patients. They were followed-up for at least 12 months after surgery and were evaluated by symptom questionnaire scores. Results The average follow-up was 16.4 months. Thirteen of fourteen ears received immediate complete relief of autophony symptoms. Autophony symptoms at the last follow-up were as follows: four ears (28.6%) had complete relief; five ears (35.7%) showed satisfactory improvement; four ears (28.6%) showed significant but unsatisfactory improvement; and one ear (7.1%) was unchanged. The PET symptom questionnaire in the affected ears showed a significant reduction in autophony (p=0.047) and improvement in breathing sound conduction (p=0.047). There were no complications such as otitis media or occlusion symptom. Conclusions Transtympanic cartilage chip insertion into the ET provides a safe and accessible surgical option for the treatment of PET.

BACKGROUND To evaluate the effectiveness of Cartilage as a grafting material in terms of graft uptake and postoperative hearing following Type I Tympanoplasty. Tympanoplasty is a procedure to eradicate disease in the middle ear and to reconstruct the hearing mechanism, with or without tympanic membrane grafting commonly due after chronic otitis media and trauma. MATERIALS AND METHODS 100 subjects were enrolled for the study for a period of 1 1/2 Years from 2015 to 2017 June. All patients between 15 to 60 Years having mucosal type of CSOM with central, subtotal perforation and conductive hearing loss

BACKGROUND The objective of the study was to compare the hearing improvement after using sliced cartilage graft with that of temporalis fascia and to compare the graft take-up between the two graft materials. MATERIALS AND METHODS A prospective clinical study including 60 patients with chronic mucosal otitis media, who were selected randomly from the outpatient department, after obtaining their consent were divided into 2 groups of 30 each, and evaluated according the study protocol. Their pre-operative audiometry was recorded and both groups of patients underwent surgery with one of the graft materials- temporalis fascia or sliced tragal cartilage with a thickness of 0.5 mm. All patients were regularly followed up and post-operative audiometry was done at 3 months. The hearing improvement in the form of closure of air-bone-gap and graft take-up was analysed statistically. RESULTS The temporalis fascia graft group had a pre-operative ABG of 22.33 ± 6.24 dB and post-operative ABG of 12.33 ± 4.72 dB with hearing improvement of 10.00 dB. The sliced cartilage graft group had a pre-operative ABG of 20.77 ± 5.75 dB and postoperative ABG of 10.50 ± 4.46 dB with hearing improvement of 10.27 dB. In the temporalis fascia group, 28 (93.3%) patients had good graft take-up and in the sliced cartilage group 29 (96.7%) had good graft take-up. There was statistically significant hearing improvement in both of our study groups but there was no statistically significant difference between the two groups. There was no statistically significant difference in graft take-up also. CONCLUSION Sliced cartilage graft is a good auto-graft material in tympanoplasty, which can give good hearing improvement and has good graft take-up, which is comparable with that of temporalis fascia.

Chronic tympanic membrane (TM) perforation associated with ventilation tube (VT) insertion was commonly encountered in pediatric patients with chronic otitis media with effusion (COME) treatment and eustachian tube dysfunction. The persistent perforation require surgical closure by myringoplasty. Song JS et al. recently a paper entitled: “Evaluating short and long term outcomes following pediatric myringoplasty with gelfoam graft for tympanic membrane perforation following ventilation tube insertion.” In their study, the authors performed gelfoam myringoplasty to repair the perforations following VT insertion in children and compare the successful TM closure rate among different graft materials. The authors believed that gelfoam alone was superior to hyaluronic acid (HA), tragal cartilage (TC), and gelfoam-plus-temporal fascia (TF). The sample size is unbalanced and incommensurable between gelfoam and other graft materials. In addition, a confounding factor was added in the gelfoam group, thereby affected the assessment of TM closure. Thus, the conclusion is not rigorous and scientific.

Aim The aim of this study was to compare the anatomical and functional outcomes of grafting the tympanic membrane (TM) – that is, previously failed grafting – by two graft materials: the first was formaldehyde-treated temporalis fascia graft (FTFG) and the second was tragal cartilage composite graft. Graft-take, hearing results, and complications were compared. Patients and methods The present study included 36 patients with chronic suppurative otitis media with recurrent TM perforation. Nineteen patients received tragal cartilage graft, and 17 patients received the FTFG. For each patient, history taking and complete general and ENT examinations were performed. Graft-take, preoperative and postoperative pure tone average, air–bone gap, and tympanometry scores were calculated and compared. Statistical analysis Data entry and data analysis were carried out using statistical package for social science version 19. Results and conclusion The present study showed that for repairing TM grafting, cartilage graft and FTFG were comparable in both graft-take and hearing results. The FTFG reflected the true configuration of tympanometry. It can be used in cases where the cartilage graft is previously consumed.

Introduction The use of endoscope is rapidly increasing in otological and neuro-otological surgery in the last 2 decades. Middle ear surgeries, including tympanoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Superior visualization and transcanal access to diseases normally managed with a transmastoid approach are touted as advantages with the endoscope. Objectives The present study aimed to compare the outcomes of endoscopic and microscopic cartilage tympanoplasty (Type I) Methods This was a retrospective comparative study of 70 patients (25 males and 45 females) who underwent type I tympanoplasty between March 2015 and April 2016. The subjects were classified into 2 groups: endoscopic tympanoplasty (ET, n = 35), and microscopic tympanoplasty (MT, n = 35). Tragal cartilage was used as a graft and technique used was cartilage shield tympanoplasty in both groups. Demographic data, perforation size of the tympanic membrane at the preoperative state, operation time, hearing outcome, and graft success rate were evaluated. Results The epidemiological profiles, the preoperative hearing status, and the perforation size were similar in both groups. The mean operation time of the MT group (52.63 ± 8.68 minutes) was longer than that of the ET group (48.20 ± 10.37 minutes), but the difference was not statistically significant. The graft success rates 12 weeks postoperatively were 91.42% both in the ET and MT groups, that is, 32/35; and these values were not statistically significantly different. There was a statistically significant improvement in hearing within the groups, both pre- and postoperatively, but there was no difference between the groups. Conclusion Endoscopic tympanoplasty is a minimally invasive surgery with similar graft success rate, comparable hearing outcomes and shorter operative time period as compared to microscopic use.

Objective: The objective of study is to compare overall success rate of myringoplasty after 6 weeks and 4 months following surgery. Materials and Methods: Retrospective analytical study was done at Lahan Ear Hospital, Nepal. All the data were collected from the operative notes of Lahan ear hospital which were done in-between August 2010 to October 2012 for a period of 26 months. All Myringoplasty were done under local anesthesia using either temporalis fascia or Tragal cartilage. Outcome measured was the graft uptake rate at the end of 6 weeks and end of 4 months. Results: Total of 978 patient underwent Myringoplasty during the period of 26 months. The mean age was 24.4 years, minimum age who underwent surgery was 15 years and maximum age was 60 years. 571 patients completed 6 weeks follow up and only 419 patient completed 4 months follow up. The overall graft uptake rate was 82 % and 78 % by the end of 6 weeks and 4 months respectively. Conclusion: The overall graft uptake rate was 82 % by the end of 6 weeks which further decreased to 78% by the end of 4 months. Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Cholesteatoma is a common occurrence in the middle ear. Cholesteatoma of the external auditory canal (EAC) is a rare entity. We report the first case of our department of cholesteatoma of the EAC limited to the posterior wall, in a 14-year-old patient presented with chronic left purulent otorrhea. We performed a canalplasty under general anesthesia. Debris of keratin were removed and the eroded bone was curetted. We repaired the bony erosion with the tragal cartilage. Two years after the surgical procedure, there was no evidence of recurrence. Clinical symptoms of EAC cholesteatoma are not specific. It is therefore important to think about cholesteatoma when a patient presents with chronic otorrhea with intact tympanic membrane.

To determine the outcomes of using tragal cartilage in performing tympanoplasty. It was a prospective study of 57 patients with chronic suppurative otitis media. In all patients, pure tone audiometry was done pre-operatively. Tragal cartilage with attached perichondrium as graft material was used for ossicular chain reconstruction. In fifty out of the 57 participants, the outcome was intact ossicular chain. Of the 7 failures, 5 were recorded in the age group of 51–65 years, where graft uptake failed and hearing was not improved. Two of the failed cases required revision tympanoplasty. Post operative audiograms on follow-up revealed reduced air–bone gaps, with dry tympanic cavity and improved hearing. This study concluded that ossiculoplasty using tragal cartilage as a grafting material was an effective and safe surgical method for reconstruction of the ossicular chain and restoration of sound transmission.

OBJECTIVE: Transcanal endoscopic type 1 tympanoplasty is a minimally invasive procedure that enables better visualization of deep and narrow spaces compared to conventional microscopic methods. In our study, we aimed to evaluate air-bone gap difference, graft success, and hearing gain according to the perforation size and location in pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty. METHODS: Fifty pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty for chronic otitis media were included in the study. Tragal cartilage grafts were used in all patients. Air conduction pure tone audiometry hearing results (500, 1000, 2000, and 4000 Hz), mean air-bone gap levels, operating times, postoperative gap closure, and graft success rates were evaluated. RESULTS: Mean operating time was 43.34±8.56 minutes. Overall graft success was 94% (47/50). Mean hearing levels at all frequencies (500, 1000, 2000, and 4000 Hz) were found to have significantly improved after the operation (p

Introduction Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Objectives The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results. Methods This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months. Results During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% (n = 123) of the patients 6 months after the intervention.Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively.Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant (p Conclusion The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

Purpose The aim of this study was to evaluate posterior pharyngeal wall augmentation using autologous tragal cartilage graft in patients with velopharyngeal valve insufficiency (VPI) after simple palatoplasty for cleft palate. Patients and methods This study included 18 patients with postpalatoplasty VPI (grade 2 or 3), with ages ranging from 5 to 14 years. Patients were followed up for 24–48 months postoperatively. Percent of speech intelligibility and grade of closure of velopharyngeal valve with nasopharyngoscope were evaluated preoperatively and postoperatively. Results Statistically significant improvement in grade of closure of velopharyngeal valve (P=0.001) and percent of intelligibility (P=0.001) was found after surgery. Conclusion Augmentation of the posterior pharyngeal wall using tragal cartilage is a safe technique, with generally good surgical and phoniatric outcomes in the management of pediatric patients with grades 2 and 3 VPI after simple palatoplasty to overcome hypernasality.

Background: A tympanoplasty is a surgical procedure to close a tympanic membrane perforation and reconstruct the tympanic membrane and hearing, commonly after chronic otitis media and trauma.Methods: 50 patients were divided into 2 groups and underwent type-1 tympanoplasty using temporalis fascia versus sliced tragal cartilage. The patient was placed in supine position. Antiseptic painting and draping was done. All cases were operated under local anaesthesia. Post aural approach with post aural Wilde’s incision with 15 number blade, the incision was made 5-10 mm posterior to post aural groove. Temporalis fascia graft was harvested. Tragal cartilage, incision was taken over the under surface of the tragus and tragal cartilage was sliced. Results: The mean duration of symptoms was 12.72 and 15.84 months in group A and B respectively. Reduced hearing was noted in 21 and 24 patients, ear discharge in 21 each and giddiness in 2 and 4 patients respectively in group A and B. The difference was non-significant when the symptoms were evaluated. Improvement in AB gap was significantly better in group B with a p value of 0.042. The mean improvement was 14.2 dB and 17 dB respectively.Conclusions: Type-1 tympanoplasty using the sliced tragal cartilage may be associated with better improvement in AB gap and can be regularly employed compared to temporalis fascia method.

This study aims to investigate the preoperative, postoperative airway hearing threshold levels, and perforation closure rates in patients who underwent primary tragal cartilage tympanoplasty. One hundred seventy-one patients who had chronic otitis media without cholesteatoma underwent primary tragal cartilage tympanoplasty with endaural approach by using underlay technique. Preoperative and postoperative airway hearing threshold levels at 500, 1000, 2000, 4000 Hz frequencies in 8 to 99 months' follow-up were found and compared with each other. Postoperative perforation closure rates were also investigated. At 500 Hz in 112 patients, at 1000 Hz in 106 patients, at 2000 Hz in 96 patients, and at 4000 Hz in 80 patients, more than 9.5 dB airway hearing gain was determined. The authors found their postoperative perforation closure rate as 84.8%. In conclusion, tragal cartilage tympanoplasty may be chosen as the primary operation technique in primary chronic otitis media patients and by this technique perforation closure rates are also acceptable in addition to satisfactory hearing gain.

Introduction In conditions like recurrent perforations, atelectatic tympanic membrane and poor eustachian tube function, temporalis fascia graft fails to give the desired result. In such cases cartilage is used for tympanoplasty. It was demonstrated that if the thickness of cartilage is reduced to around 0.5 mm, the sound conduction is comparable to that of normal tympanic membrane with excellent mechanical stability. Aim To intra-operatively measure the mean thickness of tragal and conchal cartilage and compare it for age and sex variations. Material & methods A total of 114 tragal and conchal cartilage samples of 86 patients were included in the study. Thickness of cartilages was measured intra-operatively after removing the perichondrium from both sides. Results Out of 58 tragal cartilages, 32 were from males and 26 from females. Mean thickness was 1.18 ± 0.11 mm among males and 1.12 ± 0.14 mm among females. Out of 56 conchal cartilage taken, 29 were from males and 27 females. Mean thickness among males were 1.38 ± 0.13 mm and 1.35 ± 0.08 mm in females. In 28 patients both tragal and conchal cartilage was taken. Mean thickness of both tragal (1.22 mm) and conchal cartilage (1.36 mm) increased with increase in age. Among 16 males in whom both cartilages were taken, mean thickness of tragal cartilage was 1.25 ± 0.11 mm and conchal cartilage was 1.41 ± 0.12 mm. Similarly among 12 females where both cartilages were taken, mean thickness of tragal cartilage was 1.20 ± 0.13 mm and conchal cartilage was 1.35 ± 0.07 mm. Conclusion Sliced cartilage tympanoplasty is a relatively better technique. When using cartilage splitter to get sliced cartilage, ideally thickness of every graft should be known. As it is difficult to measure the exact thickness in every case, so knowing the mean for age and sex for cartilage thickness is important to have an idea of which plates to use for a successful outcome of slicing. We concluded that thickness of tragal cartilage is significantly less than the thickness of conchal cartilage. Also there is significant age related difference between mean thickness of cartilages, both for tragal and conchal cartilage. Surprisingly the difference between thickness in male and female is not statistically different.

The anatomical and functional success rates of tragal cartilage perichondrium and temporal muscle fascia, in pediatric patients who underwent endoscopic type 1 tympanoplasty with limited tympanomeatal flap elevation, were compared. In total, 35 pediatric patients (21 females, 14 males; mean age 11.0 ± 1.5 years; range 8–14 years) who underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of the tympanomeatal flap were included in this study. Patients in group A received a tragal cartilage perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air–bone gap (ABG) and tympanic membrane status. The mean preoperative and postoperative ABG were 27.0 ± 9.2 and 9.0 ± 8.5 dB in group A, and 26.8 ± 8.8 and 11.6 ± 9.2 dB in group B, respectively. The group differences in pre- and postoperative ABG values were not significant (p = 0.882 and p = 0.417, respectively). However, in both groups, the postoperative ABG was significantly lower than the preoperative ABG (both p = 0.0001). The graft retention rate was 100% in group A and 88.2% in group B; the difference was not statistically significant (p = 0.134). There was also no statistically significant difference between the pre- and postoperative bone conduction values of the patients at 0.5, 1, 2, 3 or 4 kHz (all p > 0.05). Our study demonstrated that in pediatric patients undergoing endoscopic tympanoplasty, both the tragal cartilage perichondrium and the temporal muscle fascia can be used successfully and safely as grafts in endoscopic type 1 tympanoplasty performed by limited tympanomeatal flap elevation.

WOS: 000469906400020, PubMed: 30878559, Objective: The timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of this study was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and to evaluate the prognostic factors that may affect its success. Materials and methods: A retrospective study of 42 pediatric patients who were younger than 18 years and underwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia from January 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and 18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type (central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia, perichondrium), length of follow up and surgical outcomes were collected. Results: The overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantly higher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group (p = 0.023). The functional success rate (postoperative air-bone gap < 20 dB) obtained in the perichondrium group was 90.4% (19/21) and 85.7% (18/21) in the fascia group, respectively. After a mean follow-up of 27.5 +/- 11.55 months, the mean hearing improvement was 11.26 +/- 7.53 dBHL for overall the group. Presence of contralateral otitis media with effusion (OME) was found a risk for reperforation and bilateral perforations were negatively affected graft success rate (p < 0.01). Graft success did not affected by age, gender and type and location of perforation (p > 0.05). Conclusion: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatric tympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be the first choice of graft material due to its high success rates. There were no significant differences between the fascia and perichondrium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations and contralateral OME, and should be treated with perichondrium or cartilage graft.

Cartilage is a rigid material that is highly resistant to infection and retraction and is tolerated well by the middle ear. The purpose of this study was to review retrospectively the results of cases of mastoid cavity obliteration with cartilage performed after canal wall down (CWD) mastoidectomy and to discuss the literature.Of 983 patients who underwent surgery for chronic otitis media between January 2000 and June 2012, 54 patients who underwent CWD mastoidectomy plus mastoid cavity obliteration with cartilage and who were followed up regularly were selected from the database and invited for re-evaluation. All patients who came for a follow up after the invitation were examined and their data were evaluated retrospectively.Thirty-five of the patients who accepted the invitation were included in the study. All of the patients in the study underwent mastoid cavity obliteration with conchal and/or tragal cartilage grafts. The duration of follow up ranged from 21 to 41 months (average, 27.3 months). Epithelization occurred in all patients with dry cavity, except one who had residual cholesteatoma and underwent revision surgery.The results of this study indicate that cartilage can be preferred for obliteration of mastoid cavity after CWD mastoidectomy.Kartilaj enfeksiyon ve retraksiyona karşı oldukça dirençli ve orta kulak tarafından iyi tolere edilen sert bir malzemedir. Bu çalışmanın amacı, canal wall down (CWD) mastoidektomi sonrası kartilaj ile mastoid kavite obliterasyon yapılan olguların sonuçlarını geriye dönük olarak gözden geçirmek ve literatürü tartışmaktır.Ocak 2000 - Haziran 2012 tarihleri arasında kronik otitis media ameliyatı geçirmiş 983 hastadan, CWD mastoidektomi ve mastoid kavite obliterasyonu yapılan ve düzenli aralıklarla takip edilen 54 hasta veri tabanından seçildi ve yeniden değerlendirme için çağrıldı. Tekrar inceleme için gelen tüm hastalar değerlendirilerek verileri retrospektif olarak analiz edildi.Yeniden değerlendirme için çağırılan hastaların 35’i çalışmaya dahil edildi. Çalışmaya alınan tüm hastalara konkal ve/veya tragal kartilaj greftler ile mastoid kavite obliterasyonu uygulandı. Takip süresi 21 ila 41 ay arasında değişmekte idi (ortalama, 27.3 ay). Rezidüel kolesteatom gelişen ve revizyon ameliyatı geçirilenlerin haricinde kuru kaviteli tüm hastalarda epitelizasyon görüldü.Bu çalışmadan elde edilen sonuçlar, CWD mastoidektomi sonrası mastoid kavite obliterasyonu için kartilaj tercih edilebileceğini göstermektedir.

Several techniques have been proposed for the management of perforation of or severe damage to the temporomandibular joint disc, with a wide range of success rates reported. We describe a new method using a pedicled sliding flap of the tragal cartilage.

Objective To investigate the success rates and hearing outcomes of temporalis fascia and tragal cartilage grafts used for type-1 tympanoplasty in the elderly (³65 years) Methods The medical records of 73 elderly patients who underwent type-1 tympanoplasty at our center between January 2010 and June 2017 were retrospectively reviewed for age, gender, perforation side, presence of contralateral perforation, type and location of perforation, graft material types, preoperative and postoperative hearing levels, and length of follow-up. Results The graft success rate was 83.5% (61 patients) for the entire group, 76.2% (32 patients) for the fascia group, and 93.5% (29 patients) for the cartilage group. The success rate for the cartilage group was significantly higher than that for the fascia group (P = 0.048). The mean hearing gain was 12.5 ± 7.6 and 8.9 ± 6.1 dB in the fascia and cartilage groups, respectively, and postoperative ABG was 10 dB or better in 29 (69.0%) and 19 (61.3%) patients, respectively. The mean hearing gain was significantly higher in the fascia group than in the cartilage group (P = 0.028), whereas the mean ABG was significantly higher in the cartilage group than in the fascia group (P = 0.009). The functional success rates were similar in both groups (P = 0.490). Conclusion Tympanoplasty is a safe and effective procedure in elderly patients with a 83.5% of graft success rate. Tragal cartilage may be the first choice of graft material due to its high success rates. The functional outcomes did not show significant differences between the fascia and cartilage groups.

Cartilage-perichondrium composite graft is used in middle ear surgery for tympanic membrane, ossicular and for soft wall reconstruction. The thickness of the cartilage is thought to interfere with the sound conduction. In our otology practice for tympanic membrane reconstruction, we prefer the sliced cartilage graft to achieve acoustic benefit. At times in the process of slicing, the cartilage gets wasted if not sliced with a precision slicing instrument. We have designed and developed a multi-purpose cartilage slicer for precise reduction of the thickness of the cartilage. To describe the design of our cartilage slicer and to report our preliminary experience with the cartilage slicer. Descriptive study. The technique of slicing with our new cartilage slicer and its usage has been described in detail. A total number of 689 cartilages in tympanoplasty and mastoidectomy have been sliced with it from 2013 to 2017. Our study reports the technique of slicing the tragal cartilage for tympanoplasty, highlighting its advantages and precision of the cartilages slices obtained. Our cartilage slicer is a good option for cartilage slicing in tympanoplasty. LEVEL OF EVIDENCE: Level 4.

To evaluate graft take up and hearing improvement using the technique of tragal cartilage island in COM-mucosal type. Prospective study. A total of 258 type 1 tympanoplasty surgeries were done using tragal cartilage island graft from December 2013, to December 2015; in Jubilee Mission Medical College and Research Institute with a follow up of 1 year. Inclusion criteria—all the patients undergoing type 1 tympanoplasty for chronic otitis media (mucosal type, inactive) with an intact ossicular chain by the senior author. The youngest patient was 6 years old and the oldest was 64 years. This pattern was selected for getting a uniform pattern even though cartilage tympanoplasty can be done in other forms of COM also. Graft take up in our study was found to be 96.12% in 1 year of follow up. Closure of tympanic membrane was achieved in 248 of 258 cases. None of the patients showed retraction pockets or cholesteatoma during follow up. The average pre-op AB gap was 21.62 dB which was lowered to 4.22 dB post op. The mean gain in hearing was 17.37 dB. It is worthwhile to consider tragal cartilage island graft as an alternative to temporalis fascia.

To evaluate the outcomes of simultaneous bilateral inlay butterfly cartilage tympanoplasties (BIBCT) using tragal cartilage from one ear in patients with bilateral chronic otitis media (BCOM).33 patients (66 ears) who underwent bilateral inlay butterfly cartilage tympanoplasties between June 2013 and September 2016 in Department of Otolaryngology-Head and Neck Surgery of Adiyaman University Education and Research Hospital, Adiyaman, Turkey - a tertiary care university teaching hospital. Anatomical success and functional success were assessed postoperatively. Air-bone gap (ABG), air-conduction thresholds, and bone-conduction thresholds were all assessed. The preoperative and postoperative averages of 0.5, 1, 2, and 3kHz of pure-tone thresholds were used for the mean air- and bone-conduction thresholds according to the guidelines of the Committee on Hearing and Equilibrium.Anatomical success could be demonstrated in 57 of 66 ears (86.3%). The overall mean of ABG improved from 23.97±8.63dB preoperatively to 10.42±4.82dB postoperatively (p0.05). The ABG gain was 13.55±8.17dB. Postoperative percentages of patients with ABG less than 20dB and 10dB were excellently achieved to 98% (41% preoperatively) and 56% (10.6% preoperatively), respectively. The average length of operation time for both ears was 57.42±9.39min.When compared with conventional two-staged tympanoplasty in patients with BCOM, simultaneous BIBCT using tragal cartilage from one ear is an advantageous approach for multiple reasons which include single hospital stay with resultant decreased risk of complications associated with anesthesia and surgery, less morbidity like cosmetic and hearing discomfort, time-savingness and cost-effectiveness.

Objective: To investigate the effect of nitrous oxide to the success of tympanoplasty graft after operation. Material and methods: ASA I-II, 83 patients who underwent tympanoplasty were retrospectively analyzed. Patients were divided into 4 groups examined in the repair of the perforation under general anesthesia. In Groups 1 and 3 the temporal muscle fascia was used, in Group 2 and 4 tragal cartilage pericondrium was used. Nitrous oxide gas was closed during the operation of the Group 1 and 2, not closed in Group 3 and 4 respectively. Postoperatively, examination of the records of the membrane at the end of the year regarding the status of surgical success was defined as an intact membrane. Results: 18 to 63 years of age, 50 (60%) male and 33 (40%) female, a total of 83 case were evaluated. When the groups were compared with each other in terms of the number of graft-repellent ear, rejection rate was higher in group 3 than group 1 and in group 4 than in group 2, but there was no statistically significant difference between the groups (p>0.05). Conclusion: Nitrous oxide does not affect graft success alone, but the patient’s age, size and location of the perforation, the preoperative condition of the ear, eustachian tube function and the type of graft material used were the factors affecting the success rates

In 1994, the American Otological Society reported favourable experience with composite cartilage shield tympanoplasty. The tragal cartilage with a grommet inserted in it was used for tympanoplasty in our patient with unilateral CSOM, supposedly because of severe chronic eustachian tube dysfunction. The marriage of cartilage tympanoplasty with grommet insertion was aimed to add the advantages and abolish the disadvantages of both the procedures. In 1990 Lary Hall first introduced the “long term ventilation of the middle ear” with a T-tube placed in the tragal cartilage perichondrium composite island graft. T-tube insertion in the cartilage has been described. But insertion of the Indian Sheperds grommet (ventilation tube) in the cartilage graft as described in this case and its technique are possibly the first of its kinds in literature. The report is aimed to ignite innovation of newer and better techniques of cartilage tympanoplasty.

Objectives: To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty. Methods: Retrospective review of single surgeon experience. Results: During a 3 year period, 30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts. There were 22 boys and 8 girls, ranging in age from 3.5 to 17 years (median 6 years). All tragal cartilage grafts (31/31; 100%) survived. Twenty-seven surgeries (27/31; 82%) resulted in an intact drum (17/31; 55%) or a microperforation (10/31; 32%). In four cases (4/31; 13%) significant perforations formed in previously unaffected portions of the drum. Conclusion: Transcanal endoscopic cartilage inlay tympanoplasty offers a practical, minimally invasive approach to tympanoplasty for children of any age. It avoids postauricular or endaural incisions, tympanomeatal flap elevation, and canalplasty. Graft survival is uniform. Microperforation at the graft margins remained in 1/3 of children. Technical modifications may lead to higher rates of tympanic closure. Key words: Cartilage graft; Endoscopic ear surgery; Minimally invasive surgery; Otoendoscopy; Pediatric tympanoplasty

This study reveals that tragal cartilage tympanoplasty is a reliable technique, it has a high degree of graft take, and the tympanic re-aeration and hearing results are satisfactory.Cartilage is the grafting material of choice in advanced pathologies of the middle ear while the indications for its routine use remain controversial. The purpose of this study was to report our long-term experience with the 'tragal cartilage shield' tympanoplasty.This was a retrospective case series. The study was conducted on 612 adult patients from January 2003 until January 2012. We evaluated graft take, pure-tone average air-bone gap (PTA-ABG), postoperative aeration, and complications. The mean postoperative follow-up was 68 months.Sex, age, and tobacco smoke did not have any impact on postoperative results. Graft take was achieved in 99.35% of patients; there were no immediate postoperative complications. The overall average preoperative PTA-ABG was 44.95 ± 7.77 dB, whereas 1 year after surgery it was 10.66 ± 5.41 dB (p0.0001). Statistically significant improvement was observed up to 10 years after surgery. Moreover, we obtained a good tympanic ventilation (1 year after surgery, the average aeration score was 9.09 ± 1.93), which was stable up to 10 years.

Background: Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum (tympanic membrane) and/or the small bones of the middle ear. Chronic otitis media is a very common condition of middle ear which not only has a high incidence in the world but also in our set up. So, in view of this, we decided to conduct a study on the surgical management of CSOM-tubotympanic type.Methods: We conducted this study at ENT department of Dr. Hedgewar Rugnalaya, Aurangabad to compare air bone gap closure by using tragal cartilage and autologous incus in type IIB tympanoplasty in patients with chronic suppurative otitis media, (tubotympanic). 66 patients with central perforation of tympanic membrane, necrosed incus and mobile stapes requiring type IIB tympanoplasty, were included as a part of the study.Results: We performed type IIB tympanoplasty with a routine post-aural incision in 66 patients. According to our observation, both incus and cartilage are good materials for ossiculoplasty, tragal cartilage being better.Conclusions: After conducting this study we concluded that incus and tragal cartilage both are excellent materials for ossiculoplasty.

33 males and 12 female patients were selected for tymponoplasty either righter left harvesting of the tragalcartilage graft with a thickness between 0.2 to 0.4 mm and techniques used were underlay techniques and lateral to the hand of malleus supported by gel foam on both sides. During the study mean value of diameters of external canal in 21 males (63.6%) was 1.2 mm, and 12 males (36.3%) it was 1-4mm. In females 7 females (58.3%) the diameters of external canal was 1.2mm and in 5 females (41.6%) it was 1.3mm. The size of perforating gap in tympanic membrane Air borne gap range and average range study. 20 males had 1–2 mm perforations, air borne range was 10–31 dB and average range was 22dB. In 10 males the perforation size was upto 1mm, air borne range was-0.25mm, the average range was 11dB. In 3 males air borne range 17-31dB and average range was 23 dB. In females study 7 females had 2-3mm perforation, air borne range was 14–36 and average was 24 dB, In 3 females perforation was upto 1mm, air borne range was 0–25 dB and average was 9 dB, In 2 females had 3-4mm perforation, air borne range was 17–31 dB and average range was 23 dB. This study of tympanoplasty by tragal cartilage will be certainly helpful to junior ENT surgeons and biotechnologist to invent such similar technique in future.

Purpose Facial nerve paralysis can result in critical complications, including those to the visual, respiratory, and digestive systems. The facial nerve has been reanimated using various nerves, but the posterior auricular nerve (PAN) branching off the facial nerve has not been explored for this purpose. Materials and Methods Ten sides from 6 fresh-frozen adult cadavers were used for dissection of the PAN to explore its potential as a donor for facial nerve reanimation. The facial nerve trunk (FNT) and PAN were consistently and readily identified by deep dissection using the tragal cartilage and tragal pointer as landmarks. The PAN was transected at the point of insertion of its innervated muscles. Its length and diameter were measured, and it was transposed anteriorly to the FNT and its 2 major extracranial divisions. Results The PAN was observed on all sides. Its available length was 27.11 ± 5.02 mm and its mean diameter was 0.85 ± 0.20 mm. In all specimens, the PAN readily reached the FNT and its 2 major divisions without tension. Conclusion No previous study has explored the use of the PAN as a donor for facial nerve reanimation. Based on the present cadaveric study, surgeons might consider it for this purpose.

OBJECTIVES To standardize the information for families of children having functional surgery for middle ear malformations, we describe the audiometric results of the subgroup of patients with the most favorable anatomic conditions: viable auditory canal, intact tympanic membrane, mobile stapes, and corresponding to a Jahrsdoerfer score of 8 or higher. STUDY DESIGN Case series, tertiary referral center. METHODS Charts of patients undergoing functional surgery for congenital middle ear malformations were reviewed for demographic data, preoperative Jahrsdoerfer score, ossicular chain status, type of ossiculoplasty, and audiometric data before and 6 months postsurgery. RESULTS Eighteen consecutive interventions were performed on 13 patients (average age of 9 years, 8 girls and 5 boys) between 2004 and 2011. The ossiculoplasties performed were as follows: incus repositioning (4), double-layer tragal cartilage (5), intact native chain reconstruction (3), and partial ossicular prosthesis (6). Mean air bone gap (ABG) was 40.8 ± 12.4 dB preoperatively and 20.9 ± 12.9 dB postoperatively (p < 0.0001). Preoperative and postoperatively mean air conduction PTA thresholds were 49.9 ± 9.5 and 30.0 ± 14.1 dB, respectively (p < 0.0001). All ears operated on except one had air conduction improvement. There were no complications. CONCLUSION Functional surgery for congenital middle ear malformations gives variable hearing outcomes. In this study, with the most favorable anatomic conditions, 12 ears (67%) of 18 had air conduction improvement below 30 dB.

CSOM is a most common ENT disease in our country, among them the atticoantral variety is life threatening if not treated earlier. So treatment plan is still radical surgery to eradicate the disease to save life ignoring the hearing conservation. Henceforth post operative hearing loss remains a problem for the patient. Ensuring total clearance of the disease depending on the ossicular status, tragal cartilage graft was used as easily available material for ossiculoplasty to improve the post operative hearing .The study presents 35 ear operation of varied middle ear pathology using tragal cartilage & perichodrium as a choice graft. We have recorded our observation & result & concluded that tragal cartilage & perichondrium is an ideal graft for ossiculoplaty. The objective of study was to asses the efficacy of tragal cartilage, the functional capacity in restoring hearing acuity, it’s mechanical survival, it’s extrusion rate & it’s functional integrity in ossicular reconstruction. The patients those underwent surgery in Sir Salimullah Medical College Mitford Hospital had significant improvement of hearing with no recurrence of disease. DOI: http://dx.doi.org/10.3329/bjo.v19i1.14860 Bangladesh J Otorhinolaryngol 2013; 19(1): 24-28

Introduction: Repair of Tympanic Membrane (TM) is one of the most common surgeries performed by the otologists. Literature reveals that Indian surgeons have contributed substantially in the research on techniques and graft materials used for the repair of tympanic membrane, though no review has been written so far highlighting their contributions. Aim: To summarize and analyse the contributions of Indian authors who have used different graft materials for repair of TM and their studies listed in Medline search. Materials and Methods: A literature review was conducted using a Medline search using keywords of ‘myringoplasty’ and ‘tympanoplasty’ with ‘India’ on 30th June 2016. A total of 243 articles were found listed onwards from year 1998. Out of these 50 articles in which type 1 tympanoplasty or myringoplasty was performed using different graft materials were selected. The content of each abstract was studied in order to identify studies related to topic. Results: Authors have experimented with a variety of tissues as graft materials. Temporalis Fascia (TF) has been most widely used in 58.6% studies as graft material. The next popular graft is tragal perichondrium. The graft take up rates varied from 68.5% to 100%, while method of reporting of hearing gain in most studies was inconsistent amongst studies, though most studies have reported achievement of serviceable hearing of < 25 dB in most patients. Conclusion: TF was the most prefered material due to anatomic proximity, light material and strength. It was followed in popularity by tragal perichondrium and tragal cartilage. All graft materials have given satisfactory hearing results.

Introduction: Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. Objective: To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. Methods: In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant. Results: The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females. Conclusions: Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate. Resumo Introdução: Vários materiais de enxerto foram usados para o fechamento da perfuração da membrana timpânica. Há poucos estudos na literatura que comparam diferentes materiais de enxerto em populações pediátricas. De acordo com nossa pesquisa, não há estudo que tenha medido a espessura da cartilagem tragal em timpanoplastia pediátrica. A espessura da cartilagem tragal não é uniforme em todos os pacientes. Objetivo: Comparar os resultados anatômicos e funcionais da fáscia do músculo temporal e da cartilagem tragal com espessura total em timpanoplastias tipo 1 em crianças. Método: No total, 78 pacientes (38 do sexo masculino, 40 do sexo feminino; média de idade de 10,02 ± 1,98 anos; variação: 7-18 anos) submetidos a timpanoplastia tipo 1 em nossa clínica foram incluídos. Os resultados demográficos, anatômicos e funcionais foram registrados. A fáscia do músculo temporal e a cartilagem tragal foram usadas como materiais de enxerto. A cartilagem tragal foi usada sem fresagem e a sua espessura foi medida com um micrômetro. Os resultados anatômicos e funcionais da cartilagem e da fáscia foram comparados. Os resultados audiométricos comparando os grupos (cartilagem e fáscia) foram avaliados em 6 meses, e o acompanhamento dos pacientes prosseguiu até 1 ano após a cirurgia. Enxerto intacto e um intervalo aéreo-ósseo (gap) ≤ 20 dB foram considerados como sucesso cirúrgico. Os resultados com um valor p < 0,05 foram considerados estatisticamente significantes. Resultados: A taxa de sucesso do enxerto foi de 92,1% para o grupo cartilagem e de 65,0% para o grupo fáscia temporal. No grupo fáscia, o gap no pré-operatório foi 33,68 ± 11,44 dB, e 24,25 ± 12,68 dB no pós-operatório. No grupo cartilagem, o gap no pré-operatório foi 35,68 ± 12,94 dB, e 26,11 ± 12,87 no pós-operatório. A taxa de sucesso anatômico no grupo cartilagem foi significantemente melhor que a do grupo fáscia (p < 0,01). Não houve diferença estatisticamente significante nos resultados funcionais entre os grupos fáscia e cartilagem (p > 0,05). A espessura média da cartilagem tragal na população pediátrica foi 0,693 ± 0,094 mm em meninos e 0,687 ± 0,058 mm em meninas. Conclusões: Nossos dados sugerem que a taxa de sucesso anatômico para uma timpanoplastia com enxerto de cartilagem seja maior que a de uma timpanoplastia com enxerto de fáscia. Os resultados funcionais com cartilagem não foram diferentes daqueles com fáscia, embora não tenhamos fresado a cartilagem tragal. Porém, novos estudos devem concentrar-se na relação entre a espessura da cartilagem tragal e a taxa de sucesso da timpanoplastia.

OBJECTIVE It is an ongoing debate whether tympanoplasty should be performed in the pediatric age group. The purpose of this study was to analyze and compare the anatomical and functional outcomes of type I cartilage tympanoplasty in children and adults. MATERIALS AND METHODS The file records of patients who underwent type 1 cartilage tympanoplasty were retrospectively reviewed. In total, 133 patients who underwent type 1 tympanoplasty for chronic otitis media were included. Tragal cartilage grafts were used in all patients. The patients were divided into two groups: pediatric (age≤16 years, n=54) and adult (age>18 years, n=79) groups. The graft success rates and hearing results between the two groups were compared. RESULTS The graft success rate was 90.2% (120/133) in the study group. At the end of the 24-month follow-up, the graft was intact in 48 of the 54 (88.9%) patients in the pediatric group and 72 of the 79 patients in the adult group (91.1%) (p=0.769). The functional success rate (postoperative air-bone gap