Tri-layer Tympanoplasty as a New Technique in High-risk Tympanic Membrane Perforations

Document Type : Original

Authors

1 Department of Otorhinolaryngology, Health Science University, Bursa Yuksek Ihtisas Training and Research Hospital,16800 Yıldırım, Bursa, Turkey.

2 Department of Otorhinolaryngology, Duzce University Hospital, Duzce, Turkey.

Abstract

Introduction:
The eradication of the middle ear disease is mentioned as the fundamental principle of tympanoplasty. The presence of some factors related to patient or disease itself forces the physician to classify the chronic ear disease as high-risk perforations. The aim of this study was to present a tri-layer tympanoplasty technique and its otological and audiological outcomes in the ears with high-risk perforations.
 
Materials and Methods:
This retrospective study was carried out on a total of 46 eligible ears that had chronic otitis media with high-risk perforations. Preoperatively, 17, 15, and 14 ears were reported with Sade classification grade 4 pars tensa retraction (Group 1), total or near-total tympanic membrane perforation (Group 2), and a history of ear surgery (Group 3), respectively. All the cases had tympanoplasty using the tri-layer technique at a tertiary center during 2008 and 2014. A review of the patients’ chart showed that 46 patients underwent tri-layer tympanoplasty. Regarding the audiological outcomes, the comparison of pre- and post-operative results revealed mean air conduction level and mean air-bone gap (ABG) of 4 different frequencies in dB according to a new standardized format for reporting hearing outcome in clinical trials.
 
Results:
The mean value of the follow-up period was reported as 29.22±3.23 months. Graft take rate was 93.4 % in all the cases, as well as 94.1%, 100%, and 85.7% in Group 1, Group 2, and Group 3, respectively. The mean values of ABG were improved from 35.17±6.64 to 23.52±10.4, 30.46±5.89 to 17.20±8.04, and 29.14±8.37 to 16.14±5.02 dB in Group 1, Group 2, and Group 3, respectively (P<0.05).
 
Conclusion:
Tri-layer tympanoplasty is a reliable procedure in the surgical treatment of the chronic otitis media with high-risk re-perforations.

Keywords

Main Subjects


1. Goycoolea MV. Tympanoplasty. In: Goycoolea MV, Paparella MM, Nissen RL, editors. Atlas of otologic surgery. Philadelphia: WB Saunders; 1989. p. 218–46.
2. Boedts D. Tympanic grafting materials. Acta Otorhinolaryngol Belg. 1995; 49: 193–9.
3. Calli C, Tugyan K, Oncel S, Pinar EDemirtaşoglu FCalli AO, et al. Effectiveness of royal jelly on tympanic membrane perforations: an experimental study. J Otolaryngol Head Neck Surg. 2008; 37: 179–84.
4. Yetiser S, Hidir Y. Temporalis fascia and cartilage-perichondrium composite shield grafts for reconstruction of the tympanic membrane. Ann Otol Rhinol Laryngol. 2009; 118: 570-4.
5. Yung MW. Retraction of the pars tensa long-term results of surgical treatment. ClinOtolaryngol Allied Sci. 1997; 22: 323–6.
6. Buckingham RA. Fascia and perichondrium atrophy in tympanoplasty and recurrent middle ear atelectasis. Ann Otol Rhinol Laryngol. 1992; 101: 755–8.
7. Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series.Laryngoscope. 2003; 113: 1844–56.
8. Ozbek C, Somuk T, Ciftçi O, Ozdem C. Management of facial nerve paralysis in non-cholesteatomatous chronic otitis media. B-ENT. 2009; 5: 73-7.
9. Sismanis A, Dodson K, Kyrodimos E. Cartilage "shield" grafts in revision tympanoplasty. Otol Neurotol. 2008; 29: 330-3.
10. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty.Laryngoscope. 2000; 110: 1994-9.
11. Dornhoffer JL. Healing results with cartilage tympanoplasty. Laryngoscope. 1997; 107: 1094-9.
12. Uslu C, Tek A, Tatlipinar A, Kiliçarslan Y, Durmuş R, Ayöğredik E, et al. Cartilage reinforcement tympanoplasty: otological and audiological results. Acta Otolaryngol. 2010; 130: 375-83.
13. Martin C, Timoshenko AP, Martin C, Bertholon P, Prades JM. Malleus removal and total cartilage reinforcement in intact canal wall tympanoplasty for cholesteatoma. Ann Otol RhinolLaryngol. 2004; 113: 421-5.
14. Sadé J, Berco E. Atelectasis and secretory otitis media. Ann Otol Rhinol Laryngol. 1976; 85: 66-72.

15. Farrior JB. Sandwich graft tympanoplasty: experience, results, and complications. Laryngoscope. 1989; 99: 213-7.

16. Gurgel RKJackler RKDobie RA, Popelka GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg. 2012; 147: 803-7.
17. Kirazli T, Bilgen C, Midilli R, Ogüt F.  Hearing results after primary cartilage tympanoplasty with island technique.Otolaryngol Head Neck Surg. 2005; 132: 933–7.
18. Ozbek C, Ciftci O, Tuna EE, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in type 1 tympanoplastyin children: anatomic and functional results. Otol Neurotol. 2008; 29: 679–83.
19. Anderson J, Caye-Thomasen P, Tos M. A comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction cholesteatoma in children. Otol Neurotol. 2004; 25: 856–63.
20. Ozbek C, Ciftçi O, Ozdem C.Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears. Eur Arch Otorhinolaryngol. 2010; 267: 507–13.
21. Haksever M, Akduman D, Solmaz F, Gündoğdu E. Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure. Eur Arch Otorhinolaryngol. 2015; 272: 867-72.
22. Kaylie DM, Gardner EK, Jackson CG. Revision chronic ear surgery. Otolaryngol Head Neck Surg. 2006; 134: 443-50.
23. Djalilian HR. Revision tympanoplasty using scar tissue graft. Otol Neurotol. 2006; 27: 131-5.
24. Veldman JE, Braunius WW. Revision surgery for chronic otitis media: a learning experience. Report on 389 cases with a long term follow-up. Ann Otol Rhinol Laryngol. 1998; 107: 486-91.
25. Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD. Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope. 2006; 116: 1813-6.