Long Term Versus Short Term Hearing Results in Endoscopic Sandwich Myringoplasty

Document Type : Original

Authors

Department of Otorhinolaryngology, Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal.

Abstract

Introduction:
The use of the endoscope in otological surgeries has both diagnostic and therapeutic values. It provides an excellent view in difficult nooks and corners. The use of endoscopic sandwich myringoplasty using cartilage and perichondrium has its benefit in hearing outcome and graft uptake in long-term follow-up. The main objective was to compare the long-term with short- term hearing outcomes in those who have undergone endoscopic sandwich myringoplasty with Dhulikhel hospital (D‑HOS) technique.
Materials and Methods:
Forty-two patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage perichondrium were enrolled in the study. The hearing outcome was analyzed by comparing the pre-operative findings  with post-operative findings and amongst post-operative patients, long-term with short-term  air bone gap (ABG) and ABG closure in speech frequencies (0.5kHz, 1kHz, 2kHz, 4kHz) were compared.
Results:
Amongst forty-two patients, 40 (95.2%) had graft uptake in both short-term (6.08 months) and in long-term (20 months) follow-up. The mean pre-operative ABG was 28.1±9.3dB whereas the mean short-term post-operative ABG was 14.5±7.2dB, it showed statistical significance (P=0.001). Likewise, while comparing pre-operative with long-term post-operative ABG (13.4±4.8 dB), it showed statistical significance of P=0.000. While comparing short-term with long-term post-operative ABG, it did not show any statistical significance (P=0.065).The mean closure in ABG in both short-term and long-term hearing assessment was not statistically significant (P=0.077).
Conclusion:
Endoscopic sandwich myringoplasty with D-HOS technique is a reliable procedure with good hearing outcome and graft uptake in both short and long-term follow-up.

Keywords

References

  1. Adkins WY. Composite autograft for tympanoplasty and tympanomastoid surgery. Laryngoscope 1990;100:244‑7.
  2. Mattox DE. Endoscopy‑assisted surgery of the petrous apex. Otolaryngol Head Neck Surg 2004; 130: 229‑41.
  3. Patil RN. Endoscopic tympanoplasty – Definitely advantageous (preliminary reports). Asian J Ear Nose Throat 2003;25:9‑13.
  4. Khan I, Jan AM, Shahzad F. Middle‑ear reconstruction: A review of 150 cases. J Laryngol Otol 2002;116:435‑9.
  5. Utech H. On the diagnostic and therapeutic possibilities of tympanotomy in case of conductive disorders. Laryngol Rhinol 1959; 38: 212–21.
  6. Dornhoffer J.Cartilage tympanoplasty: indications, techniques, and outcomes in a 1000-patient series. Laryngoscope 2003; 113: 1844–56.
  7. Dornhoffer JL.Cartilage tympanoplasty. Otolaryngol Clin N Am 2006;39:1161–76.
  8. Eavey RD. Inlay tympanoplasty: Cartilage butterfly technique.Laryngoscope 1998; 108: 657‑61.
  9. Tos M. Cartilage tympanoplasty methods: proposal of a classification. Otolaryngol Head Neck Surg 2008;139:747–58.
  10. Tos M. Cartilage tympanoplasty. Thieme, Stuttgart (in print) 2009.
  11. Man SC, Nunez DA. Tympanoplasty–conchal cavum approach. J Otolaryngol Head Neck Surg 2016;45:1
  12. Lin YC, Wang WH, Weng HH, Lin YC. Predictors of surgical and hearing long-term results for inlay cartilage tympanoplasty. Arch Otolaryngol Head Neck Surg. 2011 Mar; 137(3):215-9.
  13. Wang WH, Lin YC. Minimally invasive inlay and underlay tympanoplasty. Am J Otolaryngol. 2008 Nov-Dec; 29(6):363-6.
  14. Wu PW, Wang WH, Huang CC, Lee TJ, Huang CC. Comparison of Short- and Long-term Hearing Outcomes of Successful Inlay Cartilage Tympanoplasty Between Small and Large Eardrum Perforations. Clin Exp Otorhinolaryngol. 2015; 8(4):359-363. doi:10. 3342/ ceo.2015.8.4.359
  15. Rourke T, Snelling JD, Aldren C. Cartilage graft butterfly myringoplasty: How we do it. Clin Otolaryngol 2010;35:135‑8.
  16. Committee on hearing and equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. American Academy of Otolaryngology‑Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113:186‑7.
  17. Lou ZC. Endoscopic myringoplasty: comparison of double layer cartilage-perichondrium graft and single fascia grafting J of Otolaryngol-Head & Neck Surg 2020; 49, 40. https://doi.org/10.1186/s40463-020-00440-7.
  18. Lade H, Choudhary SR, Vashishth A. Endoscopic vs. microscopic myringoplasty: A different perspective. Eur Arch Otorhinolaryngol 2014; 271:1897‑902.
  19. Marchioni D, Molteni G, Presutti L. Endoscopic anatomy of the middle ear. Indian J Otolaryngol Head Neck Surg 2011;63:101‑13.
  20. El-Hennawi DEM, Ahmed MR, Abou-Halawa AS, Al-Hamtary MA. Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations. J Laryngol Otol. 2018;132:509–13.
  21. Özdamar K, Sen A. Comparison of the anatomical and functional success of fascia and perichondrium grafts in transcanal endoscopic type 1 tympanoplasty.J Otolaryngol Head Neck Surg. 2019; 48:67.
  22. Kaya I, Turhal G, Ozturk A, Gode S, Bilgen C, Kirazli T. Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision. Acta Otolaryngol. 2017; 137:1174–7.
  23. Zahnert T, Hüttenbrink KB, Mürbe D, Bornitz M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322‑8.
  24. Kerr AG, Byrne JE, Smyth GD. Cartilage homografts in the middle ear: A long‑term histological study. J Laryngol Otol 1973;87:1193‑9.
  25. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope 2000;110:1994‑9.
  26. 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.
  27. Mauri M, Lubianca Neto JF, Fuchs SC. Evaluation of inlay butterfly cartilage tympanoplasty: A randomized clinical trial. Laryngoscope 2001;111:1479‑85.
  28. Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: A comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 2007;264:985‑9.
  29. Ozbek C, Ciftçi O, Tuna EE, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: Anatomic and functional results. Otol Neurotol 2008;29:679‑83.
  30. Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD. Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope 2006; 116:1813‑6.
  31. Glasscock ME 3rd, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: A follow‑up report. Laryngoscope 1982;92:718‑27.
  32. Raj A, Meher R. Endoscopic transcanal myringoplasty‑A study. Indian J Otolaryngol Head Neck Surg 2001;53:47‑9.
  33. Zhang H, Wu B, Xu M. A clinical research of endoscopic myringoplasty with modified sandwich technique. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012;26:293‑4, 299.
  34. Ayache S. Cartilaginous myringoplasty: The endoscopic transcanal procedure. Eur Arch Otorhinolaryngol 2013;270:853‑60.
  35. Celik H, Samim E, Oztuna D. Endoscopic “Push‑trough” technique cartilage myringoplasty in anterior tympanic membrane perforations. Clin Exp Otorhinolaryngol 2015;8:224‑9.
  36. Omran AA. Endoscopic bivalve inlay cartilage myringoplasty for central perforations: Preliminary report. Egypt J Ear Nose Throat Allied Sci 2012; 13:37‑42.
  37. Özgür A, Dursun E, Terzi S, Erdivanlı ÖÇ, Coşkun ZÖ, Oğurlu M, et al. Endoscopic butterfly cartilage myringoplasty. Acta Otolaryngol 2016; 136:144‑8.
  38. Mokbel KM, Moneir W, Elsisi H, Alsobky A. Endoscopic transcanal cartilage myringoplasty for repair of subtotal tympanic membrane perforation: A method to avoid postauricular incision. J Otolaryngol Rhinol 2015;1:1‑4.
  39. Garcia LB, Moussalem GF, de Andrade JS, Mangussi‑Gomes J, Cruz OL, Penido NO, et al. Transcanal endoscopic myringoplasty: A case series in a university center. Braz J Otorhinolaryngol 2016; 82:321‑5.
  40. Kaya I, Benzer M, Uslu M, Bilgen C, Kirazli T. Butterfly cartilage tympanoplasty long‑term results: excellent treatment method in small and medium sized perforations. Clin Exp Otorhinolaryngol 2018; 11:23‑9.
  41. Karabulut B, Mutlu F, Sahin S, Cirik AA. Anatomical and functional longterm results of endoscopic butterfly inlay myringoplasty. Eur Arch Otorhinolaryngol 2018;275:2653-8.
  42. Nemade SV, Shinde KJ, Sampate PB. Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique. Auris Nasus Larynx. 2018;45:440–6.
  43. Bedri EH, Korra B, Redleaf M, Worku A. Double-layer tympanic membrane graft in type I tympanoplasty. Ann Otol Rhinol Laryngol. 2019; 128:795–801.
  44. Chhapola S, Matta I. Cartilage-perichondrium: an ideal graft material? Indian J Otolaryngol Head Neck Surg. 2012;64:208–13.
  45. Parelkar K, Thorawade V, Marfatia H, Shere D. Endoscopic cartilage tympanoplasty: full thickness and partialthickness tragal graft. Braz J Otorhinolaryngol. 2020;86:308-14.
  46. Daneshi A, Daneshvar A, Asghari A, Farhadi M, Mohebbi S, Mohseni M, et al. Endoscopic Versus Microscopic Cartilage Myringoplasty in Chronic Otitis Media. Iran J Otorhinolaryngol.2020;32(5); 263-69.
Iranian Journal of Otorhinolaryngology
Volume 33, Issue 5
September and October 2021
Pages 291-299

Files

Share

How to cite

Statistics