Aim: Comparison of the Temporalis Fascia & tragalcartilage with perichondrium graft material in Type I tympanoplasty in cases of tubotympanic CSOM.

CSOM can cause significant morbidity in patients due to recurrent discharge, deafness, and various complications. Tympanoplasty is 1^st line approach to these problems and prevention of the further complication.

Method: This study involves the patient of tubotympanic type of CSOM presenting in OPD of ORL department in Index medical college, hospital & research center, Indore from Jan 2017 to June 2019.  Patients were divided randomly in two groups. One group was operated using temporalis fascia and another group with tragal cartilage with perichondrium. Pre operative pure tone audiometry was obtained in all the patients. This was compared post operative pure tone audiometry conducted after 12 weeks. Hearing improvement along with other parameters as graft uptake, graft material used and patient’s subjective improvement were also noted.

Results: Out of 60 cases 30 were operated using ‘temporalis fascia graft’& rest were with ‘tragal cartilage with perichondrium’. On comparison of hearing improvement both the group had no statistical difference in hearing.

Conclusion: Tragalcartilage with perichondrium & temporalis fascia are both comparable in terms of graft uptake & hearing improvement.

1. Sharma K, Manjari M, Salaria N. Middle ear cleft in chronic otitis media: a clinicohistopathological study. Indian J Otolaryngol Head Neck Surg. 2013;65 (Suppl 3):493–497. https://doi:10.1007/s12070-011-0372-x
2. Borgohain R, Talukdar R, Ranjan K. Otogenic brain abscess: A rising trend of cerebellar abscess an institutional study. Indian J Otol [serial online] 2015 [cited 2020 Jan 12];21:286-9. https://www.indianjotol.org/text.asp?2015/21/4/286/165757
3. Heine, B & Beck, J in Denker, A &Kahler, O (1927): Handbuch Der Hals- Nasen Ohrenheilkunde. Vol 8, Berlin.
4. Singh, A. & Kumar, S. Indian J Otolaryngol Head Neck Surg (2010) 62: 121. https://doi.org/10.1007/s12070-010-0027-3
5. Varshney S. Deafness in India. Indian J Otol 2016;22:73-6 https://doi.org/10.4103/0971-7749.182281
6. WULLSTEIN H. [Technic and early results of tympanoplasty]. Monatsschr Ohrenheilkd Laryngorhinol. 1953 Oct-Dec; 87 (4):308-11.
7. Athanasiadis-Simanis A (2010) Tympanoplasty: tympanic membrane repair. In: Gulya AJ, Minor LB, Poe DS (eds) Glasscock-shambaugh surgery of the ear, 6th edn. Peoples Medical Publishing House, Shelton, pp 468–478
8. Jansen Cartilage tympanoplasty Laryngoscope, 73 (1963), pp. 1288-1302
9. Saito T, Tanaka T, Toukiri M, et al. Recent outcome of tympanoplasty in the elderly. Otol Neurotol 2001;22920:153-7.
10. De Seta, E. Covelli, D. De Seta, P. Mancini, R. Filipo Cartilage tympanoplasty: how to reduce surgery time J Laryngol Otol, 124 (2010), pp. 784-785
11. Fayad JN, Baino T, Parisier SC. Preliminary results with the use of Allo Derm in chronic otitis media. Laryngoscope. 2003;113(7):1228–30
12. Fishman AJ, Marrinan MS, Huang TC, Kanowitz SJ (2005) Total tympanic membrane reconstruction: Allo Derm versus temporalis fascia. Otolaryngol Head Neck Surg 132:906–915
13. Gérard JM, Gersdorff M (2006) The Tutopatch graft for transcanal myringoplasty. B-ENT 2(4):177–179
14. Hodzic-Redzic S, Kovac-Bilic L, Branica S. Comparison of tragal perichondrium and temporal fascia grafts in tympanoplasties. Indian J Otol 2018;24:168-71.
15. Yakup Yegin Mustafa Çeliket al. Brazilian jouranla of Otorhinolaryngology vol 82, issue 6, Nov –Dec 2016. P 695-701. https://doi.org/10.1016/j.bjorl.2015.12.009
16. Dabholkar JP, Vora K, Sikdar A. Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian J Otolaryngol Head Neck Surg 2007;59:116‐9.
17. Packer P, Mac Kendrick A, Solar M (1982) What’s best in myringoplasty: underlay or overlay, dura or fascia. J Laryngol Otol 96:25–41
18. Athanasiadis-Simanis A (2010) Tympanoplasty: tympanic membrane repair. In: Gulya AJ, Minor LB, Poe DS (eds) Glasscock-shambaugh surgery of the ear, 6th edn. Peoples Medical Publishing House, Shelton, pp 468–478
19. Browning GG, Merchant SN, Kelly GK, Swan IRC, Canter R, Mckerrow WS (2008) Cronic otitis media. In: Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, Lund VJ, Luxon LM, Watkinson JC (eds) Scott-Brown’s otorhinolaryngiology, 7th edn. Hodder Arnold, London, pp 3421–3422
20. Sheehy JL, Anderson RG (1980) Myringoplasty: a review of 472 cases. Ann Otol Rhinol Laryngol 89:331–334
21. Glassock ME III, Jackson G, Nissen AJ, Schwaber MK (1982) Post auricular undersurface tympanic membrane grafting: a follow up report. Laryngoscope 92:718–727
22. Caylan R, Ttiz A, Falcioni M, Donato GD, Russo A, Taibah A, Taibah A, Sanna M (1998) Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg 118:709–713
23. Wullestein H. Method for split-skin covering of perforation of the drum by tympanoplasty operations in cases of chronic otitis. Arch
24. OhrNas- u.Kehlk –Helik 1952; 161:422.
25. Zollner F. Tympanoplasties intented to replace large drum defects combined with defects of ossicles. Panel on myringoplasty.
26. Second workshop on reconstructive Middle Ear Surgery. Arch Otolaryng 1953; 78:301.
27. Zollner F. Abandoned split skin graft because of its low resistance, preferring full thickness retro- auricular skin grafts. Proc 5
28. Int Congr Otolaryng 1953; 119Shea JJ. Vein graft closure of ear drums perforations. J. Laryng. 1960; 74: 358.
29. Singh BJ, Sengupta A, Das AK, et al. A comparative study of different graft material used in myringoplasty. Indian J otolaryngol Head neck Surg.2009;61:131-4
30. Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997;107:1094-9.
31. Abraham Aviator. Tragal perichondrium & cartilage in ear reconstructive surgery. Laryngoscope.11(88):1-23.
32. Goodhill V. Harris I and Brockmann S.J. Tragal Perichondrium and cartilage for myringoplasty. Arch Otolaryn. 1967: 71: 480-491.
33. Qureshi MS, Jones NS. Day care myringoplasty using tragal perichondrium. Clin Otolaryngol Allied sci. 1995:20(1)
34. Dabolkar JP, VoraK, Sikhdar A. Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian J Otolaryngol Head Neck Surger 2007:59:116-9.
35. Patil K, Baisakhiya N, Deshmukh PT. Evaluation of different graft material in type I tympanoplasty. Indian journal of Otology. 2014:20(3): 106-14.
36. Shetty KA, Velankar HK, Saberwal AA et al. Temporalis Fascia vstragal perichondrium: a comparative study of outcome as graft material in tympanoplasty. Journal of evolution of medical and dental sciences. 2013; 2(52):10172-76.
37. Hameed GS, Prasad BS, Babu PR. A comparative study of temporalis fascia versus tragal perichondrium as a graft in repair of tympanic membrane perforation. Indian Journal of Mednodent and allied sciences , 2015;3 (3): 150-54
38. Majeed J, Ahamed N. Comparative study between tempralis fascia and tragal perichondrium in myringoplasty. Journal of dental and medical sciences. 2016; 15(11):64-72.
39. Indorewala S. Dimentional stability of free fascia graft: clinical application. Laryngoscope 2005;115:278-82.
40. Swaminathan B, Premnivas R, Shanmugam VU et al. A comparative study between tragal perichondrium and temporalis fascia in myringoplasty. International journal of current medical and pharmaceutical research. 20017; 3(7):1993-96.
41. Herman MK. Tang: The perforated ear drum: To repair or not? Hong kong J Online 1989;11:124-5.
42. Straham RW, Aqcquarelli M, Ward PH, Jafek B. Tympanic membrane grafting. Analysis of material and techniques. Ann OtolRhinolLaryngol 1971;80:854-60.
43. Gupta N, Mishra RK. Tympanoplasty in children. Indian J Otolaryngol Head Neck Surge.2002;54:271-3.

Dr Saurabh Vijay

PG Resident, Deptt of Otorhinolaryngology, Index Medical College Hospital & Research Center, Indore, MP, India