OUTCOME OF MYRINGOPLASTY WITH TEMPORALIS FASCIA AND PERICHONDRIAL-CARTILAGE COMPOSITE GRAFT IN HIGH RISK PERFORATIONS

A Dhungana; RR Joshi; AS Rijal; KK Shrestha; S Maharjan

A Dhungana Department of Otorhinolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital,
RR Joshi Department of Otorhinolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital,
AS Rijal Department of Otorhinolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital,
KK Shrestha Department of Otorhinolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital,
S Maharjan Department of Otorhinolaryngology & Head and Neck Surgery, Nepal Medical College Teaching Hospital,

Abstract

The objective of this study was to compare the graft uptake results and postoperative hearing ofmyringoplasty with temporalis fascia and cartilage-perichondrial composite graft in high risk
perforations. Patients of age 13 years and above with diagnosis of chronic otitis media – mucosal typewith high risk perforation that is >50% perforation of tympanic membrane, revision cases, absent/eroded handle of malleus, oedematous/unhealthy middle ear mucosa and marginal involvement caseswere included for myringoplasty. Pure Tone Audiometry was done within 1 week before surgery. 80cases were included for myringoplasty which were randomly allocated by lottery method with 40cases each in temporalis fascia group and cartilage perichondrial composite graft group. Graft uptakeresults were assessed after 6 weeks and postoperative hearing was evaluated and compared withinand between the groups. Graft uptake rate in temporalis fascia group and cartilage perichondrialcomposite graft group was 90% and 92.5%, respectively with no significance difference in the graftuptake rate (p = 0.692) between the groups. The mean pre and post-operative air bone gap in temporalisfascia group and cartilage perichondrial composite group were 30.69dB±10.19,16.36±8.37dB and33.73±8.07dB, 20.76±9.47dB, respectively with highly significant difference in both groups (p < 0.001)showing improvement in the hearing after surgery in both groups. The mean air bone gain were14.33dB and 12.97dB in temporalis fascia and cartilage perichondrial composite group respectivelywith no significant difference between the groups (p=0.469). The graft uptake rate and hearingresults after cartilage perichondrial composite graft are comparable to those of temporalis fasciagraft. Furthermore, the cartilage perichondrial composite graft is more rigid and thick so it ismore resistant than fascia to anatomic deformation and necrosis. Therefore, we recommend theuse of cartilage perichondrial composite graft for tympanic membrane reconstruction in high riskperforation without concern about affecting audiometric results.

Keywords : Cartilage-perichondrium,chronic otitis media, high riskperforation, myringoplasty, puretone audiometry, temporalisfascia