A Prospective Randomised Comparative Study Between Cartilage and Fascia Tympanoplasty in a Tertiary Care Hospital to Look for Better Alternative in High Risk Cases

Anshuman Singh; Dolly Talda; Chultim Dolma Bhutia; Sushil Kumar Aggarwal; Priyanko Chakraborty; Silky Kumari; Sishupal Yadav

doi:10.1007/s12070-022-03175-1

A Prospective Randomised Comparative Study Between Cartilage and Fascia Tympanoplasty in a Tertiary Care Hospital to Look for Better Alternative in High Risk Cases

Indian J Otolaryngol Head Neck Surg. 2023 Apr;75(Suppl 1):50-59. doi: 10.1007/s12070-022-03175-1. Epub 2022 Nov 6.

Authors

Anshuman Singh¹, Dolly Talda², Chultim Dolma Bhutia¹, Sushil Kumar Aggarwal¹, Priyanko Chakraborty¹, Silky Kumari¹, Sishupal Yadav¹

Affiliations

¹ Department of ENT, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India.
² Deptt of Gynae and Obst, Institute of Medical Sciences, Banaras Hindu University, 221005 Varanasi, India.

Abstract

Introduction: CSOM patients are most commonly managed surgically by type I tympanoplasty using either cartilage shield technique or underlay grafting technique. In our study, we have compared the graft uptake and hearing results of type I tympanoplasty using temporalis fascia and cartilage shield, and also reviewed the literature regarding the results of these two methods.

Materials and methods: 160 patients aged between 15 and 60 years were randomized into two groups of 80 patients each, with odd numbers subjected to conchal or tragal cartilage shield grafting in group I, while in group II with even numbers, the patients underwent temporalis fascia grafting by underlay technique.

Results: Three months post-surgery, the graft uptake was seen in 76 patients (95%) in the cartilage shield group as compared to 58 patients (72.5%) in the temporalis fascia group, which was statistically significant between the two groups [Fisher's exact value = 0.000]. The uptake rate was much higher in cartilage shield graft as compared to fascia graft even in complicated cases like revision tympanoplasty (TP), discharging ear, subtotal perforation and retracted/adhered TP. Also, the hearing improvement in fascia and cartilage shield group was not statistically significant comparing pre- and post-operative patients, indicating that there was not much difference in audiological outcomes between the two groups.

Conclusion: We advocate the use of cartilage shield graft as a substitute for fascia graft in all feasible cases as well as in complicated situations to improve the success rate of type I tympanoplasty, without compromising on the hearing improvement, as seen in our study.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-022-03175-1.

Keywords: CSOM; Cartilage shield graft; Fascia graft; Type I tympanoplasty.

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