Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique / Comparação entre os resultados clínicos e audiológicos de timpanoplastia com a técnica "sanduíche" modificada e a técnica underlay

Abstract Introduction: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. Objective: To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. Methods: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. Results: Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4 ± 1.7 dB while in Group B; it was 22.5 ± 3.5 dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. Conclusion: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Resumo Introdução: O reparo cirúrgico da membrana timpânica, denominado timpanoplastia tipo 1, é uma modalidade de tratamento já bem estabelecida. As técnicas overlay ou underlay de timpanoplastia são comuns. A timpanoplastia "sanduíche" é a técnica de enxerto de membrana timpânica overlay e underlay combinadas. Objetivo: Descrever e avaliar a timpanoplastia com a técnica "sanduíche" modificada (timpanoplastia mediolateral) utilizando fáscia temporal e fáscia aureolar. Comparar o desfecho clínico e audiológico da timpanoplastia com a técnica "sanduíche" modificada com o da timpanoplastia com a técnica underlay. Método: Foram estudados 88 pacientes com otite média crônica, 48 (Grupo A) foram submetidos à timpanoplastia tipo 1 com enxerto "sanduíche" modificado. A fáscia temporal foi utilizada na técnica underlay e a fáscia areolar na técnica overlay. 48 pacientes (Grupo B) foram submetidos à timpanoplastia tipo 1 com a técnica underlay. Foram avaliados os resultados da cicatrização e da audição. Resultados: O sucesso do enxerto ocorreu em 47 pacientes (97,9%) no Grupo A e em 40 (83,3%) do Grupo B. O fechamento médio do gap aéreo-ósseo no Grupo A foi de 24,4 ± 1,7 dB, enquanto no Grupo B foi de 22,5 ± 3,5 dB. Houve diferença estatisticamente significativa na taxa de cicatrização do enxerto. A diferença na melhora auditiva não foi estatisticamente significante. Conclusão: O enxerto de camada dupla e o tímpano-martelo posicionados como o "recheio" do sanduíche mantém um equilíbrio perfeito entre a estabilidade necessária e adequada sensibilidade acústica.

A study on the outcome of tympanoplasty with various graft materials

Background: Chronic Suppurative Otitis Media (CSOM) is one of the most common causes of preventable hearing loss especially in developing countries CSOM is a disease condition characterized by persistent perforation of tympanic membrane with recurrent or persistent mucopurulent Otorrhoea Aim: This study was undertaken to review the outcomes (hearing improvement) achieved by using various graft materials like temporalis fascia (TF), tragal cartilage (TC), Conchal cartilage (CC), autologous sculpted incus (I), autologous cortical bone (BG) in tympanoplasty surgery Material and methods: This study comprised of 14 males and 16 females patients with age ranging from 12 years to 55 years They were selected for surgery after adequate history taking, clinical, otoscopic and microscopic examination Type 1 tympanoplasty was done in 19 patients, Type 3 tympanoplasty + Modified Radical Mastoidectomy (MRM) was done in 11 patients by using various graft materials The results were evaluated in the form of rate of graft success, hearing gain, and the pre and post-operative Air Bone gap Results: Out of 30 patients, in 20 TF graft patients AB gap improvement seen in 14 patients, 5 patients did not show any change and 1 patient did not come for follow up In 2 TC graft patients, both showed improvement in AB gap In 1 patient where CC graft was used showed improvement in AB gap In 6 patients I graft was used, 2 patients showed improvement, 2 patients did not show any change, 1 patient did not come for follow up and in 1 patient AB gap worsened In 1 patient BG was used and no change in AB gap was seen Out of 30 cases graft uptake was seen in 25 cases and graft rejection was seen in 3 cases and 2 patients did not come for follow up Graft rejection was documented in one case where TF was used, one case where incus graft was used and in another case where BG was used Harinarayana N, Srikanth M A study on the outcome of tympanoplasty with various graft materials IAIM, 2018; 5(12): 77- 82 Page 78 Conclusion: Post-operative hearing gain obtained was found to be better in patients operated upon with tubotympanic disease than those operated upon with atticoantral disease The post-operative hearing improvement depends not only on the graft material used and the type of tympanoplasty but also on the pre-operative status of the ossicular chain

Surgical Treatment of Scleral Ulceration as a Complication of Pterygium Excision

Mitomycin C is now being used not only as an adjunct in the surgical treatment of pterygia but also in glaucoma surgery. However, several serious complications that are possibly related to mitomycin C treatment have been reported. We report on a series of 8 patients(10 eyes) who experienced scleral ulcer after pterygium excision. The period from operation to onset of scleral ulcer was between 5 months and 20 years. Complications included corneoscleral perf oration(1 eye), scleral ulceration(9 eyes), corneal ulceration(2 eyes), complicated cataract(5 eyes) and uveitis(4 eyes). We used autogenous temporalis fascia to reinforce the weakened lesion of 10 eyes with scleral or corneoscleral ulceration. Three eyes underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation after stable grafting. Grafts remained stable in 9 eyes over a mean follow-up of 10.8 +/- 10.4 months(3 to 37 months). One graft melted but regrafting salvaged the eye. Six of 10 eyes improved vision. All patients resolved their subjective symptoms after temporalis fascia grafting. We found autogenous temporalis fascia grafting is efficacious in both treating and preventing ocular perforation due to progressively destructive scleral ulceration.

Temporalis Fascia Grafting in Scleral Necrosis after Pterygium Excision

We performed scleral grafting with autogenous temporalis fascia and autogenous conjunctiva in 32 patients (32 eyes) in scleral necrosis after pterygium excision. The average age of patients was 54.3 years (range, 38 to 74 years). Nine of them were male and twenty-three were female. The intervals between pterygium excision and scleral necrosis were from 2 months to 23 years (mean, 6.2 years). After the mean follow-up 6.6 months, in 29 eyes graft was stably adhered but in three eyes graft was melted. Conjunctival wound dehiscence and conjunctival necrosis were noticed in three eyes and one eye respectively. There were no cases showing significant difference between the preoperative and the postoperative visual acuity and intraocular pressure. Autogenous temporalis fascia appears to be a good alternative to homologous sclera for scleral reinforcement.