ABSTRACT
Introduction: Type 1 tympanoplasty is one of the commonest operations done by an ENT surgeon. There are a number of choices regarding the graft material that one uses in this operation. Among those, temporalis fascia and tragal perichondrium are the most common. The aim of the study was to compare the results of tympanoplasty between two groups of patients- one using temporalis fascia as the graft material and the other using tragal perichondrium. Material and methods: This prospective study group consisted of 46 patients between the ages of 10 to 49 years. Only patients with dry safe central perforations and pure conductive hearing loss were included. Success was defined as ear-drum closure with no residual perforation. Hearing improvement was defined as air-bone gap less than 10dB. Results: We had included 46 patients in our study. Of them, 23 had tympanoplasty with temporalis fascia and the other 23 had tympanoplasty with tragal perichondrium. Conclusion: The study showed that both temporalis fascia and tragal perichondrium gave more or less the same results with regard to successful drum closure and hearing improvementthere was little to choose between these two
ABSTRACT
Background: Several graft material used in tympanoplasty operation to repair the perforated tympanic membrane. Our aim of this study is to compare the efficacy of tragal perichondrium and tragal cartilage with perichondrium as graft material Matetials and Methods:This study was a prospective one, conducted in Malda Medical College during January 2015 to December 2017, over 60 patients divided in two equal group randomly 30 patients each. One group undergone Tympanoplasty with tragal perichondrium as graft and in the other group we used tragal cartilage with perichondrium as graft material. The data was collected from above patients and statistically analyzed regarding graft taken or rejected and hearing improvement. Results and Analysis: Underlay tympanoplasty with tragal perichondrium as graft show about 86.67% success rate in respect to drum closure and Tragal cartilage with perichondrium show drum closure in about 80%. Post-operative AIR BONE gap improvement also little better in tragal perichondrium group than cartilage with perichondrium group. Conclusion: The study showed that both tragal perichondrium and tragal perichondrium with cartilage are good graft material in respect to drum closure and hearing improvement.
ABSTRACT
Background: Hearing is a sense that enables man to establish contact with his fellows via speech to experience life more fully. Deafness in varying degrees of severity is a big impediment to the integration of a person into the social structure. The otologist in the past had not much to offer to hearing handicapped people with chronic middle ear disease. With recent times the advent of the antibiotic era, the operating microscope and modern anesthetics techniques aimed at producing a dry, magnified operating field, have radically altered the outlook. Methods: This Prospective Randomised Comparative Study comprises of patients who were subjected to tympanoplasty for the treatment of chronic suppurative otits media. Each patient was subjected to a detail examination of nose, paranasal sinuses and throat to rule out any focus of infection, which could influence the result of tympanoplasty. 35 Patients were subjected to tympanoplasty with temporalis fascia while the remaining 35 patients underwent with tragal perichondrium in the age group of 15-50 years (males and females both ). Patients with the complaint of discharging ear and decreased hearing were also screened . Results: Majority of the patients preoperatively showed mild to moderate hearing loss.45.7% patients showed upto 20 db air bone gap range, 48.5% patients being in 21-40db air-bone gap and only 5.7% patients is above 40db. Graft take rate was overall 78.5%. Take-rate was 80% with temporalis fascia and 77.1% with tragal perichondrium. In the postoperative hearing analysis, 75.7% of the patients showed air- bone gap upto 20dB. 21.4% of the patients showed air- bone gap in the range of 21-40 Db. Mean improvement in hearing for temporalis fascia was 12.8 db and for tragal perichondrium was 11.4 db. Take rate of graft was not influenced by the size of perforation. Improvement in hearing was also not significantly influenced by the type of graft used. Conclusion: Tympanoplasty is the most effective method for control of the tubotympanic type of CSOM disease and hearing improvement. Both temporalis fascia and tragal perichondrium are excellent graft materials for closure of perforation of tympanic membrane and hearing improvement. Graft uptake rate is good for both with slightly better take rates for temporalis fascia, than tragal perichondrium.Improvement in hearing is not significantly influenced by duration of disease, age or sex of patients site or size of perforation
ABSTRACT
Aim: To compare the result of graft materials i.e. temporalis fascia, tragal perichondrium and ear lobule fat in various aspects but the prime interest would be the closure of tympanic membrane perforation and postoperative hearing improvement. Materials and methods: The study was carried out on 60 patients admitted for myringoplasty as per selection criteria in the Department of Ear Nose and Throat for a period of 1 year in patients autogenous graft materials was used and they were divided into three groups. In Group A 20 patients in which termporalis fascia was used as graft, Group B 20 patients in which tragal perichondrium was used as graft and Group C 20 patients in which ear lobule fat was used as graft. Results: Maximum number of patients (41.7%) was in the age group of 21-30 years. Female patients outnumber the male patients. The male female ratio was 1: 2. Rural population was more as compared to urban in study groups. Left ear was more involved in all the groups. Maximum number of patients i.e. in group A (50%), in group B (45%) and in group C (55%) was having duration of ear discharge of 1-5 years. Dry ear of <3 months of duration in group A, group B and group C was 50%, 80%, and 70% of patients respectively. In group A, 50% of patients had more than 30dB AB gap while 45% of group B and 50% of group C had less than 20dB AB gap. Overall total AB gap was 10.33 ± 9.62 dB. Mean improvement in hearing was 12.32 ± 8.42 dB, 10.38 ± 5.73 dB and 12.62 ± 8.06 dB in group A B and C respectively. Conclusion: Temporalis fascia graft has good improvement of hearing when compared to other grafts in study. Ear lobule fat when used in small perforations has encouraging results.
ABSTRACT
The perforations of the tympanic membrane may be of traumatic origin or due to chronic suppurative otitis media. If the perforations fail to heal conservatively, they require surgical closure. Autologous graft materials have stood the test of time in repairing tympanic membrane perforations. In our tertiary care institution, we conducted a prospective randomised control trial on 20 subjects to evaluate the comparative efficacy of temporalis fascia and tragal perichondrium as grafting material in underlay tympanoplasty. In this study, surgical success was evaluated in terms of intact drum membrane and minimal complications during the follow-up period. Temporalis fascia achieved a graft uptake of 90% and a satisfactory hearing improvement in 76% of the patients with minimal postoperative complications. Tragal perichondrium achieved a success rate of 80% graft uptake and 75% hearing gain. The rates are comparable with no statistical significance of difference between them.
ABSTRACT
PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for an active Mooren's ulcer. CASE SUMMARY: A 49-year-old male was referred to our clinic with Mooren's ulcer in his left eye. On the first visit, the ulcer involved the entire 360 degrees of the peripheral cornea and the visual acuity was 0.04. As the ulcer did not respond to medical treatment and progressed rapidly, the authors decided on surgical treatment. First, the involved cornea and nearby conjunctiva were removed and the defect was successfully reconstructed with autologous tragal perichondrium and allogenic limbal graft. The progression of corneal ulceration ceased after surgery and the patient's symptoms remarkably improved. Additionally, the graft showed rapid vascularization and engraftment within a week. However, as the opacity evolved and progressed to the central cornea, penetrating keratoplasty (PKP) was performed 5 months after the perichondrial graft. There was no rejection and corneal translucency was kept clear with low-dose steroid eye drops until 6 months after PKP without any sign of limbal deficiency. The patient's final best corrected visual acuity was 0.125. CONCLUSIONS: The present study shows that autologous tragal perichondrium graft is an effective method of treatment for active Mooren's ulcer by defect reconstruction and results in survival of the co-transplanted graft as well as maintaining corneal functions.
Subject(s)
Humans , Male , Middle Aged , Conjunctiva , Cornea , Corneal Ulcer , Keratoplasty, Penetrating , Mesenchymal Stem Cells , Ophthalmic Solutions , Transplants , Ulcer , Visual AcuityABSTRACT
PURPOSE: To introduce autologous tragal perichondrium transplantation as a novel surgical modality for the management of intractable symptomatic bullous keratopathy. METHODS: In three eyes of three patients with painful bullous keratopathy, autologous tragal perichondria were transplanted on the corneal surface with the human amniotic membrane transplanted above. We included an additional three eyes of three patients with painful bullous keratopathy who received amniotic membrane transplantation only to serve as controls. Clinical symptom outcomes were assessed using a visual analogue scale at postsurgical months 1, 3, 5, 7, and 9. In addition, transplanted tragal perichondrium and amniotic membrane complex tissue button obtained from one patient who underwent penetrating keratoplasty was evaluated by immunohistochemical analysis of CD34, vimentin, and alcian blue staining. RESULTS: All three patients who underwent autologous tragal perichondrium and human amniotic membrane co-transplantation showed improvements in pain and tearing. However, all three patients in the control group experienced aggravation of tearing and no further improvement of pain 3 months after surgery. In addition, one patient in the control group developed premature degradation of the amniotic membrane. Histopathologic and immunohistochemical analysis showed intact surface epithelization and positive CD34, vimentin and alcian blue staining of transplanted tragal perichondria. CONCLUSIONS: The tragal perichondrium has a high mechanical structural force and high potency due to well-organized epithelization and the presence of mesenchymal stem cells. Autologous tragal perichondrium transplantation may be an effective modality for the management of painful bullous keratopathy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Amnion/transplantation , Corneal Diseases/pathology , Ear Cartilage/transplantation , Keratoplasty, Penetrating/methods , Transplantation, Autologous , Treatment OutcomeABSTRACT
PURPOSE: To compare the efficacy of an autologous tragal perichondrium graft after proper antifungal treatment between 2 cases of fungal necrotizing scleritis. CASE SUMMARY: A 58-year-old female was referred to our clinic with fungal necrotizing scleritis of the left eye which had occurred after pterygium removal. Scleral melting around calcification was observed. After proper treatment with antifungal agents, the authors performed autologous tragal perichondrium graft; however, 3 months after surgery, a necrosis of sclera recurred and the, patient underwent additional treatment with antifungal agents. No complication has been observed up to 3 months postoperatively. A 36-year-old male visited our clinic with ocular pain and decreased visual acuity associated with necrotizing scleritis which occurred after local conjunctival resection. After 4 weeks of antifungal treatments, scleral lesions were stabilized and the authors confirmed negative findings with repetitive fungus smear test. Therapeutic autologous tragal perichondrium graft was performed, and no complication was observed 3 months postoperatively. CONCLUSIONS: When treating a patient with fungal necrotizing scleritis, preoperative antifungal therapy and confirmation of negative findings in repetitive fungus smear test are important. Autologus tragal perichondrium graft accompanied with proper antifungal therapy is an effective treatment of fungal necrotizing scleritis.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antifungal Agents , Freezing , Fungi , Necrosis , Pterygium , Sclera , Scleritis , Transplants , Visual AcuityABSTRACT
PURPOSE: To report the effectiveness of an autologous tragal perichondrium graft for a necrotizing scleritis case which was refractory to conventional surgery. CASE SUMMARY: A 75-year-old woman was referred to our clinic with recurrent necrotizing scleritis of the left eye which occurred after pterygium removal five years earlier. The patient underwent scleral graft, pericardium graft, and amniotic membrane graft in other clinics; however, necrosis of the sclera progressed. The best corrected visual acuity was 0.06, and choroidal tissue was nearly exposed below the melted pericardium graft in the nasal area. The authors harvested tragal perichondrium from the right ear, and the scleral defect was successfully reconstructed with an autologous tragal perichondium graft. The graft showed rapid epithelization and neovascularization within a week and conjunctivalization after three months. No complications have been observed up to one year after surgery. CONCLUSIONS: Autologous tragal perichondrium graft is an effective treatment to alter necrotized sclera via neovascularization and rapid epithelization in refractory necrotizing scleritis cases.