Effect of primary T-tube insertion in a cartilage-perichondrium graft in tympanoplasty

ABSTRACT

Cartilage/perichondrium composite graft with concomitant placement of a ventilation tube is a common practice among otologists to repneumatize the middle ear, and to reverse atelectasis in poor Eustachian tube function. We conducted this study to investigate the necessity of a ventilation tube primarily incorporated into the cartilage/perichondrium graft for reconstruction of the tympanic membrane[TM] in tympanoplasty with a potential Eustachian tube dysfunction to improve the rate of graft success. A prospective clinical trial. Benha Teaching Hospital. Twenty patients with chronic suppurate otitis media [CSOM], were included in the study, for tympanoplasty. They were randomly divided into 2 groups. In Group [A], 10 patients underwent reconstruction of the TM with cartilage/perichondrium graft and intra-operative T-tube insertion, and in Group[B], 10 cases were operated upon using the same procedure without ventilation tube insertion. Outcome measures were graft taking success, improvement of hearing, and postoperative complications. Analysis of the results was performed by Student's paired t test. The level of significance was set at 5%. Significant postoperative improvement of pure tone air-conduction threshold averages and air-bone gap averages were reported in the two groups. The postoperative air-bone gap averages showed statistically significant difference between Group A and B, with a better results in group A. In group A, there were one failed case, postoperative otorrhea in 2 cases which were resolved within 3 weeks follow up by medical treatment, and three plugged tubes were also encountered on the tenth day which managed successfully. In group B, we had two failed cases and another 2 post-operative otorrhea which were resolved medically. Primary insertion of a ventilation T-tube during simultaneously tympanoplasty with cartilage/perichondrium graft in cases of [CSOM] with, potential poor Eustachian tube function may improve the success rate of graft taking and hearing gain