Surgical and Audiological outcomes of Wet versus Dry Temporalis Fascia Graft in Type 1 Tympanoplasty
DOI:
https://doi.org/10.22317/imj.v7i3.1251Abstract
Objectives: Evaluate the surgical success and postoperative hearing outcome of type 1 tympanoplasty using temporalis fascia graft in its wet versus its dry fashion.
Methods: A prospective randomized comparative study which was conducted in Sulaimanyah otorhinolaryngology & head and neck surgery centre between October 2018 and November 2019 on patients with sign and symptom of tympanic membrane perforation who underwent type1 tympanoplasty in 2 groups in whom wet graft used in one group, and dry graft used in the other group, these patient followed up after 3 month for graft take and postoperative hearing.
Results: Of the 29 patients included in the study in 15 of them dry graft used and the graft take was 86.7% and in 14 of the wet graft used and the take rate was78.6%, postoperative mean hearing gain was 14.07 dB in the dry graft group and 12 dB in the wet graft group, all cases in both group had improvement in hearing (P value= 0.001), but neither wet nor dry was better than the other (P value=0.345). Graft take and hearing gain in different site and size of perforations were not significant, graft take rate was 100% in small size and 50% in subtotal perforation, hearing gain was 14.50 dB for subtotal perforation and 9.50 dB in small size perforation, mean time of wet graft group with 75.36 minutes were shorter significantly than the dry graft with 95 minutes with (P value=0.001).
Conclusion: The Nature of the temporalis fascia not affect the outcome type 1 tympanoplasty, and temporalis fascia is a good graft material regarding the success rate and hearing gain, however the wet Temporalis fascia graft use may shorten the operation time.
References
NFrancis HW. Anatomy of the Temporal bone. External Ear and Middle Ear. Cummings Otorhinolaryngology -Head and Neck Surgery. 6th edition. Philadelphia: Elsevier Saunders; 2015. p1977-86.
Valentine P, Wright T. Anatomy And Embryology Of the External and Middle Ear Scott-Brown`s Otorhinolaryngology- Head and Neck Surgery .8th edition. London: CRC Press; 2018: p.525-43.
Huins C, lavy J. Myringoplasty. Scott-Brown`s Otorhinolaryngology- Head and Neck Surgery .8th edition. London: CRC Press; 2018. p.1021-1027.
Athanasiadis A, Sismanis. Tympanoplasty: Tympanic Membrane Repair.
Glasscock- Shambaugh Surgery of the EAR. 6th edition. Connecticut: People`s Medical Publishing House; 2010. page 468-88
Kaylie DM, Jackson C.G, Glasscock ME, Strasnick B. Tympanoplasty- Undersurface Graft Technique: Postauricular Approach. Otologic Surgery 4th edition Philadelphia: Elsevier ; 2016 . p.123-33.
Adams ME, El- Kashlan HK. Tympanoplsty and Ossiculoplasty. Cummings
Otorhinolaryngology -Head and Neck Surgery. 6th edition. Philadelphia: Elsevier Saunders; 2015. p: 2177-187
Jiang Z, Lou Z. Impact of the nature of the temporalis fascia graft on the outcome of type I underlay tympanoplasty. The Journal of Laryngology & Otology. 2017 Jun;131(6):472-5.
Alkan S, Baylançiçek S, Sözen E, Başak T, Dadaş B. Effect of the use of dry (rigid) or wet (soft) temporal fascia graft on tympanoplasty. Journal of Otolaryngology-Head & Neck Surgery. 2009 Feb 1;38(1).
Loock JW, Naude N. A randomised controlled trial comparing fresh, dried, and dried‐then‐rehydrated temporalis fascia in myringoplasty. Clinical Otolaryngology. 2008 Apr;33(2):97-101.
Fisch U, May J, Linder T. Mastoidectomy and stapes surgery. Stuttgart : Thieme, 2007.
Shenoi PM. Autogenous temporalis fascia grafts: detailed light and electron microscopical observations on the effects of preparations. The Journal of Laryngology & Otology. 1982 Sep;96(9):801-10.
Walby AP, Kerr AG, Nevin NC, Woods G. Tissue culture of surgically prepared temporalis fascia. Clinical Otolaryngology & Allied Sciences. 1982 Oct;7(5):313-7.
Sheehy JL, Anderson RG. Myringoplasty: a review of 472 cases. Annals of Otology, Rhinology & Laryngology. 1980 Jul; 89(4):331-4.
Garag SS. M.B.B.S, A clinical study of myringoplasty using temporalis fascia, The Rajiv Gandhi University of Health Sciences
Karnataka, Bangalore, mysore , Karantaka, April 2009. Acta Otolaryngology 93. Page 441-6
Merchant SN. Rosowski JJ. Acoustic and Mechanics of the Middle Ear. Glasscock- Shambaugh Surgery of the Ear.6th edition. Connecticut: People`s Medical Publishing House; 2010: p. 49-72
Mirko tos. Michael E.Glasscock. Manual of Middle Ear Surgery Approaches, Myringoplasty, Ossiculoplasty and Tympanoplasty volume 1. Thieme Medical Publisher NewYork 1993.
Griffin Jr WL. A retrospective study of traumatic tympanic membrane perforations in a clinical practice. The Laryngoscope. 1979 Feb;89(2):261-82.
. Dornhoffer JL. Gluth MB Reconstruction of the Tympanic Membrane and Ossicular chain. Bailey`s Head& Neck Surgery- OTOLARYNGOLOGY 5th edition. Philadelphia: Wolters Kluwer|Lippincott Williams& Wilkins; 2014: p. 2465-86.
Singh GB, Kumar D, Aggarwal K, Garg S, Arora R, Kumar S. Tympanoplasty: does dry or wet temporalis fascia graft matter? . The Journal of Laryngology & Otology. 2016 Aug;130(8):700-5.
England RJ, Strachan DR, Buckley JG. Temporalis fascia grafts shrink. The Journal of Laryngology & Otology. 1997 Aug;111(8):707-8.
Wormald PJ, Alun-Jones T. Anatomy of the temporalis fascia. The Journal of Laryngology & Otology. 1991 Jul;105(7):522-4.
Indorewala S. Dimensional stability of free fascia grafts: clinical application. The Laryngoscope. 2005 Feb;115(2):278-82.
Chow LC, Hui Y, Wei WI. Permeatal temporalis fascia graft harvesting for minimally invasive myringoplasty. The Laryngoscope. 2004 Feb;114(2):386-8.
Emir H, Ceylan K, Kizilkaya Z, Gocmen H, Uzunkulaoglu H, Samim E. Success is a matter of experience: type 1 tympanoplasty. European archives of oto-rhinolaryngology. 2007 Jun 1;264(6):595-9.
Black JH, Wormald PJ. Myringoplasty-effects on hearing and contributing factors. South African medical journal. 1995;85(1):41-3.
de Lima JC, Marone SA, Martucci O, Gonçalez F, da Silva Neto JJ, Ramos AC. Evaluation of the organic and functional results of tympanoplasties through a retroauricular approach at a medical residency unit. Brazilian journalof otorhinolaryngology. 2011 Mar 1;77(2):229-36
Naderpour M, Moghadam YJ, Ghanbarpour E, Shahidi N. Evaluation of factors affecting the surgical outcome in tympanoplasty. Iranian journal of otorhinolaryngology. 2016 Mar;28(85):99.
Yung MW. Myringoplasty for subtotal perforation. Clinical Otolaryngology & Allied Sciences. 1995 Jun;20(3):241-5.
Applebaum EL, Deutsch EC. An endoscopic method of tympanic membrane fluorescein angiography. Annals of Otology, Rhinology & Laryngology. 1986 Sep;95(5):439-43.
Halik JJ, Smyth GD. Long-term results of tympanic membrane repair. Otolaryngology—Head and Neck Surgery. 1988 Feb; 98(2):162-9.
Booth JB. Myrigoplasty—Factors affecting results. The Journal of Laryngology & Otology. 1973 Nov;87(11):1039-84.
Frade CG, Castro CV, Cabanas ER, Elhendi W, Vaamonde PL, Labella TC. Prognostic factors influencing anatomic and functional outcome in myringoplasty. Acta otorrinolaringologica espanola. 2002 Dec;53(10):729-35.
Karela M, Berry S, Watkins A, Phillipps JJ. Myringoplasty: surgical outcomesand hearing improvement: is it worth performing to improve hearing?. European archives of oto-rhino-laryngology. 2008 Sep 1;265(9):1039-42.
Yung MW. Myringoplasty: hearing gain in relation to perforation site. The Journal of Laryngology & Otology. 1983 Jan;97(1):11-7.