Effect of a boomerang-shaped Conchal cartilage graft for Type three Tympanoplasty on Hearing
Introduction Chronic suppurative otitis media atticoantral disease (CSOM-AAD) is often associated with ossicular erosion resulting in significant hearing loss. Absence of the stapes suprastructure is a poor prognostic indicator of hearing outcome, which necessitates an effective reconstruction technique for ossicular continuity and restoration of middle ear volume. In the present study, we used a boomerang-shaped conchal cartilage graft.
Objective To evaluate the improvement in hearing using a boomerang-shaped conchal cartilage graft for Type III tympanoplasty in cases of CSOM-AAD in which the stapes suprastructure was absent and to study the incidence of intraoperative/postoperative complications of this procedure.
Method A total of 21 patients with CSOM-AAD who were found to have absent stapes suprastructure intraoperatively were included. A boomerang-shaped conchal cartilage graft was placed over the stapes footplate for reconstruction following canal wall down mastoidectomy. Pure tone audiogram (500, 1,000, 2,000 and 4,000 Hz) was done preoperatively and at 12 weeks postoperatively. Hearing outcome and incidence of complications were noted.
Results There was a statistically significant reduction in the hearing loss for air conduction and air-bone gap (ABG) of 6.1 dB and 6.9 dB respectively (p < 0.05). Air-bone gap < 30 dB could be achieved in 71.4% of the patients as compared with 23.8% preoperatively. No significant difference was noted in the bone conduction threshold (p > 0.05). A better hearing outcome was observed at higher frequencies (2,000, 4,000 Hz). No major complications were encountered.
Conclusion A boomerang-shaped conchal cartilage graft is effective when used for Type III tympanoplasty, especially at higher (2,000, 4,000 Hz) frequencies, and is comparable to newer materials such as titanium total ossicular reconstruction prosthesis (TORP). No major intraoperative/postoperative complications were noted.
Eingereicht: 22. Juli 2019
Angenommen: 13. April 2020
30. Juni 2020 (online)
© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
- 1 Lalwani AK. Current Diagnosis & Treatment in Otolaryngology: Head & Neck Surgery. Lange Medical Books/McGraw Hill; 2004: 1084
- 2 Kartush JM, Balough BJ. Contemporary ossiculoplastic options. Curr Opin Otolaryngol Head Neck Surg 2001; 9 (05) 272
- 3 Hillman TA, Shelton C. Ossicular chain reconstruction: titanium versus plastipore. Laryngoscope 2003; 113 (10) 1731-1735
- 4 Puls T. Tympanoplasty using conchal cartilage graft. Acta Otorhinolaryngol Belg 2003; 57 (03) 187-191
- 5 Brockman SJ. Cartilage graft tympanoplasty type 3. Laryngoscope 1965; 75 (09) 1452-1461
- 6 Jansen C. CARTILAGE--TYMPANOPLASTY. Laryngoscope 1963; 73: 1288-1301
- 7 Salen B. MYRINGOPLASTY USING SEPTUM CARTILAGE. Acta Otolaryngol Suppl 1964; 188 (Suppl. 188) 188 , 82
- 8 Adkins WY, Osguthorpe JD. Use of a composite autograft to prevent recurrent cholesteatoma caused by canal wall defects. Otolaryngol Head Neck Surg 1984; 92 (03) 319-321
- 9 Manual ofÂ Middle Ear Surgery, Volume 2 [Internet]. [cited 2018 Jun 15]. Available from: https://www.thieme.com/books-main/otolaryngology/product/2580-manual-of-middle-ear-surgery-volume-2
- 10 Şevik Eliçora S, Erdem D, Dinç AE, Damar M, Bişkin S. The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery. Eur Arch Otorhinolaryngol 2017; 274 (02) 773-780
- 11 Shinnabe A, Hara M, Hasegawa M. et al. Relationship between postoperative aeration around the stapes and postoperative hearing outcome after canal wall down tympanoplasty with canal reconstruction for cholesteatoma. Otol Neurotol 2011; 32 (08) 1230-1233
- 12 Gupta S, Kalsotra P. Hearing gain in different types of tympanoplasties. Indian J Otol. 2013; 19 (04) 186
- 13 Desaulty A, Shahsavari S, Pasquesoone X. [Ossicular reconstruction with autograft in type III]. Rev Laryngol Otol Rhinol (Bord) 2005; 126 (01) 19-23
- 14 Gostian A-O, Kouamé J-M, Bremke M, Ortmann M, Hüttenbrink K-B, Beutner D. Long-term Results of the Cartilage Shoe Technique to Anchor a Titanium Total Ossicular Replacement Prosthesis on the Stapes Footplate After Type III Tympanoplasty. JAMA Otolaryngol Head Neck Surg 2016; 142 (11) 1094-1099
- 15 Iñiguez-Cuadra R, Alobid I, Borés-Domenech A, Menéndez-Colino L-M, Caballero-Borrego M, Bernal-Sprekelsen M. Type III tympanoplasty with titanium total ossicular replacement prosthesis: anatomic and functional results. Otol Neurotol 2010; 31 (03) 409-414
- 16 House JW, Teufert KB. Extrusion rates and hearing results in ossicular reconstruction. Otolaryngol Head Neck Surg 2001; 125 (03) 135-141
- 17 Gardner EK, Jackson CG, Kaylie DM. Results with titanium ossicular reconstruction prostheses. Laryngoscope 2004; 114 (01) 65-70
- 18 Choi H-G, Lee DH, Chang KH, Yeo SW, Yoon SH, Jun BC. Frequency-specific hearing results after surgery for chronic ear diseases. Clin Exp Otorhinolaryngol 2011; 4 (03) 126-130
- 19 Kolo ES, Ramalingam R. Hearing Results Post Tympanoplasty: Our Experience with Adults at the KKR ENT Hospital, India. Indian J Otolaryngol Head Neck Surg 2014; 66 (04) 365-368