A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type

Authors

  • Amitkumar Rathi Department of ENT, HBTMCH and Dr. R.N. Cooper Hospital, Mumbai, Maharashtra, India
  • Vinod Gite Department of ENT, HBTMCH and Dr. R.N. Cooper Hospital, Mumbai, Maharashtra, India
  • Sameer Bhargava Department of ENT, HBTMCH and Dr. R.N. Cooper Hospital, Mumbai, Maharashtra, India
  • Neeraj Shetty Department of ENT, HBTMCH and Dr. R.N. Cooper Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20180703

Keywords:

CSOM, Full cuff, Anterior tucking

Abstract

Background: The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking.

Methods: In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db.  

Results: Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db.

Conclusions: Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.

References

Kumar N, Chilke D, Puttewar MP. Clinical Profile of Tubotympanic CSOM and Its Management With Special Reference to Site and Size of Tympanic Membrane Perforation, Eustachian Tube Function and Three Flap Tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):5-12.

Frootko NJ. Reconstruction of the ear. In: Kerr AG, Booth JB, editors. Scott Brown’s Otolaryngology: Otology. 6th ed. Oxford: Butterworths-Heinnman; 1997;3:1-25.

Rafi T. Tympanoplasty in children: A study of 30 cases. J Surg Pak. 2001;6:11:2.

Rizer FM Overlay versus underlay tympanoplasty. Part I: historical review of the literature. Laryngoscope. 1997;107(12):1-25.

Wehrs RE. Grafting techniques, Otolaryngologic Clinics North Am. 1999;32(3):443–55.

Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital. 2011;31(6):366-71.

Applebaum EL, Deutsch EC. An endoscopic method-of tympanic membrane fluorescein angiography. Annuals Otol Rhinol Laryngol. 1986;95:439–43.

Dabholkar JP, Vora K, Sikdar A. Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian J Otolaryngol Head Neck Surg. 2007;59(2):116-9.

Monsell EM. New and revised reporting guidelines from the Committee on Hearing and Equilibrium. Am Acad Otolaryngol-Head and Neck Surg Foundation, Inc. Otolaryngol Head Neck Surg. 1995;113(3):176-8.

Labatut PT, Sierra GC, Mora RE, Cobeta MI. Primary myringoplasties. Results after a 2 year follow-up period. Acta Otorhinolaryngol Esp 2009;60:79-83 .

Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: Report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital. 2011;31:366-71.

Yaor MA, El-Kholy A, Jafari B. Surgical Management of Chronic Suppurative Otitis Media: A 3-year Experience. Annals of African Medicine 2006;5(1):24-7.

Yoon TH, Park SK, Kim JY, Pae KH, Ahn JH. Tympanoplasty, with or without mastoidectomy, is highly effective for treatment of chronic otitis media in children. Acta Otolaryngol Suppl. 2007;558:44-8.

Magsi PB, Jamro B, Sangi HA. Clinical presentation and outcome of mastoidectomy in chronic suppurative otitis media (CSOM) at a tertiary care hospital Sukkur, Pakistan. RMJ. 2012;37(1):50-3.

Webb BD, Chang CY. Efficacy of tympanoplasty without mastoidectomy for chronic suppurative otitis media. Arch Otolaryngol Head Neck Surg. 2008;134(11):1155-8.

Terkildsen K. Pathologies and their effect on middle ear function. In: Feldman AS, Wilber LA, editors. Acoustic Impedance and Admittance: The Measurement of Middle Ear Function. Baltimore, MD: Williams & Wilkins; 1976: 78–102.

Glasscock ME, Shambaugh GE. Surgery of the Ear. 4. Philadelphia: Saunders; 1990.

Mehta RP, Rosowski JJ, Voss SE, O'Neil E, Merchant SN. Determinants of hearing loss in perforations of the tympanic membrane. Otol Neurotol. 2006;27(2):136-43.

Doyle PJ, Schleuning AJ, Echevarria J. membrane. Laryngoscope. 1972;82(8):1425-30.

Glasscock ME 3rd, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope. 1982;92(7):718-27

Rizer FM. Overlay versus underlay tympanoplasty. Part II: the study. Laryngoscope. 1997;107(12):26-36

Mishra P, Sonkhya N, Mathur N. Prospective study of 100 cases of underlay tympanoplasty with superiorly based circumferential flap for subtotal perforations. Indian J Otolaryngol Head Neck Surg. 2007;59:225-8.

Hosmani P, Ananth L, Medikeri SB. Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal- type chronic otitis media. J Laryngol Otol. 2012;126(2):125-30.

Sharp JF, Terzis TF, Robinson J. Myringoplasty for the anterior perforation :experience with the Kerr flap”. J Laryngol Otol.1992;106:14-6.

Mokhtarinejad F, Barzegar SARF. Surgical and hearing results of the circumferential sub annular grafting technique in tympanoplasty randomized clinical study. Am J Otolaryngol Head Neck Med Surg. 2012;33:75-9.

Zollner F. Surgery of malformations of the auditory canal and middle ear. Acta Otolaryngol. 1954;44(5-6):517-24.

Shea, JJ Vein graft closure of ear drum perforation. J Laryngol Otol. 1960;74:358–62.

Heermann H. Tympanoplasty with fascial tissue taken from the temporal muscle after straightening the anterior wall of the auditory meatus. HNO. 1961;9:136-7.

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Published

2018-02-23

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