Cartilage tympanoplasty for management of tympanic membrane atelectasis: is ventilatory tube necessary?
OBJECTIVE
Cartilage/perichondrium composite graft with concomitant placement of a ventilation tube is a common practice among otologists to reverse atelectasis and to repneumatize the middle ear. We conducted this study to investigate the necessity of a ventilation tube primarily incorporated into the perichondrium/cartilage graft for reconstruction of the atelectatic tympanic membrane (TM).


METHODS
Prospective clinical trial.


METHODS
Forty-six patients with TM atelectasis and intact ossicular chain were randomized to 2 groups. In Group I, 23 patients underwent reconstruction of the TM with perichondrium/cartilage graft and intraoperative T-tube insertion and in Group II, 23 patients underwent reconstruction of the TM with perichondrium/cartilage graft without ventilation tube insertion. Outcome measures were as follows: graft 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%.


RESULTS
Significant postoperative improvement of pure-tone air-conduction threshold averages and air-bone gap averages were reported in the 2 studied groups (p < 0.001). The postoperative air-bone gap averages showed no statistically significant difference between Groups I and II (p > 0.05). Conductive hearing loss requiring revision developed in 2 patients (8.69%) in Group I and in 3 patients (13%) in Group II.


CONCLUSIONS
In the atelectatic ear, cartilage allowed reconstruction of the TM with good anatomical and functional results. Primary insertion of a ventilation tube into the graft is not necessary.
Elsheikh
Mohamed Nasser
MN
Otolaryngology Department, Tanta University, Tanta, Egypt. mnel_sheikh@hotmail.com
Elsherief
Hosam S
HS
Elsherief
Sayed G
SG
D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D004427:Ear Diseases / Q000601:surgery*; D005064:Eustachian Tube / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*