title: Tympanoplasty in subtotal perforation with graft supported by a slice of cartilage: a study with near 100 % results.
abstract: The aim of this study is to evaluate the results of closure of subtotal perforation by tympanoplasty using underlay technique with the perichondrium/temporalis fascia graft supported by single cartilage slice anteriorly. Our hypothesis was that the cartilage support, single slice, offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction. Retrospective and prospective study of patient undergoing tympanoplasty in subtotal perforation with graft supported by a slice of cartilage between March 2000 and October 2005. Intact perichondrium/temporalis fascia was placed as graft in subtotal perforation, supported by a slice of cartilage. Slice was placed anteriorly from hypotympanum to anterior part of attic. It does not obstruct Eustachian tube opening, as it is curved with concavity facing towards medial wall and lined by perichondrium without any raw area, which prevents adhesion formation. Hearing results were reported using four frequency (500, 1,000, 2,000 and 3,000) pure tone average air-bone gap. During the study period, perichondrium/temporalis fascia graft with support of cartilage slice was used for tympanic membrane reconstruction in 94 patients. Overall graft take rate was 98.94 %. In 95.74 % of patients of different types of tympanoplasty achieved hearing level of 30 dB or less. Complications included residual perforation in (1.06 %), infection or gaping of wound in 2 (2.13 %). Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (subtotal perforation, retraction pocket, cholesteatoma, anterior perforation of tympanic membrane).
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, Indore, Madhya Pradesh India ; 2 Kanchan Vihar, 2 Kanchan Bagh, Indore, 452001 Madhya Pradesh India.
authors.forename: R K
authors.initials: RK
authors.lastname: Mundra
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, Indore, Madhya Pradesh India ; 39, Bijli Nagar Private Colony, Govindpura, Bhopal, 462023 Madhya Pradesh India.
authors.forename: Richi
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, MGM Medical College & MY Hospitals, Indore, Madhya Pradesh India ; Itwara Bazaar, Distt Harda, Timarni, 461228 Madhya Pradesh India.
authors.forename: Richa
authors.initials: R
authors.lastname: Agrawal
keywords: Cartilage slice; High-risk perforation; Subtotal perforation; Tympanoplasty