title: Comparison of a microsliced modified chondroperichondrium shield graft and a temporalis fascia graft in primary type I tympanoplasty: A prospective randomized controlled trial.
abstract: We conducted a prospective, randomized, controlled trial to compare outcomes in type I tympanoplasty patients who received an autologous microsliced modified cartilage perichondrium shield graft (cartilage group) and those who received an autologous temporalis muscle fascia graft (fascia group). Our three outcomes measures were (1) anatomic success rates at 3 months, (2) hearing results at 6 months, and (3) rates of morphologic success (i.e., the absence of reperforation, retraction, and graft displacement) at 2 years among those in each group who had an intact graft at 3 months. Of 56 patients who were initially enrolled and who underwent one of these type I tympanoplasty procedures, 51 completed the study-28 in the cartilage group and 23 in the fascia group. The former was made up of 11 males and 17 females, aged 15 to 48 years (mean: 27.4), and the latter included 9 males and 14 females, aged 15 to 52 years (mean: 31.7). The overall graft take rate at 3 months with respect to perforation closure (anatomic success) was 93.3% in the cartilage group and 91.7% in the fascia group, which was not a statistically significant difference. The mean hearing gain at 6 months was 11.7 ± 7.6 dB in the cartilage group and 12.6 ± 6.0 dB in the fascia group-again, not statistically significant. At 2 years, morphologic success rates were 92.3 and 81.0%, respectively-again, not statistically significant. We conclude that autologous microsliced modified cartilage perichondrium shield graft tympanoplasty is as effective as conventional temporalis fascia tympanoplasty in terms of graft take rates and functional results. Indeed, medium-term outcomes (2-yr follow-up) revealed that sustainable morphologic success was actually better with the cartilage technique than with the fascia technique because it was associated with fewer revision surgeries.
authors.affiliation: Corresponding author: Dr. Sudipta Pal, Department of ENT, Calcutta National Medical College, 32 Gora Chand St., Kolkata 700014, India. Email: drsudiptapal@gmail.com From the Department of ENT, Murshidabad Medical College, Berhampur, Murshidabad, West Bengal, India (Dr. Bhattacharya); the Department of ENT, Calcutta National Medical College, Kolkata, India (Dr. Pal); the Department of ENT, NRS Medical College, Kolkata (Dr. Saha and Dr. Roy); and the Department of ENT, North Bengal Medical College, Siliguri, West Bengal (Dr. Gure). The study described in this article was conducted when all the authors were in the Department of ENT, R.G. Kar Medical College and Hospitals, Kolkata.
authors.forename: Shambhu Nath
authors.initials: SN
authors.lastname: Bhattacharya
authors.forename: Sudipta
authors.initials: S
authors.lastname: Pal
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.forename: Prasanta Kumar
authors.initials: PK
authors.lastname: Gure
authors.forename: Anupam
authors.initials: A
authors.lastname: Roy
mesh_terms: D000293:Adolescent; D000328:Adult; D004425:Ear Cartilage / Q000637:transplantation*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult