A Comparative Study Between the use of Temporalis Fascia and Fascia Lata as Graft During Tympanoplasty Performed in A Tertiary Care Centre

##plugins.themes.academic_pro.article.main##

Rohan Vijay Gupta
Shreeya Vinay Kulkarni
Kiran Burse
Chaitanya Bharadwaj
Vandana Sancheti
Rushika Patel

Abstract

Background: Chronic suppurative otitis media is a common otological condition in India causing hearing loss for which patients seek advice from an otolaryngologist. The perforation seen in chronic suppurative otitis media may be the only sequel remaining when the pathological process in middle ear cleft has healed. Tympanoplasty, the procedure for repairing the perforations of the pars tensa, can be done using a variety of graft materials. In this study two different types of graft materials, fascia lata and temporalis fascia, which can be used in tympanoplasty will be studied. The study will help to know which is better in terms of graft uptake as well as improvement in hearing. This will help in a better understanding of which grafts can be used in tympanoplasty in the future. Aims and Objectives: To compare hearing gain and graft uptake rate between temporalis fascia and fascia lata in tympanoplasty and to study the postoperative morbidity/complications associated with the 2 modalities. Materials and Methodology: The study was conducted on 42 patients divided in 2 groups of 21 each. The 1st group underwent tympanoplasty type 1 by endomeatal approach using fascia lata graft and the 2nd group by a post aural approach using temporalis fascia graft. Regular follow ups and otoscopic examination was done on the patients to check the graft uptake. Pure tone audiometry was done after a minimum period of 2 months post-surgery and was compared with the preoperative audiometry to assess the hearing improvement in hearing. Results and Conclusions: This study compared both temporalis fascia and fascia lata as graft materials used in tympanoplasty. Graft uptake results and gain in hearing were better with temporalis fascia as compared to fascia lata. Temporalis fascia was also associated with lesser post-operative complications. So this study finds that tympanoplasty done by postaural technique using temporalis fascia is better in terms of graft uptake, hearing improvement and postoperative complications when compared to tympanoplasty done by fascia lata.

##plugins.themes.academic_pro.article.details##

How to Cite
Gupta, R. V., Kulkarni, S. V., Burse, K., Bharadwaj, C., Sancheti, V., & Patel, R. (2020). A Comparative Study Between the use of Temporalis Fascia and Fascia Lata as Graft During Tympanoplasty Performed in A Tertiary Care Centre. MVP Journal of Medical Sciences, 141–150. https://doi.org/10.18311/mvpjms/2020/v7i2/24545

References

  1. Chadha SK, Sayal A, Malhotra V, Agarwal AK. Prevalence of preventable ear disorders in over 15 000 schoolchildren in northern India. The Journal of Laryngology & Otology. 2013 Jan; 127(1): 28-32.
  2. Varshney S. Deafness in India. Indian journal of otology. Apr 1, 2016; 22(2): 73.
  3. Muqtadir F, Rahul S. A study of hearing improvement gained after tympanoplasty using various methods in cases of CSOM. Int J Otorhinolaryngol Head Neck Surg. 2018 Jan; 4(1):107–11. https://doi.org/10.18203/issn.2454-5929. ijohns20174682.
  4. Merchant SN, Mckenna MJ, Rosowski JJ. Current status and future challenges of tympanoplasty. Ear Arch Otorhinolaryngol. 1998; 225:221–8. PMid: 9638462. https://doi.org/10.1007/s004050050047.
  5. Prakash R, Juyal D, Negi V, Pal S, Adekhandi S, Sharma M, Sharma N. Microbiology of chronic suppurative otitis media in a tertiary care setup of Uttarakhand state, India. North American journal of medical Sciences. Apr 2013; 5(4): 282.
  6. Lieu JE, Kenna M, Anne S, Davidson L. Hearing loss in children: a review. JAMA. Dec 1 2020; 324(21): 2195-205.
  7. James AL. Endoscope or microscope‐guided pediatric tympanoplasty? Comparison of grafting technique and outcome. The Laryngoscope. Nov 2017; 127(11): 2659-64.
  8. Bedri EH, Korra B, Redleaf M, Worku A. Double-layer tympanic membrane graft in type I tympanoplasty. Annals of Otology, Rhinology & Laryngology. Sept 2019; 128(9): 795-801.
  9. Jaiswal RK, Chettri ST, Shah SP, Karki S, Sah BP, Paudell D. Comparison of outcomes of palisade cartilage with temporalis fascia following tympanoplasty at a tertiary care centre in Nepal. Int J Otorhinolaryngol Head Neck Surg. 2016 Oct; 2(4):224. https://doi.org/10.18203/issn.2454- 5929.ijohns20163470.
  10. Heermann J, Jr, Heermann H, Kopstein E. Fascia and cartilage palisade tympanoplasty: Nine years’ experience. Arch Otolaryngol. 1970; 91(3):228–41. PMid: 4905504. https://doi.org/10.1001/archotol.1970.00770040334004.
  11. Couloigner V, Baculard F, El Bakkouri W, Viala P, Francois M, Narcy P. Inlay butterfly cartilage tympanoplasty in children. Otol Neurotol. 2005; 26:247–51. PMid: 15793413. https://doi.org/10.1097/00129492-200503000-00020.
  12. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000; 110:1994–9. PMid: 11129007. https://doi. org/10.1097/00005537-200012000-00002.
  13. Murugendrappa MA, Siddappa PN, Shambulingegowda A, Basavaraj GP. Comparative study of two different myringoplasty techniques in mucosal type of chronic otitis media. J Clin Diagn Res. 2016; 10(2):1–3. PMid: 27042491 PMCid: PMC4800556. https://doi.org/10.7860/ JCDR/2016/16843.7194.
  14. Verma S, Arora A, Narvey VP. Comparison of conventional temporalis fascia myringoplasty with fascia lata myringoplasty among patients with hearing loss. Int J Otorhinolaryngol Head Neck Surg. 2019 Jul; 5(4):926–31. https://doi.org/10.18203/issn.2454-5929.ijohns20192706.
  15. Harkare VV, Mishra RK, Deosthale NV, Khadakkar SP, Dhoke PR, Dhote K, Kamal N, Reddy ST. A comparative study of different tissues used for tympanic membrane grafting. Journal of Evolution of Medical and Dental Sciences. 2013 Oct; 2(41):7834–40.
  16. Landge SU, Jatale PV, Kirdak V, Chintale S, Shaikh K. Comparative study of temporalis fascia graft, tragal cartilage graft and fascia lata in tubotympanic type of CSOM. MedPulse International Journal of ENT. 2019 Jan; 9(1):37–40. https://doi.org/10.26611/1016919.
  17. Patil K, Baisakhiya N, Deshmukh PT. Evaluation of different graft material in type 1 tympanoplasty. Indian J Otol. 2014; 20:106–14. https://doi.org/10.4103/0971-7749.136844.
  18. Gupta P, Prajapati BJ, Gupta MY, Mehta R, Sinha V. Different types of graft materials in type I tympanoplasty. Indian J Otol. 2007; 13:9 11.
  19. Indorewala S. A study on dimensional stability of the free fascia grafts, 2004 Mar; 114(3):543–7. PMid: 15091232. https://doi.org/10.1097/00005537-200403000-00029.