Outcome of Single-Sitting Bilateral Type 1 Tympanoplasty in Indian Patients

Original Article

Abstract

Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations. Traditionally each ear drum is taken up for grafting sequentially in two different sittings, which leads to huge increase in operation cost, time and discomfort to the patient. Since, simultaneous bilateral tympanic membrane grafting could be quite safe and helpful to the patients, we performed the same in 32 patients with bilateral (64) ear drum perforations due to chronic suppurative otitis media. All patients had a conductive hearing loss corresponding to the size and site of the perforation, without evidence of ossicular chain defect or any other middle or inner ear pathology. The post-aural route was approached for the grafting in 27 ears, endaural in 22 perforations and the remaining 15 small perforations were done via endomeatal approach. All the ears were operated using the Underlay technique. The majority of the grafts were harvested from temporalis fascia (59 grafts), remaining five were obtained from tragal perichondrium. All the patients were subjected to regular follow-up evaluation and audiometry for up to 1 year after the surgery. Six ears showed incomplete recovery with residual perforation, although in two of them the tissue regeneration over next few weeks led to entire shutting down of the defect. Thus, the graft take rate was 93.75 % without any retraction pockets or displaced grafts. We did not encounter any iatrogenic sensorineural hearing loss. Thus the results from our study reinforce the safety of the single-step procedure and question the traditional apprehension regarding theoretical risk of iatrogenic sensorineural hearing loss making the ENT surgeon reluctant to perform this readily acceptable minor surgery in one sitting.

Keywords

Single stage bilateral type1 tympanoplasty Sensorineural hearing loss Outcome 

Notes

Conflict of interest

None.

References

  1. 1.
    Child and Adolescent Health and Development; Prevention of Blindness and Deafness (2004) Chronic suppurative otitis media: burden of illness and management options. World Health Organization, Geneva. ISBN 92-4-1591587Google Scholar
  2. 2.
    Singh A, Kumar S (2010) A survey of ear, nose and throat disorders in rural India. Indian J Otolaryngol Head Neck Surg 62:121–124. doi:10.1007/s12070-010-0027-3 PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Fukuchi I, Cerchiari DP, Garcia E, Rezende CE, Rapoport PB (2006) Tympanoplasty: surgical results and a comparison of the factors that may interfere in their success. Braz J Otorhinolaryngol 72:267–271PubMedGoogle Scholar
  4. 4.
    Palva T, Karja J, Palva A (1976) High-tone sensorineural losses following chronic ear surgery. Arch Otolaryngol 102:137–139PubMedCrossRefGoogle Scholar
  5. 5.
    Smyth GD (1977) Sensorineural hearing loss in chronic ear surgery. Ann Otol Rhinol Laryngol 86:1–6Google Scholar
  6. 6.
    Tos M, Lau T, Plate S (1984) Sensorineural hearing loss following chronic ear surgery. Ann Otol Rhinol Laryngol 93:403–409PubMedGoogle Scholar
  7. 7.
    Hung T, Knight JR, Sankar V (2004) Anterosuperior anchoring myringoplasty technique for anterior and subtotal perforations. Clin Otolaryngol Allied Sci 29:210–214PubMedCrossRefGoogle Scholar
  8. 8.
    Yu MS, Yoon TH (2010) Bilateral same-day surgery for bilateral perforated chronic otitis media: inlay butterfly cartilage myringoplasty. Otolaryngol Head Neck Surg 143:669–672PubMedCrossRefGoogle Scholar
  9. 9.
    Caye-Thomasen P, Nielsen TR, Tos M (2007) Bilateral myringoplasty in chronic otitis media. Laryngoscope 117:903–906PubMedCrossRefGoogle Scholar
  10. 10.
    Adkins WY, White B (1984) Type I tympanoplasty: influencing factors. Laryngoscope 94:916–918PubMedGoogle Scholar
  11. 11.
    Caylan R, Titiz A, Falcioni M, De Donato G, Russo A, Taibah A, Sanna M (1998) Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg 118:709–713PubMedGoogle Scholar
  12. 12.
    Lima JC, Marone SA, Martucci O, Gonçalez F, Silva Neto JJ, Ramos AC (2011) Evaluation of the organic and functional results of tympanoplasties through a retro-auricular approach at a medical residency unit. Braz J Otorhinolaryngol 77:229–236PubMedCrossRefGoogle Scholar
  13. 13.
    Singh GB, Sidhu TS, Sharma A, Singh N (2005) Tympanoplasty type I in children—an evaluative study. Int J Pediatr Otorhinolaryngol 69:1071–1076PubMedCrossRefGoogle Scholar
  14. 14.
    Hydr AS, Ashfaq M (2007) Single stage bilateral myringoplasty. Pakistan J Otolaryngol 23:66–67Google Scholar
  15. 15.
    Mitchell RB, Periera KD, Younis RT, Lazar RH (1996) Bilateral fat graft myringoplasty in children. Ear Nose Throat J 75:652–656PubMedGoogle Scholar
  16. 16.
    Sakagami M, Mishiro Y, Tsuzuki K, Seo T, Sone M (2000) Bilateral same day surgery for bilateral perforated chronic otitis media. Auris Nasus Larynx 27:35–38PubMedCrossRefGoogle Scholar
  17. 17.
    Katsura H, Sakagami M, Tsuji K, Muto T, Okunaka M, Mishiro Y, Fukazawa K (2005) Reevaluation of bilateral same-day surgery for bilateral perforated chronic otitis media. Otol Neurotol 26:842–845PubMedCrossRefGoogle Scholar
  18. 18.
    Homøe P, Sørensen HC, Tos M (2009) Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas. J Laryngol Otol 123:1108–1113PubMedCrossRefGoogle Scholar
  19. 19.
    Mane R, Patil B, Mohite A, Varute VV (2011) Bilateral type 1 tympanoplasty in chronic otitis media. Indian J Otolaryngol Head Neck Surg. doi:10.1007/s12070-011-0294-7 Google Scholar

Copyright information

© Association of Otolaryngologists of India 2013

Authors and Affiliations

  1. 1.Department of ENTLN Medical College and Research CentreBhopalIndia
  2. 2.Department of DermatologyLN Medical College and Research CentreBhopalIndia

Personalised recommendations