Shekharappa Munish Kambatatti, Siddappa Shruthi Malavalli
Associate Professor, Department of Ear, Nose and Throat, S.S Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India.
Postgraduate Student, Department of Ear, Nose and Throat, S.S Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India.
J Clin Diagn Res. 2017 Jul;11(7):MC06-MC08. doi: 10.7860/JCDR/2017/26877.10264. Epub 2017 Jul 1.
Tympanoplasty is one of routinely performed surgeries in ENT practice. Using cartilage-perichondrium composite graft in selective cases gives better outcome.
To study the outcome and feasibility of cartilage-perichondrium composite graft in repair of complex tympanic membrane perforations.
This cross-sectional, intervention study was conducted at SSIMS and RC, Tertiary Care Teaching Hospital, Davangere, Karnataka, Southern India. Study sample consisted of 30 patients with chronic otitis media- tubo tympanic type in inactive stage. Patients were randomly selected and evaluated between January 2015 to June 2016. A detailed history, clinical examination, diagnostic nasal endoscopy, otoendoscopy were done for all patients preoperatively and postoperatively at three weeks, three months and six months. Audiological evaluation was done at six months postsurgery. Cartilage-perichondrium composite graft from tragal and conchal cartilage was used for the repair of tympanic membrane in all the cases. The data were presented in proportions, percentages.
Of 30 cases who underwent surgery, 24 patients (80%) had large central and subtotal perforations. Only one patient had a total perforation. The remnant tympanic membrane showed atrophic changes in 16 cases (53%) and sclerotic plaque was seen in 14 cases (46%). In our study, tragal cartilage was used in 17 and conchal cartilage in 13 cases. All the patients underwent type-1 tympanoplasty. Successful graft uptake was seen in 28 cases (93%) by six months. Two patients (7%) had a residual perforation at three months and in four cases (13%), the neotympanum showed anterior blunting by the end of six months. With respect to hearing, maximum air bone gap closure achieved in our study was 21db in one patient and minimum was 3db. Average air bone gap closure achieved was 10.1db.
Cartilage-perichondrium composite graft can be considered a good choice in repair of tympanic membrane perforations with specific selective indications.
鼓室成形术是耳鼻喉科常规开展的手术之一。在特定病例中使用软骨 - 软骨膜复合移植物可取得更好的效果。
研究软骨 - 软骨膜复合移植物修复复杂鼓膜穿孔的效果及可行性。
本横断面干预性研究在印度南部卡纳塔克邦达万盖尔的三级护理教学医院SSIMS和RC进行。研究样本包括30例处于静止期的慢性中耳 - 咽鼓管鼓室型炎患者。于2015年1月至2016年6月随机选取并评估患者。所有患者在术前以及术后3周、3个月和6个月进行详细病史询问、临床检查、诊断性鼻内镜检查、耳内镜检查。术后6个月进行听力学评估。所有病例均采用取自耳屏和耳廓软骨的软骨 - 软骨膜复合移植物修复鼓膜。数据以比例、百分比形式呈现。
30例接受手术的患者中，24例（80%）有大的中央性和次全穿孔。仅1例为全穿孔。残余鼓膜16例（53%）呈现萎缩性改变，14例（46%）可见硬化斑。在我们的研究中，17例使用耳屏软骨，13例使用耳廓软骨。所有患者均接受Ⅰ型鼓室成形术。6个月时28例（93%）移植物成功吸收。2例（7%）在3个月时有残余穿孔，4例（13%）在6个月末新鼓膜出现前方钝圆。在听力方面，我们研究中最大气骨导差闭合为1例患者21dB，最小为3dB。平均气骨导差闭合为10.1dB。
软骨 - 软骨膜复合移植物在有特定选择指征的鼓膜穿孔修复中可被视为一种良好选择。
