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Over-under cartilage tympanoplasty: technique, results and a call for improved reporting
I D Erbele1,2, M R Fink3, G Mankekar1,4
1Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, New Orleans, USA.
Objective:
This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications.
Method:
This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained.
Results:
Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring.
Conclusion:
Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
Insights
The over-under cartilage tympanoplasty technique effectively improves hearing and closes perforations with few complications. This surgical method shows promising results for patients needing tympanic membrane repair.
Area of Science:
- Otolaryngology
- Surgical Techniques
- Auditory Health
Background:
- Tympanic membrane perforations can impair hearing and quality of life.
- Cartilage tympanoplasty is a reconstructive technique for eardrum repair.
- The over-under technique offers a specific approach to cartilage grafting.
Purpose of the Study:
- To describe the microscopic over-under cartilage tympanoplasty technique.
- To report hearing outcomes following this procedure.
- To detail clinically significant postoperative complications.
Main Methods:
- Retrospective case series chart review.
- Inclusion of 68 over-under cartilage tympanoplasty procedures performed between January 2015 and January 2019.
- Exclusion of cases with cholesteatoma, mastoidectomy, or ossiculoplasty.
Main Results:
- Mean pure tone average improvement of 6 dB (p < 0.0001).
- Perforation closure rate of 97% (66 out of 68 cases).
- Revision surgery recommended for 9% of cases (n=6) due to complications like post-operative perforations or scarring.
Conclusions:
- The over-under cartilage tympanoplasty technique is effective for hearing improvement.
- The procedure demonstrates a low rate of clinically significant postoperative complications.
- This technique offers a viable option for tympanic membrane reconstruction.
