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Inlay triple- "C" tympanoplasty: a comparative study for its use in large, marginal perforations.
Mauricio Cohen-Vaizer1,2, Roni Barzilai3, Shadi Shinnawi4,5
1Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rappaport Institute of Medicine and Research, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel. m_cohenvaizer@rmc.gov.il.
Inlay triple-C tympanoplasty offers comparable anatomical and audiological success to the underlay technique for tympanic membrane perforations. This inlay method significantly reduces surgical time, making it a valuable option for all perforation types.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Middle Ear Surgery
Background:
- Tympanic membrane perforations can impair hearing and quality of life.
- Cartilage tympanoplasty techniques aim to reconstruct the eardrum effectively.
- Large or marginal perforations present unique surgical challenges.
Purpose of the Study:
- To compare the efficacy of inlay, composite chondroperichondrial clip (triple-C) tympanoplasty with conventional underlay cartilage island tympanoplasty.
- To evaluate the triple-C technique's effectiveness in treating large and marginal tympanic membrane perforations.
Main Methods:
- Retrospective chart review of 183 patients undergoing tympanoplasty at a tertiary referral center.
- Comparison of 65 patients in the inlay triple-C group versus 118 patients in the underlay cartilage island group.
- Analysis of postoperative anatomical success, surgical time, hearing outcomes, and complications, with a focus on large/marginal perforations.
Main Results:
- Both inlay and underlay techniques demonstrated excellent results with similar re-perforation rates (9.2% vs 7.6%).
- Significant hearing improvement was observed in both groups, with 60% of inlay patients achieving an air-bone gap closure <10 dB compared to 36% in the underlay group.
- The inlay triple-C technique showed a significant reduction in surgical time (38 min vs 58 min) with comparable outcomes for large/marginal perforations.
Conclusions:
- Inlay triple-C tympanoplasty is a viable alternative to underlay cartilage island tympanoplasty, offering comparable anatomical and audiological success rates.
- The technique is effective even for large and marginal tympanic membrane perforations.
- Shorter operative times make inlay triple-C tympanoplasty a favorable surgical option for various tympanic membrane perforations.
