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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.
Objective And Intervention:
To compare the efficacy of the inlay, composite chondroperichondrial clip (triple-C) tympanoplasty with conventional underlay cartilage island tympanoplasty, and to evaluate its efficacy in treating large, marginal perforations.
Study Design:
The study involved 183 patients that were selected from a retrospective chart review of tympanoplasties performed at our center from March 2016 to June 2018.
Setting:
A tertiary referral center hospital.
Patients:
65 patients underwent inlay, triple-C cartilage tympanoplasty (inlay group) and 118 underwent underlay cartilage island tympanoplasty (underlay group).
Main Outcome Measures:
Postoperative anatomical success rate, surgical time, hearing outcomes, and complications were analyzed. Focused analysis was performed on large or marginal perforations.
Results:
Both groups exhibited similar characteristics in demographic distribution, general health status, preoperative anatomical and hearing disabilities. Excellent results were achieved in both groups. Re-perforation occurred for 9.2% of the inlay group and 7.6% of the underlay group (p = 0.71). Hearing improvement was significant in both groups. Within the separate groups, 36% of underlay patients and 60% of inlay patients improved to achieve closure of the air-bone gap (ABG) to less than 10 dB (p = 0.1). In large or marginal perforations, both groups performed similarly. No significant complications were seen in this cohort. Nevertheless, a significant reduction in surgical time was observed in the inlay group (38 min. vs 58 min.; p = 0.0004).
Conclusion:
Inlay triple-C tympanoplasty is comparable to conventional underlay cartilage island tympanoplasty in both anatomical and audiological success rates, even for large, marginal perforations. Due to its shorter operation time, inlay triple-C tympanoplasty should be considered a good surgical option for all tympanic membrane perforations.
