Graft recommendation bursts onto eardrum repair scene

Jan 14 2013

By Piriya Mahendra, medwireNews Reporter

Researchers say that a 0.2-mm partial thickness graft is optimal for reconstruction of subtotal tympanic membrane perforation.

Khaled Mokbel and El-Saeed Thabet, both from Mansoura University in Egypt, evaluated the function and take rate of a 0.2-mm thickness cartilage shield in comparison with a full thickness cartilage graft and a temporalis fascia graft.

They found that although the graft take was complete with both partial and complete thickness cartilage grafts, it was not complete in fascia cases.

By comparison, there was a greater improvement in hearing, assessed by measurements of air conduction average (ACA) and air bone gap (ABG), in cases repaired by partial thickness and fascia grafts than those repaired by full thickness grafts.

Indeed, mean ACA at 500-4000 Hz improved significantly from 39.3 dB preoperatively to 20.1 dB postoperatively for partial thickness grafts, and from 39.2 dB to 19.9 dB for fascia grafts, compared with 38.8 dB to 23.0 dB for full thickness grafts.

Mean ABG improved significantly from 29.7 dB to 9.9 dB for partial thickness grafts, and from 28.9 dB to 9.4 dB for fascia grafts, compared with an improvement of 29.4 dB to 13.9 dB for full thickness grafts.

The take rate was 100% for full and partial thickness grafts and 60% for the fascia graft.

The study involved 85 patients with a mean age of 30.5 years. All patients were classified into three groups: in group A, reconstruction of the tympanic membrane was done by partial thickness graft; in group B, full thickness cartilage graft was used; and temporalis fascia alone was used in group C.

In individuals where partial and full thickness grafts were used, thinning of the cartilage was achieved with an instrument called the Conchotome (Kurz Company, Germany). The notched cartilage shield was placed in an underlay fashion, with the malleus handle fitting into the notch. The cartilage was covered by a piece of temporalis fascia.

In group C, the temporalis fascia graft was harvested from the ipsilateral temporalis muscle via a postauricular approach. The canal was protected by gel foam and antibiotic ointment gauze pack, which were removed 10 days and 3 weeks, respectively, after surgery.

"We concluded that a 0.2-mm partial thickness cartilage is excellent for reconstruction of subtotal tympanic membrane perforation because it is characterized by high take rate with good hearing result," write the authors in the European Archives of Oto-Rhino-Laryngology.

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