Endoscopic cartilage type 1 tympanoplasty : our experience

1. A Observational Study of Endoscopic
Cartilage Type 1 Tympanoplasty : Our
experience
Presented By,
Dr Vivek Makadiya
2nd Year Resident Doctor
makadiyavivek1010@gmail.com
Dr M K Shah Medical College And Research Centre,
Ahmedabad
Guided by,
Dr Viral Prajapati
Professor and HOD of ENT department
Dr M K Shah Medical College And
Research Centre, Ahmedabad

2. INTRODUCTION
• Tympanoplasty is a procedure for repair and
reconstruction of tympanic membrane and/or
ossicles[1].
• Various grafting materials like temporalis fascia,
fasica lata, vein, cartilage, peri-chondrium have
been used to reconstruct the perforation with
different success rates.

3. AIMS & OBJECTIVES
• To see the success rate of tragal cartilage
grafts take up in tympanoplasty.
• To check hearing gain with use of tragal
cartilage graft following tympanoplasty.

4. METHODOLOGY
• Patient above 18 years of age having chronic
otitis media of Mucosal type.
• Patient having dry ear for at least 6 weeks.
• Patient having normal cochlear reserve.
• Patient having intraoperative intact and mobile
ossicular chain.
INCLUSION CRITERIA :-
This is a Observational study that was conducted on diagnosed case of
chronic otitis media, visiting Otorhinolaryngology admitted in S.M.S.
Multispecialty Hospital under department of Otorhinolaryngology from
May 2022 to May 2023.

5. EXCLUSION CRITERIA :-
• Patient having Squamous type of chronic otitis
media.
• Patient with active mucosal suppurative otitis
media.
• Patient with sensorineural hearing loss element.
• Patient with any ossicular damage
intraoperative.
• Patient with eustachian tube dysfunction.

6. PRESENTING SYMPTOMS
5
20
25
0
5
10
15
20
25
30
Ear discharge Ear discharge and
decreased hearing
Total
• Total 25 cases were included in this study according to
inclusion criteria.

7. AGE DISTRIBUTION(YEARS)
10
8
3
4
0
2
4
6
8
10
12
18 to 30 31 to 40 41 to 50 51 to 60

8. SITE OF PATHOLOGY
16
9
0
2
4
6
8
10
12
14
16
18
UNILATERAL BILATERAL

9. OTOSCOPIC FINDING
9
12
4
Moderate CP
Large CP
Subtotal CP

10. 0%
5%
10%
15%
20%
25%
30%
35%
20-25dB 26-30dB 31-35dB 36-40dB 41-45dB
Preoperative AB gap(dB)
• PTA examinations at average of 500,1000 and 2000 Hz were done preoperatively with
average preoperative AB gap is 29.95 dB.

11. INTRAOPERATIVE
Left side margin of perforation freshened
• All Patients underwent Endoscopic transcanal type 1
tympanoplasty with use of full thickness tragal cartilage along with
one side perichondrium(facing laterally) as graft material under
anesthesia.

12. Harvesting tragal cartilage

13. INTRAOPERATIVE
Graft placed

14. • Patients were requested to come for follow-up at 3
weeks, 6 weeks and 12 weeks after surgery.
• Oto-endoscopy and PTA examinations at average of
500,1000 and 2000 Hz were done postoperatively at
12 weeks after surgery and results are compared for
graft uptake and hearing improvement.
• On oto-endoscopy at 12 weeks, cases with complete
closure of tympanic membrane defect were labelled as
successful graft uptake.

15. Graft appearance at 12 weeks after surgery

16. 0%
5%
10%
15%
20%
25%
30%
35%
40%
1-5dB 6-10dB 11-15dB 16-20dB 21-25dB Unchanged
Postoperative AB gap(dB)
• PTA examinations at average of 500,1000 and 2000 Hz were done postoperatively at 3
month with average AB gap is 13.47dB.

17. SUCCESS RATE OF GRAFT
23
2
GRAFT UPTAKE
GRAFT FAIL
RESULTS
• Other study results of success rate of graft :--
Özdemir D et al [2] – 93.2%
Ulka CH [3] – 91.3%
Yung M et al [4] – 80%
= 91.30 %

18. HEARING GAIN AFTER SURGERY
AB gap dB(decibel)
Preoperative AB
gap (dB)
Postoperative
AB gap(dB)
Hearing Gain AB
gap(dB)
29.95 dB 13.47 dB 16.48 dB
Average of Air bone gap of 23 Patients
• Other study results of hearing gain in AB gap(dB) :--
Özdemir D et al [2] – 10.77 dB
Ulka CH [3]– 12.30 dB
Yung M et al [4]– 12.60 dB

19. CONCLUSION
• Endoscopic approach is a expertise single hand
technique.
• Endoscopes provide a wider and angled view of middle
ear structure and ventilation pathway.
• Tragal cartilage tympanoplasty is a reliable technique,
it has a high degree of graft uptake and hearing results
are satisfactory[5].
• Tragal cartilage is excellent graft especially in
endoscopic tympanoplasty.
• Transcanal approach is scarless, field is bloodless and
less time consuming than postauricular approach[6].

20. REFERENCE
1) Vadiya SI, Makwana P, Khetani S, Mehta N. Comparison of tragal cartilage
and conchal cartilage in tympanoplasty. Indian J Otol 2022;28:41-4.
2) Özdemir D, Özgür A, Akgül G, Çelebi M, Mehel DM, Yemiş T. Outcomes of
endoscopic transcanal type 1 cartilage tympanoplasty. Eur Arch
Otorhinolaryngol. 2019 Dec;276(12):3295-3299. doi: 10.1007/s00405-019-
05636-w. Epub 2019 Sep 13. PMID: 31520162.
3) Ulka CH. Cartilage tympanoplasty with island technique for reconstruction of
tympanic membrane perforation; anatomic and audiologic results. Kulak
Burun Bogaz Ihtis Derg. 2010;20:7–12.
4) Yung M, Vivekanandan S, Smith P. Randomised study comparing fascia and
cartilage grafts in myringoplasty. Ann Otol Rhinol Laryngol. 2011;120:535–
541. doi: 10.1177/000348941112000808.
5) Cavaliere M, Mottola G, Rondinelli M, Iemma M. Tragal cartilage in
tympanoplasty: Anatomic and functional results in 306 cases. Acta
Otorhinolaryngol Ital 2009;29:27-32.
6) Parelkar K, Thorawade V, Marfatia H, Shere D. Endoscopic cartilage
tympanoplasty: full thickness and partial thickness tragal graft. Braz J
Otorhinolaryngol. 2020;86:308---14.