Double-Layer Tympanic Membrane Graft in Type I Tympanoplasty.

Bedri EH1, Korra B2, Redleaf M3, Worku A4.

Author information

1

1 OtoRino ENT Speciality Clinic, Honorary Otology Faculty, University of Illinois, Addis Ababa, Ethiopia.

2

2 St. Peter's Hospital, Addis Ababa, Ethiopia.

3

3 Department of OHNS, University of Illinois, Chicago, Chicago, Illinois, USA.

4

4 Addis Ababa University, Tikkur Anbessa, Addis Ababa, Ethiopia.

Abstract

BACKGROUND:

Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques.

MATERIALS AND METHODS:

A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement.

RESULTS:

A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( P = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( P < .0001). Preoperative hearing levels ( P = .179), postoperative hearing ( P = .857), and decibels of hearing improvement ( P = .356) were the same for all 3 groups.

CONCLUSION:

Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.

KEYWORDS:

eardrum perforation; myringoplasty; tympanic membrane rupture; tympanoplasty

PMID:

 

30991811

 

DOI:

 

10.1177/0003489419843551

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