Sánchez HCM, Mario Támez VM

Language: Spanish
References: 8
Page: 51-59
PDF size: 497.42 Kb.

ABSTRACT

Objective: To determine the effectiveness of the endaural inlay approach using a butterfly-shaped cartilage graft to close tympanic perforations.
Methods: All patients with primary tympanic perforation at the ORL department of the South Central Specialty Hospital of Petroleos Mexicanos, were assisted (between May 1, 2005 and May 30, 2008) as outpatients. Preoperative protocol, consisting of laboratory tests, preoperative cardiac evaluation (for people over 40 years of age), and a complete audiometric study (audiometry, logoaudiometry and impedanciometry) was required. From the clinical record the following data was collected: affected ear, permeability and state of the ear canal, size and location of the perforation, presence of remnants, ossicular chain, and state of the middle ear mucosa. Surgery was proposed, requiring written informed consent, and a medical record was open. The same surgeon operated on all patients using the technique described in the Methods section. The data to estimate the frequency of successful graft integration and the frequency of new perforation by type of surgical procedure was analyzed using Fisher’s exact test. Quantitative variables were compared using Mann-Whitney U test, and continuous variables were subjected to Wilcoxon signed-rank test. A p less than or equal to 0.05 was considered statistically significant.
Results: It was a prospective study of 14 ears, five right (35.7%) and nine left (64.3%), belonging to 13 patients: five women and eight men, mean age of 40.07 years (range 11 to 62). Perforations of the patients studied were mostly of infectious origin (11 subjects, 78.6%), the rest were iatrogenic (three persons, 21.4%) [after insertion of trans-tympanic ventilation tubes]. In none of the individuals was the cause traumatic. The average size of the holes was 25.7% (5 to 40%), most of them was 20 to 40% (six patients, 42.8%), followed by under 20% (five subjects, 35.8%) and from 40 to 60% (three individuals, 21.4%). The audiometric baseline study revealed that 57.1% (eight patients) had conductive hypoacusia, and six subjects (42.8%) had predominantly conductive mixed hypoacusia. Regarding their severity, it was of superficial degree in 12 people (85.7%) and moderate in two (14.3%). The average threshold found was 32.4 dB (18.3 to 53.3 dB). The average GAP in the cohort was 16.9 dB (8.3 to 31.7 dB). When classifying by limits, one from 0 to 10 dB was observed in 14.3% (two patients), from 11 to 20 dB in 71.4% (10 patients), and greater than 20 dB in 14.3% (two subjects). All patients showed graft integration and healing of the perforated eardrum; only one patient (8.3%) showed discrete granulation tissue. There were no other complications. To compare results, we decided to recruit a retrospective cohort of 12 patients with similar characteristics to those of the control group. We reviewed the surgical records and found a group of 11 patients who had undergone an underlay retroauricular tympanoplasty with superficial temporalis fascia graft. Based on the above, two groups were formed: the study group (inlay tecnique) and the control group (underlay technique). In audiometric terms, the two groups were very similar, showing no differences in the type and degree of hypoacusia or air-bone gap. The integration of the graft was accomplished successfully in 100% of the study group and in 91.6% of the control group (p = 0.12). Only one patient (8.3%) showed discrete granulation tissue. There were no complications in the study group.
Conclusions: Tympanoplasty by endaural inlay approach using butterfly-shaped cartilage graft inlay (butterfly technique) is an innovative new technique initially developed to treat central tympanic perforations with comfortable tubes, but that has also shown to be useful to treat larger perforations, and in more extensive otologic procedures such as mastoidectomy and ossiculoplasty. It has also been reported to be effective in treating retraction pockets and adhesive disease of the middle ear. Endaural inlay tympanoplasty using a butterfly-shaped cartilage graft (butterfly technique) is a suitable technique for the closure of tympanic perforations because it produces results equal to those of the traditional technique (underlay). In addition, it gives great advantages in terms of patient comfort, less operative time, transoperative bleeding and postoperative pain.

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