A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results.

ABSTRACT

OBJECTIVE: To assess the anatomic and functional results of primary Type1 cartilage tympanoplasty performed with the palisade technique and to compare them with the results of primary Type 1 tympanoplasty performed with temporalis fascia in children. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS The records of 45 children with intact ossicular chain and no history of mastoidectomy or tympanic perforations occupying more than 50% of the membrane area were evaluated. Patients with similar age and middle ear pathologic findings were selected in an effort to make the groups as homogeneous as possible. Of those, 21 children were included in the cartilage study group, and 24 patients were included in the fascia group. INTERVENTIONS: An over-under tympanoplasty technique using either a palisaded tragal cartilage or temporalis muscle fascia. MAIN OUTCOME MEASURES: Successful outcome was defined as full, intact healing of the graft without perforation, retraction, or lateralization for at least 12 months after the operation and with improvement of hearing. Postoperative speech reception thresholds and postoperative air-bone gap were compared with preoperative levels within and between the groups. RESULTS: Tympanoplasty with the palisade cartilage technique resulted in a significantly higher graft acceptance rate (100%) than with the fascia technique (70.2%; p = 0.008). Speech reception threshold levels, pure-tone average, and air-bone gaps improved significantly with surgery in both the palisade and fascia groups (p < 0.001). Comparison of audiologic results between the groups did not reveal any statistically significant difference (p > 0.05). CONCLUSION: Palisade tympanoplasty in children yielded good anatomic and functional results. The anatomic results obtained using this technique were superior to those obtained using temporalis muscle fascia. Children who underwent Type 1 tympanoplasty with palisaded cartilage had equivalent postoperative audiometric results compared with children who underwent Type 1 tympanoplasty with temporalis fascia. Thus, palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closure and hearing improvement in children.