A study on the outcome of tympanoplasty with various graft materials

Background: Chronic Suppurative Otitis Media (CSOM) is one of the most common causes of preventable hearing loss especially in developing countries. CSOM is a disease condition characterized by persistent perforation of tympanic membrane with recurrent or persistent muco-purulent Otorrhoea. Aim: This study was undertaken to review the outcomes (hearing improvement) achieved by using various graft materials like temporalis fascia (TF), tragal cartilage (TC), Conchal cartilage (CC), autologous sculpted incus (I), autologous cortical bone (BG) in tympanoplasty surgery. Material and methods: This study comprised of 14 males and 16 females patients with age ranging from 12 years to 55 years. They were selected for surgery after adequate history taking, clinical, otoscopic and microscopic examination. Type 1 tympanoplasty was done in 19 patients, Type 3 tympanoplasty + Modified Radical Mastoidectomy (MRM) was done in 11 patients by using various graft materials. The results were evaluated in the form of rate of graft success, hearing gain, and the pre and post-operative Air Bone gap. Results: Out of 30 patients, in 20 TF graft patients AB gap improvement seen in 14 patients, 5 patients did not show any change and 1 patient did not come for follow up. In 2 TC graft patients, both showed improvement in AB gap. In 1 patient where CC graft was used showed improvement in AB gap. In 6 patients I graft was used, 2 patients showed improvement, 2 patients did not show any change, 1 patient did not come for follow up and in 1 patient AB gap worsened. In 1 patient BG was used and no change in AB gap was seen. Out of 30 cases graft uptake was seen in 25 cases and graft rejection was seen in 3 cases and 2 patients did not come for follow up. Graft rejection was documented in one case where TF was used, one case where incus graft was used and in another case where BG was used. Conclusion: Post-operative hearing gain obtained was found to be better in patients operated upon with tubotympanic disease than those operated upon with atticoantral disease. The post-operative hearing improvement depends not only on the graft material used and the type of tympanoplasty but also on the pre-operative status of the ossicular chain.