Medial or lateral to the malleus graft tympanoplasty: Comparison of the functional results
DOI:
https://doi.org/10.34631/sporl.729Keywords:
tympanoplasty, overlay, underlay, over-underlayAbstract
Introduction: tympanoplasty refers to the surgical procedure of repairing of the tympanic membrane, which may be associated with ossicular reconstruction. The best relative position to the handle of the malleus in which the graft is placed is still controversial. Some authors advise the placement of the graft under the malleus’ handle, while others defend its placement over this structure, position which, although implying manipulation of the ossicular chain with its associated risks, gives support to the graft.
Objective: compare two techniques of placement of the graft in tympanoplasty, medial and lateral to the handle of the malleus.
Methodology and methods: it is a retrospective study. Clinical records of patients who went through a type I tympanoplasty between 2013 and 2017. We selected the patients whose used graft was fascia temporalis. The patients were then divided in two groups: group 1 included the patients in which the graft was placed under the handle of the malleus; group 2 comprised patients in which the graft was placed over the malleus’ handle.
Results: pre-operatively mean air-bone gap was 24 dB, and, post-operatively was 12 dB. There was no statistical significant difference in the mean air-bone gap pre-operatively between both groups. We verified a statistical significant improvement in the air-bone gap with surgery in both groups; nevertheless, difference between both was not statistically significant. In 18,5% (n=13) of all cases the average pure tone-threshold worsened, by 7,5dB the most; 10% of the cases were in group 1, and 8,5% in group 2, with no statistical significant difference between both.
Conclusion: according to our results, any of the techniques for placement of the graft is valid, with good functional result with both.
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