Learning Objectives: Comparison of three different autologous graft tissues in simple myringoplasty in term of effectiveness and hearing gain.
Introduction: In case of chronic otitis medica it is possible to reconstruct the defect of the eardrum with different autologous materials: fascia (F), perichondrium (P),or cartilage ©. Last tissue shows greater resistance but might reduce the gain of the auditory canal due to its thickness. Aim of the study is to compare the effectiveness and the success in auditive gain of the 3 different tissues in simple myringoplasty.
Material and Methods: All simple myringoplasty of the last 3 years have been revaluated. Exclusion criteria were the presence of a cholesteatoma and chronic otitis. An otoscopic picture of both ears was taken for each patient. The site of perforation was classified into anterior, posterior and subtotal. A PTA, according to the guidelines of the AAO-HNS has been performed before and 2 months after surgery.
Results: A total of 123 patients undergoing simple myringoplasty was identified. In 33 patients we used C, in 33 F and in 26 P. The overall failure rate was 10%, divided in: 12.1 % for C (plus a further 12.1 % of microperforation all repaired), 2.7 % for F, 18.2 % for P. The status of the contralateral ear showed it was pathological in 48.5 % of cases of C, 16.6 % F and 18.2 % of P. The site of the perforation was anterior in 48.5 % of C, 41.6 % of F and 40.1 % of P; posterior in 12.1 % of C, 13.8 % of F and 45.4 % of P; subtotal in 39.4 % of C, 44.4 F and 13.6 % of P. The ABG was 26.9 dB for the preoperative C, 20.7 dB for F and 18.6 dB for and P; The postoperative ABG was 17.3 dB for C, 13.1 dB for F and 11.5 dB for P. The auditive gain (difference of ABG pre and postop) was 9.5 dB for C, 7.5 dB for F and 7 dB for P.
Conclusions: The results show an overall success rate in line with the literature. It emerges that F has the best success rate but C is used mostly in cases where the contralateral ear is pathological. The auditory gain is comparable, even if C is chosen in the cases with a worse initial ABG.
