Otolaryngology: Open Access
Open Access

Abstract

Objective: To evaluate the efficacy of the fat graft used on type III tympanoplasty. Study Design: Retrospective study. Methods: This study was conducted, from September 2006 to September 2010 at our Otolaryngology Department of S.G. Moscati Hospital. The investigation included 92 patients who underwent a type III tympanoplasty. Patients were divided into two 2 groups (Group A and Group B) on the basis of the graft used for the eardrum reconstruction. From September 2006 to September 2008 forty-seven patients underwent a temporalis fascia graft type III tympanoplasty (Group A). From October 2008 to September 2010 forty-five patients underwent a fat graft type III tympanoplasty (Group B). The ossiculoplasty in both groups was performed used the modified double cartilage block ossiculoplasty (mDCB). All patients had a perforation of eardrum which did not reached the annulus; no evidence of active chronic otitis media, colesteatoma or retraction pocket formation; long incus process defect; hearing threshold of 45 dB or worse. In the group A the anesthesia was general and the approach was retroauricolar. . In the group B the anesthesia was local and the approach was transcanal. Audiometric data were obtained at 2 months, 6 months and every year post-operatively. The Chi2 test was used to compare results in the described groups. A p<0.05 was considered significant. The follow-up ranged from 15 to 63 months. The mean follow-up was 39 months. Audiometric data were calculated according to the 1995 American Accademy of Otolaryngology Head and Neck surgery guidelines. Main outcome measures: Closure of perforation; hearing improvement. Results: At the end of the follow-up none of the cases of the two groups had a worsening of bone conduction. Successful closure of the perforation was 95.7% (n=45) in Group A and 93.3% (n=43) in Group B. This difference was no statistically different ( X2=0,28). Post- operative air-bone gap less or equal to 20 dB was observed 83% (n=39) in group A and 84% in groupB (n=38). This difference was no statistically different ( X2=0,05). The mean duration of surgical procedure in group A was 70 minutes and in group B 30 minutes. This difference was statistically significant. . In group A all patients were discharged the day after procedure. In group B all patients were discharged a few hours after procedure. Conclusions: Fat graft tympanoplasty with mDBC ossiculoplasty success rate is comparable with temporalis fascia type III tympanoplas ty Furthermore, it decrease the operating time, the hospitalization, the waiting list, the cost of the procedure and increase the satisfaction of the patients. Due to increasing interests in both patients comfort and a more efficient use of operating time, fat graft tympanoplasty with mDBC ossiculoplasty, in selected cases, is a good alternative.

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