Type III tympanoplasty applying the palisade cartilage technique: a study of 61 cases

Abstract

Objective: To determine the morphologic and hearing results of the combined application of the palisade cartilage technique and titanium ossicular replacement prostheses in Type III tympanoplasty.

Study design: Retrospective review of 61 tympanoplasties.

Setting: Tertiary referral center.

Patients: 59 patients (39 women and 20 men, mean age 36 years, range 7-81 years) consecutively operated on because of cholesteatoma, adhesive otitis, chronic otitis media, subtotal tympanic membrane defects, and tympanofibrosis requiring tympanoplasty with ossiculoplasty.

Interventions: Tympanoplasty Type III, with application of the palisade cartilage technique and total or partial titanium ossicular replacement prosthesis.

Main outcome measures: Otoscopic findings and hearing results using a four-frequency pure tone average air-bone gap.

Results: A recurrent defect was seen in 1 ear (1.6%). The graft take rate was 100%. There were no extrusions of prostheses. Preoperatively, a pure tone average air-bone gap of 0 to 10 dB was seen in 1 ear, 11 to 30 dB in 30, and 31 to 50 dB in another 30 ears. Postoperatively, the corresponding numbers were 11, 41, and 9 ears, respectively. Hearing results were better in the total ossicular replacement prosthesis group.

Conclusions: The palisade cartilage technique is suitable to manage difficult pathologic conditions in middle ear surgery. It was demonstrated that the palisade cartilage technique can be combined safely with titanium ossicular replacement prostheses. Regarding postoperative hearing results, the negative preselection of pathologic conditions must be considered.