Cartilage palisades in type III tympanoplasty: anatomic and functional long-term results

Abstract

Objective: To evaluate the long-term anatomic and functional results after partial and total autologous cartilage palisade type III tympanoplasties to assess the efficacy of cartilage palisades in preventing recurrent cholesteatoma.

Study design: Retrospective data bank and patient review.

Setting: Tertiary referral center.

Patients: The study population included all patients with more than 36 months follow-up who underwent tympanoplasty or tympanomastoidectomy for previously untreated cholesteatoma using partial or total autologous cartilage palisade graft associated with a reconstruction of the ossicular chain from October 1, 1992, to October 31, 1998.

Intervention: Tympanoplasty or tympanomastoidectomy using autologous cartilage palisade graft for partial or total reconstruction of the tympanic membrane and the ossicular chain.

Main outcome measures: Anatomic results, i.e., closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and reperforation rate related to the use of autologous cartilage were clinically evaluated. Postoperative speech reception thresholds, speech discrimination scores, and postoperative air-bone gap were compared with preoperative levels. The outcomes of canal wall up and canal wall down procedures were compared.

Results: Closure of the tympanic membrane was achieved in 98.3% of patients. Speech reception thresholds did not change significantly. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was less than 10 dB in 29.8% of patients and between 11 and 20 dB in 32.3%. The complication rate of the tympanoplasty in general was 0.67%. The rate of recurrences of cholesteatoma was 2.2%. No complications could be related to the use of cartilage.

Conclusions: The cartilage palisade technique is effective for the reconstruction of the tympanic membrane and also prevents new retractions and recurrences of cholesteatoma. The functional results show that autologous cartilage grafts are able to transmit sound.