Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties

Abstract Introduction: Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient. Objective: To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties. Methods: In total, 78 patients (38 males, 40 females; average age 10.02 ± 1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap ≤ 20 dB were regarded as a surgical success. Results with a p-value < 0.05 were considered statistically significant. Results: The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68 ± 11.44 dB and postoperative air-bone gap was 24.25 ± 12.68 dB. In the cartilage group, the preoperative air-bone gap was 35.68 ± 12.94 dB and postoperative air-bone gap was 26.11 ± 12.87 dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p < 0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p > 0.05). The average thickness of tragal cartilage in the pediatric population was 0.693 ± 0.094 mm in males and 0.687 ± 0.058 mm in females. Conclusions: Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate.

摘要：

引言：目前已有多种移植物材料被用于闭合鼓膜穿孔（tympanic membrane perforations）。现有文献中，针对儿科人群比较不同移植物材料疗效的研究较为匮乏。据我们所知，目前尚无针对儿科鼓室成形术（tympanoplasties）中耳屏软骨（tragal cartilage）厚度进行测量的相关研究报道。且不同患者的耳屏软骨厚度并不均一。

研究目的：比较1型儿科鼓室成形术中采用颞肌筋膜（temporalis fascia muscle）与全层耳屏软骨作为移植物的解剖学与功能学结局。

研究方法：本研究纳入于我科室接受1型鼓室成形术的78例患者（其中男性38例，女性40例；平均年龄10.02±1.98岁，年龄范围7~18岁）。收集患者的人口学资料、解剖学结局与功能学结局数据。手术移植物选用颞肌筋膜与耳屏软骨，其中耳屏软骨未进行削薄处理，并通过千分尺（micrometer）测量耳屏软骨厚度。比较软骨组与筋膜组的解剖学及功能学结局。分别于术后6个月对两组患者的听力学结果进行对比评估，并持续随访至术后1年。以移植物完整存活且气骨导差（air-bone gap）≤20 dB作为手术成功标准。以P值<0.05作为差异具有统计学意义的判定标准。

研究结果：软骨组的移植物成功率为92.1%，而颞肌筋膜组为65.0%。筋膜组患者术前气骨导差为33.68±11.44 dB，术后气骨导差为24.25±12.68 dB；软骨组患者术前气骨导差为35.68±12.94 dB，术后气骨导差为26.11±12.87 dB。软骨组的解剖学成功率显著高于筋膜组（P<0.01）。两组患者的功能学结局差异无统计学意义（P>0.05）。儿科人群的耳屏软骨平均厚度为：男性0.693±0.094 mm，女性0.687±0.058 mm。

研究结论：本研究数据显示，采用软骨进行鼓室成形术的解剖学成功率高于筋膜组鼓室成形术。尽管未对耳屏软骨进行削薄处理，软骨移植物的功能学结局与筋膜移植物并无显著差异。但未来仍需开展进一步研究，以探讨耳屏软骨厚度与鼓室成形术成功率之间的关联机制。