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CARTILAGE "SHIELD" GRAFTING IN REVISION CHRONIC EAR SURGERY

Aristides Sismanis, Efthymios Kyrodimos, Kelley Dodson

Department of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA

■ OBJECTIVES: To report the effectiveness of cartilage “shield” grafting in revision surgery for chronic ear disease. ■ METHODS: Conchal cartilage, shaped as a shield, was used for replacing the entire tympanic membrane in revision chronic ear

cases. Graft take, graft position, and hearing results were evaluated in follow up.

■ RESULTS: Between January 1998 and December 2006, 43 patients (15 children and 31 adults) underwent 46 procedures. The mean age of these patients was 33 years (range 7-76 years) and the mean follow up 23 months (range 6–110 months). For cholesteatoma cases the minimum follow-up was 12 months. Fourteen procedures (30.5 %) were for total tympanic membrane perforations, 12(26%) for lateralized tympanic membranes, 11(24 %) for perforations with cholesteatomas, and 9 (19.5 %) for atelectatic tympanic membranes. The overall graft take was successful in 43 cases (93 % success rate). No lateralization or displacement in the middle ear was noted. Audiometric results were available for comparison in 39 patients. The overall average pre-op air-bone gap (ABG) was 33.57dB +/-13.22 dB and the post-op ABG was 25.71 dB +/-11.33dB, an average improvement of 11.22 dB (p<0.0001). A post-operative ABG of 25 dB or less was achieved in 22 out of the 39 patients (56.41%). Speech discrimination scores remained unchanged post-operatively. No complications were identified.

■ CONCLUSION: Cartilage “shield” grafts are highly effective for- revision chronic ear surgery, with excellent graft take and satisfactory hearing results.