The use of a combined flap in closed-type tympanoplasty

Introduction. Cartilage graft has been used in otosurgery since 1959. Cartilage resistance to pressure drops in the tympanic cavity and blood supply deficit in the early postoperative period favorably distinguish it from autofascia. When performing myringoplasty, it is important to create conditions for the formation of a neotympanic membrane that has the same three-dimensional spatial configuration as the native tympanic membrane with full contact of the membrane with the bone tympanic ring and the handle of the malleus. Also, the formation of the neotympanic membrane (myringoplasty) is a key step in tympanoplasty with ossiculoplasty, which ensures not only the restoration of the tightness of the tympanic membrane, but also the contact and proper fixation of the distal part of the prosthesis used to replace the lost elements of the auditory ossicular chain.

Objective. Evaluate the effectiveness of closed-type tympanoplasty by using a combined autofascial-autocartilaginous flap.

Materials and methods. A study group was formed, including patients who underwent tympanoplasty of types 1–3 according to M. Tos according to the proposed method of using an autofascial-autocartilaginous flap (343 patients), and a comparison group, including patients who underwent type 1 tympanoplasty with using autofascia (54 patients).

Results. Long-term anatomical results showed greater stability of the neotympanic membrane formed by the proposed method (2% reperforations). Functional results in the range of speech frequencies had no significant differences. Comparison of functional results in the high frequency range demonstrated a significant advantage of the proposed technique.

Conclusion. The conclusion is drawn that the proposed method of forming a neotympanic membrane close in configuration to the native tympanic membrane provides a high functional result with a reduction in the gap in sound conduction between the diseased and healthy ear to 5–10 dB at frequencies of 0.5–16 kHz.

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