THESIS

TITLE

Hearing Outcome of Type 1 Tympanoplasty with

Cartilage-Perichondrium Graft in comparison with
Temporalis Fascia Graft

Guide
Professor Dr. DGM Akaiduzzaman
MBBS, MS (ENT), FCPS (ENT)
Vice Principal and Head
Department of Otolaryngology & Head-Neck Surgery
Sir Salimullah Medical College Mitford Hospital, Dhaka

Investigator
Dr. Md. Mahmudur Rahman
MS (Resident), Phase – B
Department of Otolaryngology & Head-Neck surgery
Sir Salimullah Medical College Mitford Hospital, Dhaka

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 DECLARATION

I hereby to declare that this thesis entitled “Hearing Outcome of Type 1 Tympanoplasty with
Cartilage-perichondrium graft in Comparison with Temporalis Fascia Graft” is based on
work carried out by me and no part of it has been presented previously for any degree. The
research work was carried out in the department of ENT and Head Neck Surgery, Sir Salimullah
Medical College Mitford Hospital, Dhaka, Bangladesh under the guidance of Professor Dr.
DGM Akaiduzzaman, Professor and Head, Department of Otolaryngology and Head-Neck
Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka.

Dr. Md. Mahmudur Rahman

Resident,
Phase B
Department of Otolaryngology & Head-Neck surgery
Sir Salimullah Medical College Mitford Hospital, Dhaka

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 CERTIFICATE

This is to certify that Dr. Md. Mahmudur Rahman has completed his thesis entitled “ Hearing
outcome of Type 1 Tympanoplasty with Cartilage-perichondrium in Comparison with
Temporalis Fascia Graft” in the department of Otolaryngology and Head-Neck Surgery, Sir
Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh under my guidance.

His work was genuine and up to my satisfaction.

Guide:

Professor Dr. DGM Akaiduzzaman

MBBS, MS (ENT), FCPS (ENT)
Vice Principal and Head
Department of Otolaryngology & Head-Neck Surgery
Sir Salimullah Medical College Mitford Hospital, Dhaka

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 ACKNOWLEDGEMENT

First of all, I express my profound gratitude to the Almighty Allah for giving me the opportunity,
courage and patience in completing this research work successfully in time.

It is my immense pleasure to express my sincere gratitude to my guide Professor Dr. DGM

Akaiduzzaman, Professor and Head, Department of Otolaryngology and Head-Neck Surgery,
Sir Salimullah Medical College Mitford Hospital, Dhaka, for his kind, valuable and
indispensable guidance, constant supervision and constructive criticism.

I would also like to express my profound gratefulness to my respected teacher Associate

Professor Dr. Aktaruzzaman for his psychological influence, generous co-operation and cordial
help & suggestions during carrying out my research study.

I am very much grateful to Dr.Shahabub Alam, Associate professor, Department of

Otolaryngology & Head-Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka
for his continuous co-operation and support to complete the study

I would pay my deep and heartfelt gratitude to Dr. S. M. Abdul Awual, Assistant Professor of
Department of Otolaryngology & Head-Neck Surgery, Sir Salimullah Medical College Mitford
Hospital, Dhaka for his effective guidance, continuous co-operation, and cordial support to
complete the study.

I am thankful to Dr. Md. Towhidul Islam Mondal, Assistant Professor of Otolaryngology &
Head-Neck Surgery department, for his kind help and guidance.

I am very much grateful to Dr. Md. Rafiul Alam, Assistant Professor of Department of
Otolaryngology & Head Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka
for their valuable suggestions and sincere cooperation, excellent academic and overall dynamic
support during my working period.

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I would express my gratitude to Dr. Ahmed Tariq and Dr. Md Mostafizur Rahman, Dr. Obaidul
Islam, Dr. Utpaul kumar sarkar, Assistant Professors, Department of Otolaryngology & Head-
Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka for their continuous co-
operation and support to complete the study.

I also express my heartiest thanks to my colleagues Dr Md Abul Kashem, Dr. Amzad Hossain
Riad, Dr. Shihab Uddin, Dr. Shahidullah, Dr. Farooki, Dr. Rashed, Dr. Ripon, Dr. Anik, Dr. Md.
Yusuf Ali, Dr.M M Hasan Ali and all other colleagues for their kind co-operations and help.

Respectfully remembering my late father Mustafizur Rahman. Love for my daughter Mahnisa
yusairah Rahman (Nisa), her activities inspired me to wrap up my work properly. Also a big
thanks goes to my mother Zebunnesa begum,brothers Ahmod ullah, Foyezur rahman and sister
Sufia begum, Nasrin akter for inspiring me. Special thanks to my elder brother Anisur Rahman
for helping me.

Finally, my acknowledgements would remain incomplete if I don't offer my special gratitude to

those patients who were enrolled in this research work to carry out my study successfully and I
also wish their healthy future.

Dr. Md. Mahmudur Rahman

Resident, Phase – B
Department of Otolaryngology & Head-Neck surgery
Sir Salimullah Medical College Mitford Hospital, Dhaka

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 LIST OF CONTENTS

Subject: Page no
Declaration I
Certificate II
Acknowledgements III
List of Contents V
List of Tables VII
List of Figures VIII
List of Abbreviation IX
Abstract X
Chapter 1: Introduction 1
1.1 Background 2
1.2 Rationale 8
1.3 Research question 9
1.4 Objectives 10
Chapter 2: Literature review 12
Chapter 3: Materials & Methods 35
3.1 Study design 35
3.2 Place of Study 35
3.3. Period of Study 35
3.4 Study population 35
3.5 Sample size 35
3.6 Sampling technique 36
3.7 Inclusion criteria 36

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 3.8 Exclusion criteria 36
3.9 Content of data collection sheet 37
3.10 Variables 38
3.11 Ethical issue 39
3.12 Study procedure 41
3.13 Statistical analysis 42-43
3.14 Surgical procedure 44-45
3.15 Operational definitions

Chapter 4: Results 46-60

Chapter 5: Discussion 61-66
Chapter 6: Conclusion, Limitations and Recommendation 67
Conclusion 68
Limitations 69
Recommendation 70
References: 73-80
Appendices XI
Appendix I: Ethical Clearance XII
APPENDIX II: Budget XIII
Appendix III: Questionnaire and checklist XIV-XVIII
Appendix IV: Statistical formula XIX-XX
Appendix V: Consent form XXI- XXIV

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 LIST OF TABLES

Table No. Title Page no

Table I Distribution of the study subjects according to age in two 47
groups

Table II Distribution of the study subjects according to gender in 49

two groups

Table III Distribution of respondents by presenting complaints 51

Table IV Size of perforation in two groups 52

Table V Duration of ear discharge, deafness and tinnitus in two 54

groups

Table VI Distribution of the study subjects according to operated air 55

in two groups

Table VII Pre and postoperative PTA-AB gap 56

Table VIII Graft taken in two groups at 1 months 57

Table IX Graft taken in two groups at 2 months 58

Table X Pre and postoperative tinnitus in two groups 59

Table XI Postoperative complications of the study subjects in two 60

groups

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 List of figures

Figure No. Title Page no

Figure I : Auricle and Temporalis fascia 19

Figure II : Middle ear. 24

Figure III : Inner ear showing different parts 25

Figure IV : Conduction of sound from external ear to inner ear. 27

Figure V : Auditory pathways 28

Figure VI : Harvesting tragal cartilage 44

Figure VII : Occupational status of the respondents 48

Figure VIII : Distribution of respondents by residential location 50

Figure IX : Size of perforation of the respondents 53

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 LIST OF ABBREVIATIONS

BSMMU : Bangabandhu Sheikh Mujib Medical University

SSMCMH : Sir Salimullah Medical College Mitford Hospital

WHO : World Health Organization

COM : Chronic otitis media

TMF : Temporalis fascia

PTA-AB : Pure tone audiometry-air bone

ABG : Air Bone Gap

ABC : Absolute Bone Conduction

AC : Air Conduction

BC : Bone conduction

SPSS : Statistical Packages for Social Science

TM : Tympanic membrane

SD : Standard deviation

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 ABSTRACT
Background: Chronic otitis media (COM) mucosal type is characterized by recurrent ear
discharge and hearing loss secondary to tympanic membrane perforation. Type 1 tympanoplasty
is the reconstruction of perforated tympanic membrane with an intact and mobile ossicular chain.
Among various autologous graft materials, temporalis fascia and tragal cartilage are commonly
used.

Objectives: Aim of the study was to compare the hearing outcomes between tragal cartilage-
perichondrium and temporalis fascia in type 1 tympanoplasty.

Methods: This quasi-experimental study included 60 cases of inactive chronic otitis media
which was carried out in a tertiary care center. They were allocated into two groups of 30
patients each and were subjected to tympanoplasty using either tragal cartilage-perichondrium
(group A) or temporalis fascia graft (group B) from 1st July 2022 to 30th June 2023. Hearing
loss was quantified by pure tone audiometry (PTA). Graft uptake rate at 1 st and 2nd postoperative
month and objective hearing improvement at 3rd month were compared.
Results: In both groups, there was a statistically significant improvement in terms of mean air
conduction threshold and decrease in mean ABG postoperatively. The PTA changes in terms of
success (P=.242) showed no statistically significant difference between the groups.

Conclusion: Both temporalis fascia and tragal cartilage-perichondrium are suitable graft
materials for type 1 tympanoplasty and hearing gain through tragal cartilage-perichondrium graft
was better than temporalis fascia

Keyword: Cartilage, Fascia, Graft, Tympanoplasty, Air-bone gap, Hearing gain.

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