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Published: Laryngoscope. 2018 Aug;128(8):1922-1926. Type III tympanoplasty applying the palisade cartilage
DOI: 10.1002/lary.27021. Epub 2017 Nov 24. technique: a study of 61 cases
Objectives/Hypothetis: To evaluate the influence of the diameter of stapes Neumann A., Schultz-Coulon H.-J., Jahnke K.
prosthesis on functional outcomes in stapes surgery. Study Design: Pro-
spective cohort study. Published: Otol Neurotol. 2003 Jan;24(1):33-7.
Methods: Fifty consecutive small fenestra stapedotomies performed using Objective: To determine the morphologic and hearing results of the com-
a 0.4-mm-diameter prosthesis were compared with 50 consecutive small bined application of the palisade cartilage technique and titanium ossicular
fenestra stapedotomies carried out using a 0.6-mm-diameter piston. Audi- replacement prostheses in Type III tympanoplasty.
ological assessment following the recommendations of the Committee on
Hearing and Equilibrium was performed 1 month after surgery. Postopera- Study Design: Retrospective review of 61 tympanoplasties. Setting: Tertiary
tive complications between the two groups were noted. referral center. Patients: 59 patients (39 women and 20 men, mean age 36
years, range 7-81 years) consecutively operated on because of cholesteatoma,
Results: There were no statistically significant differences in demographic adhesive otitis, chronic otitis media, subtotal tympanic membrane defects,
data between the two groups, and no differences in preoperative bone-con- and tympanofibrosis requiring tympanoplasty with ossiculoplasty.
duction (BC) or air-conduction (AC) hearing thresholds for all frequencies
(analysis of variance [ANOVA] and χ2 tests). No differences were found Interventions: Tympanoplasty Type III, with application of the palisade car-
in the mean preoperative BC and AC pure-tone average and air-bone gap tilage technique and total or partial titanium ossicular replacement prosthesis.
(ABG). In the postoperative evaluation, a statistically significant difference
was found for the mean AC gain (20 ± 8.7 vs. 24 ± 11.5, P = .042, ANOVA) Main Outcome Measures: Otoscopic findings and hearing results using a
as well as for the postoperative AC threshold at 0.125 and 0.25 kHz and the four-frequency pure tone average air-bone gap.
postoperative BC threshold at 0.25 kHz (P < .01, ANOVA). A postoperative
ABG ≤10 dB was obtained in 90% and 94% of patients in the 0.4-mm- and Results: A recurrent defect was seen in 1 ear (1.6%). The graft take rate was
0.6-mm-diameter piston groups, respectively (difference not significant, 100%. There were no extrusions of prostheses. Preoperatively, a pure tone
χ2 test). No postoperative dead ear and/or sensorineural hearing loss was average air-bone gap of 0 to 10 dB was seen in 1 ear, 11 to 30 dB in 30, and
noted in either group. 31 to 50 dB in another 30 ears. Postoperatively, the corresponding numbers
were 11, 41, and 9 ears, respectively. Hearing results were better in the total
Conclusions: The 0.6-mm piston allowed a statistically significant higher ossicular replacement prosthesis group.
AC gain compared with the 0.4-mm diameter piston. A larger diameter
piston may be preferable if there are no anatomical or technical reasons Conclusion: The palisade cartilage technique is suitable to manage difficult
that would favor a smaller prosthesis. pathologic conditions in middle ear surgery. It was demonstrated that the
palisade cartilage technique can be combined safely with titanium ossicular
replacement prostheses. Regarding postoperative hearing results, the nega-
tive preselection of pathologic conditions must be considered.
KURZ PRECISE C ARTIL A GE KNIFE

Acoustic properties of different cartilage reconstruction
Cartilage Plate Tympanoplasty techniques of the tympanic membrane
Beutner D., Huettenbrink K.-B., Stumpf R., Beleites T., Mürbe D., Zahnert T., Bornitz M., Hüttenbrink K.-B.
Zahnert T., Luers J.-C., Helmstaedter V.
Published: Laryngoscope 2002 Oct; 112(10):1769-76.
Published: Otology & Neurotology, 2009 DOI: 10.1097/00005537-200210000-00012
DOI: 10.1097/MAO.0b013e3181be6b48
Objectives/Hypothesis: The use of cartilage in reconstruction of the tym-
Objectives: The purpose of this work was to report our modified cartilage panic membrane has been established especially in cases such as tubal dys-
plate tympanoplasty technique ("tulip leaves") and to analyze its clinical function and adhesive processes. Cartilage offers the advantage of higher
outcome in primary and recurrent cases of chronic otitis media with and mechanical stability compared with membranous transplants but may alter
without cholesteatoma. the acoustic transfer characteristics of the graft. Apart from material proper-
ties, it can be assumed that, also, the microsurgical reconstruction technique
Study Design: Clinical retrospective study. might influence the sound transmission properties of the reconstructed tym-
panic membrane. The purpose of the study was to investigate the acoustic
Methods: Patients being operated on with this technique at the University transfer characteristics of different cartilage transplants being typically used
Department of Otorhinolaryngology, Dresden, Germany, between 1993 and in different reconstruction techniques of the tympanic membrane.
2001 were invited for survey, otomicroscopy, and pure-tone audiometry in
2003. Patients’ charts were used to draw necessary conclusions. Methods: Cartilage plates of different thicknesses (1.0, 0.7, 0.5, and
0.3 mm), cartilage palisades, and cartilage island transplants of varying size
Results: A total of 39 patients who were treated with this technique af- were investigated by means of an ear canal-tympanic membrane model. In
ter canal wall down tympanomastoidectomy and cavity obliteration were contrast to former single-point measurements, sound-induced vibrational
included in this long-term analysis after a median follow-up of 6 years. amplitudes of the entire transplant were measured by scanning laser Dop-
Seventeen patients (44%) experienced chronic otitis media with choleste- pler vibrometry (measuring points, n = 133) (PSV-200, Polytec, Waldbronn,
atoma, whereas 22 (56%) of them had a diagnosis of chronic otitis media Germany). Frequency response functions (displacement vs. sound pressure)
without cholesteatoma. At the time of examination, all patients displayed of all measured points were determined in the frequency range of 200 Hz to
a closed tympanic membrane. However, retractions were observed in 19 4 kHz for the different transplants.
patients (48%). One patient required (3%) revision surgery for recurrent
cholesteatoma due to prosthesis extrusion during the study period. Results: Cutting thick cartilage transplants into thin plates or palisades de-
creased the first resonance frequency and increased its amplitude, reflecting
Conclusion: On the basis of this study, we recommend the tuliplike ar- improved sound transmission properties of the transplant. From an acous-
rangement of thin but large auricular cartilage slices for the reconstruction tical point of view, the 0.5-mm cartilage plate seems preferable compared
of tympanic membrane defects in high-risk ears. This combination proved with the palisade technique. Cartilage island techniques showed vibration
its high stability and long-lasting vitality in our long-term study. These char- characteristics superior to plate or palisade techniques.
acteristics are crucial for permanent disease removal and for reducing the
risk of recurrent pathologic abnormality. Conclusions: Apart from material characteristics, the sound transmission

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