Effects of Cartilage Overlay on the Tympanic Membrane: Lessons From a Temporal Bone Study for Cartilage Tympanoplasty. 2018

Mostafa M A S Eldaebes, and Thomas G Landry, and Manohar L Bance
Division of Otolaryngology, Department of Surgery, Dalhousie University.

Placing cartilage grafts on different tympanic membrane (TM) locations will affect sound transfer function, and the effects will differ according to the part of the TM modified. Cartilage tympanoplasty is increasingly popular because of lower reperforation rates, and better long-term stability. In this temporal bone study, we investigated the effect of placing cartilage grafts over different parts of the normal TM on sound transmission. In 10 human fresh frozen temporal bones, umbo and stapes vibrations to acoustic stimuli from 250 to 8000 Hz were measured at multiple points using a scanning laser vibrometer. Four different cartilage arrangements were measured in each temporal bone. 1) Overlay condition leaving an umbo rim of normal TM (Umbo Rim). 2) Overlay condition leaving annular rim of normal TM (Annular Rim). 3) Overlay condition leaving both rims of normal TM (Two Rims). 4) Overlay condition leaving no normal TM exposed (No Rims). At low frequencies, there was a statistically significant decrease in velocity from baseline for the No Rims (umbo mean -4 dB; stapes -6 dB) and Umbo Rim (umbo -4 dB; stapes -3.7 dB) conditions. All conditions showed significant decreases for middle frequencies (umbo -4.0, -5.9, -7.4 and -6.3 dB; stapes -10.8, -6.6, -6.3 and -7.7 dB) and high frequencies (umbo -13.2, -3.0, -3.1 and -5.5 dB; stapes -4.6, -2.4, -2.6 and -3.5 dB). Results are in order for No Rims, Umbo Rim, Two Rims, and Annular Rim conditions. In the low frequencies, it seems to matter where the cartilage is placed, and in particular the annular rim of the TM seems to be important for the low-frequency acoustic transfer function. In the higher frequencies, all graft placements caused some drop at all frequencies. In all frequencies, effects were modest by clinical standards.

UI MeSH Term Description Entries
D002356 Cartilage A non-vascular form of connective tissue composed of CHONDROCYTES embedded in a matrix that includes CHONDROITIN SULFATE and various types of FIBRILLAR COLLAGEN. There are three major types: HYALINE CARTILAGE; FIBROCARTILAGE; and ELASTIC CARTILAGE. Cartilages
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000161 Acoustic Stimulation Use of sound to elicit a response in the nervous system. Auditory Stimulation,Stimulation, Acoustic,Stimulation, Auditory
D013016 Sound A type of non-ionizing radiation in which energy is transmitted through solid, liquid, or gas as compression waves. Sound (acoustic or sonic) radiation with frequencies above the audible range is classified as ultrasonic. Sound radiation below the audible range is classified as infrasonic. Acoustic Waves,Elastic Waves,Sonic Radiation,Sound Waves,Acoustic Wave,Elastic Wave,Radiation, Sonic,Radiations, Sonic,Sonic Radiations,Sound Wave,Sounds,Wave, Acoustic,Wave, Elastic,Wave, Sound,Waves, Acoustic,Waves, Elastic,Waves, Sound
D013701 Temporal Bone Either of a pair of compound bones forming the lateral (left and right) surfaces and base of the skull which contains the organs of hearing. It is a large bone formed by the fusion of parts: the squamous (the flattened anterior-superior part), the tympanic (the curved anterior-inferior part), the mastoid (the irregular posterior portion), and the petrous (the part at the base of the skull). Stylomastoid Foramen,Bone, Temporal,Temporal Bones
D014432 Tympanic Membrane An oval semitransparent membrane separating the external EAR CANAL from the tympanic cavity (EAR, MIDDLE). It contains three layers: the skin of the external ear canal; the core of radially and circularly arranged collagen fibers; and the MUCOSA of the middle ear. Eardrum,Eardrums,Membrane, Tympanic,Membranes, Tympanic,Tympanic Membranes
D014433 Tympanoplasty Surgical reconstruction of the hearing mechanism of the middle ear, with restoration of the drum membrane to protect the round window from sound pressure, and establishment of ossicular continuity between the tympanic membrane and the oval window. (Dorland, 28th ed.) Tympanoplasties
D014732 Vibration A continuing periodic change in displacement with respect to a fixed reference. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Vibrations

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