BrazJOtorhinolaryngol.2017;83(5):606---607
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
LETTER
TO
THE
EDITOR
Response
to
the
Letter
to
the
Editor
regarding
‘‘Comparison
of
temporalis
fascia
muscle
and
full-thickness
cartilage
grafts
in
type
1
pediatric
tympanoplasties’’
by
Yegin
et
al.
(Braz
J
Otorhinolaryngol.
2016;82:695---701)
夽Resposta
à
carta
à
editora
sobre
‘‘Comparac
¸ão
de
enxertos
com
fáscia
do
músculo
temporal
e
cartilagem
de
espessura
total
em
timpanoplastias
tipo
1
em
crianc
¸as’’
de
Yegin
et
al.
(Braz
J
Otorhinolaryngol.
2016;82:695---701)
DearEditor,
WewouldliketothankDr.Zheng-caiLoufor valuableand precise comments on our article.1 Firstly, the main out-comes of type 1 pediatric tympanoplasty are the graft success rates and postoperative hearing outcomes. Our results indicate that the graft success rate was 92.1% of the cartilage group compared with 65.0% of the tem-poral fascia group, respectively. In the fascia group, preoperative ABG was 33.68±11.44dB and postoperative ABG was 24.25±12.68dB. In cartilage group, preopera-tiveABGwas35.68±12.94dBandpostoperative ABGwas 26.113±12.87dB.Theanatomicalsuccessrateofcartilage groupwassignificantly betterthanfasciagroup(p<0.01). Therewasnosignificantdifferenceamongfunctional out-comesbetweenfasciaandcartilage groups (p>0.05).The thicknessoftragalcartilagewasaccuratelymeasuredbya micrometerandrecordedintraoperatively.Aregular
whole-DOIoforiginalarticle:
http://dx.doi.org/10.1016/j.bjorl.2016.09.006
夽 Pleasecitethisarticleas:YeginY,C¸elikM.Responsetothe
Let-tertotheEditorregarding‘‘Comparisonoftemporalisfasciamuscle andfull-thicknesscartilagegraftsintype1pediatric tympanoplas-ties’’byYeginetal.(BrazJOtorhinolaryngol.2016;82:695---701). BrazJOtorhinolaryngol.2017;83:606---7.
lengthbaroftragalcartilagewasexcisedandthethickness oftragalcartilagewasmeasured.Measurementofthickness wasperformedbythesamesurgeon(YY).Allmeasurements wererepeatedbythesecond surgeon(MC¸) toavoid inter-observervariations. Threemeasurementswereperformed to avoid discrepancy andincorrect results. Measurements consisted of superior, middle and inferior parts of tragal cartilage. The average thickness of tragal cartilage was acceptedastheaverageofthreemeasurements.Thetotal averagethicknessoftragalcartilagewas0.693±0.094mm in males and 0.687±0.058mm in females. To our knowl-edge, the present study is the first study of measuring thicknessoftragalcartilageinpediatrictympanoplasty.2
Dr. Zheng-cai Lou stated that ‘‘We believed that a ‘‘retrospectivereview’’and‘‘randomlyallocated’’are con-tradictory.’’inhiscommentsonourstudydesign.Ofcourse, youareright.But,indiscussion,explanationofthis condi-tion was putted in an appearance. Honestly, there is no consensus on the selection of graft materials for tym-panoplasties;itdependsentirelyonsurgeonexperienceand preferences.Inourclinic, theselectionof graftmaterials for pediatrictympanoplastiesdependsentirelyonsurgeon experience and preferences. It means utilization of tem-poralisfasciamuscleor tragalcartilage graftsis randomly allocatedbythesurgeons.Itisnotthepurposeofourstudy designtodeterminethetermsofselectionofthegraft mate-rials.Therefore,forthisstudy,therewasnocontradiction. We agreewithyou about the furtherprospective studies, withrandomcontrol,alargersamplesizeandlonger follow-upsareneededtocomparetheanatomicalandfunctional outcomesofvariouscartilagetypes.
Foryourothercommentsonexclusioncriterias,youare right andwe wouldlike to thank you for bringingthis to our attention. Granulation tissue may affect the success of pediatric tympanoplasties,but nostudies todatehave reportedaboutthiscondition.Inourpatients’charts,wedo notrecordthepresenceofgranulationtissuefor pediatric tympanoplasties.
Although data on the selection of graft materials for pediatric tympanoplasties continues to rise, there is at present no consensus on the selection of graft materials for tympanoplasties.3 However, we have also planned to compare the anatomicalandfunctional outcomesof vari-ousgrafttypes (pericondriumgrafts,fasciagrafts,various cartilagegraft[conchalandtragalcartilages])anddiffering
http://dx.doi.org/10.1016/j.bjorl.2017.02.007
LETTERTOTHEEDITOR 607
thicknessesofcartilagegraftsinpediatrictympanoplasties infuture.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.LouZ.Type1pediatrictympanoplastiesusingfasciaandcartilage grafts.BrazJOtorhinolaryngol.2017;83:371---2.
2.Yegin Y, C¸elik M, Koc¸ AK, Küfeciler L, Elbistanlı MS, Kayhan FT. Comparisonof temporalisfascia muscle and full-thickness
cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol.2016;82:695---701.
3.JalaliMM,MotasaddiM,KouhiA,DabiriS,SoleimaniR. Compar-isonofcartilagewithtemporalisfasciatympanoplasty:a meta-analysisofcomparativestudies.Laryngoscope.2016;December,
http://dx.doi.org/10.1002/lary.26451[Epubaheadofprint].
YakupYegin,MustafaC¸elik∗
BakırköyDr.SadiKonukTrainingandResearchHospital, DepartmentofOtorhinolaryngology---HeadandNeck Surgery,Istanbul,Turkey
∗Correspondingauthor.
