BrazJOtorhinolaryngol.2017;83(3):371---372
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
LETTER
TO
THE
EDITOR
Type
1
pediatric
tympanoplasties
using
fascia
and
cartilage
grafts
夽Timpanoplastias
pediátricas
tipo
1
usando
enxertos
com
fáscia
e
cartilagem
DearEditor,
Here, we present a review of the article entitled ‘‘Comparisonoftemporalisfasciamuscleandfull-thickness cartilage grafts in type 1 pediatric tympanoplasties’’ by Yeginetal.1 The workdescribed intheirpaperwas
inter-esting.Cartilagegraftsimprovedthelong-termsuccessrate of tympanoplastiesversus temporalisfascia graftsin tym-panoplastiesduetoEustachiantubedysfunctioninchildren. However, the study design and short follow-up weakened theirconclusions.
Theauthorsstatedthat‘‘Aretrospectivereviewofdata collected fromJanuary 2013to September 2014was per-formedatourhospital’’and‘‘Thepatientswererandomly allocatedtosurgeryusingtemporalisfasciamuscleor tra-galcartilagegraftsbythesurgeons’’intheirMethods.1We
believedthata‘‘retrospectivereview’’and‘‘randomly allo-cated’’ are contradictory. Randomized control cannot be performedinaretrospectivestudy.Randomizedcontrolled trials, considered the gold standard of study design, are prospective studies. They can provide evidence of cause-and-effect relationships and support changes in clinical practiceorworkplaceinterventions. Inarandomized con-trolledtrial,subjectsarerandomlyassignedtoreceivethe interventionorcontroltreatment,andoutcomesare eval-uatedafter the intervention period. The control group is thegroupthatreceivesstandardcare, nointervention,or aplacebo.Ifthepatientswerenotrandomized,theresults might includesome bias.Thus,we believethat thestudy needs to be a prospective study, with randomcontrol, a larger sample size, and longer follow-up to reach valid conclusions.
夽
Pleasecitethisarticleas:LouZ.Type1pediatric tympanoplas-ties using fascia and cartilage grafts. Braz J Otorhinolaryngol. 2017;83:371---2.
Theauthorsonlyexcludedpatientswithossicularchain defects,cholesteatoma,tympanosclerosis,atelectasia,and a history of previous ear surgery in their criteria. The authors did not state whether patients with granulation tissue in the middle ear were included. Granulation tis-sue may affect the success of pediatric tympanoplasties, especially for temporalis fascia grafts. Additionally, they reportedthatthegraftsuccessratewas92.1%forthe car-tilage group versus 65.0% for the temporalis fascia group duringthe first postoperative year.1 Their success rate in
the temporalis fascia group seems very low. There are many reported success rates of >80% in temporalis fas-ciatype1tympanoplasties.2,3 AlthoughCabraandMonoux
reported a success rate of 64.6% in a fascia group and 82.26% in a cartilage group, their follow-up time was 24 months.4 Experimental studies have shown that
tempo-ralis fascia grafts can suffer degeneration and shrinkage over time, resulting in reperforation.5 Additionally, the
Eustachian tube has a significant role in the success of myringoplasty.Twostudiesinchildrenaloneshowedbetter morphologicaloutcomeswiththeuseofcartilagethanwith fasciagrafts.OneoftheeffectsofEustachiantube dysfunc-tioninthepediatricpopulationisnegativepressureinthe middleearcavity, whichcancause retractionof the tym-panicmembrane, withresultingfailure ofmyringoplasty.2
TheauthorsshouldevaluatetheEustachiantube infuture studies.
The authors stated that the tragal cartilage was har-vested together with perichondrium on both sides. An inferior cut wasmade aslow as possible to obtain all of thetragalcartilageintheMethods.Althoughcartilagegraft tympanoplastiesmayobtainahighersuccessrate,the exci-sionofallofthetragalcartilagewouldhaveestheticeffects intheearsofchildren.Tragalperichondrium tympanoplas-tieshavecertainadvantagesincludinghighersuccessrates andnoeffectonesthetics.Thus,theauthorsshouldcompare thesuccessratesoftype1pediatrictympanoplastiesusing fasciagrafts,cartilage grafts,andperichondriumgraftsin futurework.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
http://dx.doi.org/10.1016/j.bjorl.2016.09.006
372 LETTERTOTHEEDITOR
References
1.Yegin Y, C¸elik M, Koc¸ AK, Küfeciler L, Elbistanlı MS, Kayhan FT.Comparison of temporalisfascia muscleand full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol.2016.S1808-8694(16)30011-8.
2.IacovouE,Vlastarakos PV, PapacharalampousG, KyrodimosE, NikolopoulosTP.Iscartilagebetterthantemporalismuscle fas-cia in typeI tympanoplasty?Implications for currentsurgical practice.EurArchOtorhinolaryngol.2013;270:2803---13. 3.Shishegar M, Faramarzi A, Taraghi A. A short-term
compari-son between result of palisade cartilage tympanoplasty and
temporalisfasciatechnique.IranJOtorhinolaryngol.2012;24: 105---12.
4.CabraJ,MonouxA.Efficacyofcartilagepalisadetympanoplasty: randomisedcontrolledtrial.OtolNeurotol.2010;31:589---95. 5.EnglandRJ,StrachanDR,Buckley JG.Temporalisfasciagrafts
shrink.JLaryngolOtol.1997;111:707---8.
Zheng-caiLou
