Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study

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"pii" => "S2173573518300760" "doi" => "10.1016/j.otoeng.2017.10.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573518300760?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651918300141?idApp=UINPBA00004N" "url" => "/00016519/0000006900000006/v1_201811040624/S0001651918300141/v1_201811040624/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "317" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Avani Jain, Sunil Samdani, Man Prakash Sharma, Vinod Meena" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Avani" "apellidos" => "Jain" "email" => array:1 [ 0 => "avanijain87@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sunil" "apellidos" => "Samdani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Man Prakash" "apellidos" => "Sharma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Vinod" "apellidos" => "Meena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of ENT, Lok Nayak Hospital, New Delhi, India" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Department of ENT, Sawai Man Singh Medical College and attached group of hospitals, Jaipur, Rajasthan, India" "etiqueta" => "b" "identificador" => "aff0005" ] 2 => array:3 [ "entidad" => "District Hospital, Dausa, Rajasthan, India" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cartílago en isla vs. fascia de músculo temporal en timpanoplastia tipo 1: un estudio prospectivo" ] ] "textoCompleto" => "IntroductionThe term tympanoplasty was first used in 1952 by Wullstein<a class="elsevierStyleCrossRef" href="#bib0205">1</a> to describe the surgical techniques for reconstruction of the middle ear hearing mechanism that had been impaired or destroyed by chronic otitis media. The rapid evolution of tympanoplasty as a routine surgical procedure has brought with it controversies and discussions over the procedure, techniques and graft materials.<a class="elsevierStyleCrossRef" href="#bib0210">2</a> Various graft materials have been described since then such as temporal fascia,<a class="elsevierStyleCrossRef" href="#bib0215">3</a> perichondrium,<a class="elsevierStyleCrossRef" href="#bib0220">4</a> periosteum,<a class="elsevierStyleCrossRef" href="#bib0225">5</a> vein,<a class="elsevierStyleCrossRef" href="#bib0230">6</a> dura mater<a class="elsevierStyleCrossRef" href="#bib0235">7</a> and cartilage.<a class="elsevierStyleCrossRefs" href="#bib0240">8,9</a> The most frequently used grafting material is temporal fascia graft, due to the ease of its accessibility at the surgical site and the high graft take up rate in most of the normally ventilated middle ears. However, in conditions such as advanced middle ear pathology, large perforations, or retraction pockets, temporalis fascia may have higher failure rates regardless of the surgical technique used.<a class="elsevierStyleCrossRefs" href="#bib0250">10,11</a> This is because the post-operative dimensions of temporal fascia are unpredictable as it is composed of irregularly arranged elastic fibers and fibrous connective tissue.<a class="elsevierStyleCrossRef" href="#bib0260">12</a> In such cases, a more rigid grafting material such as cartilage is preferred because of its increased stability and resistance to middle ear pressure. Due to the thickness and rigidity of cartilage, conductive loss might be anticipated, however, several studies suggest the hearing results with cartilage to be no different than those for fascia.<a class="elsevierStyleCrossRefs" href="#bib0265">13–16</a> Majority of the studies carried out earlier to evaluate the anatomic and audiological outcome of grafting by cartilage method were retrospective studies. In this study we prospectively compared the hearing and graft take up results of tympanoplasty by temporalis muscle fascia and by island cartilage graft, and also review the literature.Aims and objectives<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.To compare the results of graft take up and audiological outcomes of temporalis fascia versus island cartilage graft in type 1 tympanoplasty.</li><li class="elsevierStyleListItem" id="lsti0010">2.To compare the rate of post-operative retraction of neotympanum in both.</li></ul>Material and methodsThe present study was conducted in 70 patients between 11 and 50 years of age. The patients included were – cases of chronic suppurative otitis media with perforation involving >50% of tympanic membrane with intact ossicular chain. The exclusion criteria was – perforation involving less than 50% of tympanic membrane, cholesteatoma, ossicular chain immobility or defect in ossicles, otorrhoea, or sensorineural hearing loss. Ethics committee approval was taken prior to commencing study.The patients were divided by blocked randomization method into two groups – Group I: Temporal fascia graft, Group II: Island cartilage graft. Written informed consent was taken from all the subjects/guardians prior to enrolling them in the study and the subjects were blinded. The details of all the patients including name, age, sex, address were documented on a specially prepared proforma. A detailed history including duration and nature of symptoms, history of previous surgery was taken. Otomicroscopic examination was done in all patients prior to surgery and at 1 month, 6 months and 1 year postoperatively. A pure-tone audiometry was done within 1 week prior to surgery and 1 year postoperatively.<a class="elsevierStyleCrossRef" href="#bib0285">17</a> The audiologist was also blinded. Pre and post-operative four-tone pure tone average was calculated at frequencies – 0.5, 1, 2, 3kHz. Pre and post-operative air bone gap was calculated as the four-tone pure tone average for air conduction minus the same average for bone conduction. Air bone gap closure was calculated by subtracting pre-operative air bone gap from post-operative air bone gap.All the surgeries were performed by the same surgeon to avoid inter surgeon variability.Surgical procedureAll the patients were operated under local anesthesia except for children (<18 years) who were operated under general anesthesia. The patients were given pre medication before surgery to sedate the patient – Injection Pentazocine 30mg and Injection Promethazine 25mg. All ears were infiltrated with a local anesthesia using 2% lignocaine with 1:80,000 adrenaline. Post auricular approach was used in all the patients.In the cases where temporalis fascia was used as a grafting material, the graft was harvested from the temporalis muscle fascia, using the same post auricular incision. In the island cartilage group, an incision was made over skin on the medial side of the tragus, leaving a 2-mm strip of cartilage in the dome of the tragus for cosmesis. Cartilage, with attached perichondrium, was dissected medially from the overlying skin and soft tissue. The inferior cut was made as low as possible to maximize the length of harvested cartilage. A flap of perichondrium was dissected off the convex surface of the tragal cartilage, which would drape over the posterior canal wall. Cartilage was removed peripherally in a piecemeal fashion to produce an island of cartilage. The final shape of cartilage included a notch for manubrium mallei.Ossicular chain was systematically checked for any abnormalities or fixation. Temporalis fascia graft was slid under (medial to) the tympanomeatal flap and the handle of malleus. Island cartilage graft<a class="elsevierStyleCrossRef" href="#bib0290">18</a> was placed in an underlay fashion, with the malleus fitting in the groove. The cartilage was placed toward the promontory, with the perichondrium immediately adjacent to the tympanic membrane remnant, both of which were medial to the malleus. The posterior flap of the perichondrium was draped over the posterior canal wall. After the graft was placed, the tympanomeatal flap was reposited and the external auditory canal was packed with gel foam soaked in antibiotic eardrops. The post aural wound was closed in layers and mastoid bandage was applied on the ear.Patients received a course of suitable broad spectrum antibiotics, analgesic, and decongestants for 2 weeks. Sutures were removed on seventh postoperative day. Thereafter, all patients were called for regular follow up after 1 month, then after 4–6 months and 1 year. The condition of the neotympanum was assessed in terms of graft acceptance or failure, any active disease, signs of retraction. Hearing assessment by pure-tone audiometry was done at 1 year of follow up.The results were evaluated in the form of graft uptake and hearing outcome. Healed neo-tympanic membrane which moved on seigelization was taken as successful graft take-up, while any residual perforations or retraction of neotympanum were taken as failures.Data analysisThe collected data was tabulated and statistical analysis was done using Statistical Package for Social Sciences (SPSS) for Windows. Statistical analysis with the Student's t-test and Chi square test, were used to examine these parameters with regards to graft take-up and hearing improvement and comparisons were made between the two patient groups. The criteria for statistical significance was p<0.05.ResultsA total of 70 patients of age ranging from 11 to 50 years with dry subtotal perforation were included in the study (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). There were 38 males and 32 females in the study. The maximum numbers of patients were in the age group 11–20 years (48.6%). Out of the 70 patients with subtotal perforation, temporalis fascia graft was used in 35 patients and island cartilage graft was used in 35 patients.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>At 1 year follow up, the graft take up rate (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) for temporalis fascia and island cartilage graft were found to be 82.9% and 97.1% respectively, which was found to be statistically significant (p<0.05). In patients with temporalis fascia graft, 4 out of 35 patients (11.4%) had a small residual perforation in the anterior quadrant. Whereas, 2 out of 35 patients (5.7%) had a retraction of the neo tympanum. The graft take up rate for the island cartilage group was 97.1%, and only 1 out of 35 patients had a small residual perforation in the anterior quadrant. There was no incidence of retraction using island cartilage graft.This study included 31 pediatric patients (aged 11–18 years) and 39 adults (aged 19–50 years). Out of the 31 pediatric patients, temporalis fascia was used in 14 patients, and island cartilage graft was used in 17 patients. At 1 year follow up, in pediatric patients, the graft take up rate for temporalis fascia and island cartilage graft were found to be 71.4% (10 out of 14 patients) and 94.1% (16 out of 17 patients). Out of the 39 adult patients, temporalis fascia graft was used in 21 patients and island cartilage graft was used in 18 patients. At 1 year follow up, in adult patients, the graft take up rate for temporalis fascia and island cartilage graft were found to be 90.5% (19 out of 21 patients) and 100%.In the temporalis fascia graft group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), the mean pre-operative and post-operative air conduction threshold was found to be 42.9±10dB and 21.7±4.8dB respectively. Its p value was calculated to be less than 0.001 using paired t-test. The mean pre and post-operative air-bone gap was found to be 28.7±9dB and 11.4±3.5dB respectively. Its p value was calculated to be less than 0.001 using paired t-test. Therefore, there was a significant improvement in the average air conduction threshold and air-bone gap using temporalis fascia graft.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In the island cartilage graft group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), the mean pre-operative and post-operative air conduction threshold was found to be 47.3±10.3dB and 25.7±5.2dB respectively. Its p value was calculated to be less than 0.001 using paired t-test. The mean pre and post-operative air-bone gap was found to be 32.5±10.1dB and 13.5±3.7dB respectively. Its p value was calculated to be less than 0.001 using paired t-test. Therefore, there was a significant improvement in the average air conduction threshold and air-bone gap using island cartilage graft.At 1 year follow up, post-operative air-bone gap was found to be within 20dB for 34 out of 35 patients using temporalis fascia graft and for 32 out of 35 patients using island cartilage graft. The average air-bone gap closure was 17.2±8dB and 19±10.9dB for temporalis fascia and island cartilage graft, respectively. Its p value was found to be not statistically significant. Thus, there was no significant difference in the hearing outcome between temporalis fascia graft and island cartilage graft.DiscussionTympanoplasty is a surgical procedure used for eradicating chronic middle ear infection and for reconstructing the hearing mechanism. Numerous surgical techniques and grafting materials have been used for reconstruction of the sound conducting mechanism. The anatomic and audiological outcomes mostly depend on the properties of the graft materials such as skin, fascia,<a class="elsevierStyleCrossRef" href="#bib0215">3</a> vein,<a class="elsevierStyleCrossRef" href="#bib0230">6</a> dura mater,<a class="elsevierStyleCrossRef" href="#bib0235">7</a> perichondrium,<a class="elsevierStyleCrossRef" href="#bib0220">4</a> and cartilage.<a class="elsevierStyleCrossRefs" href="#bib0240">8,9</a>Due to the ease of harvesting the graft with the same incision and the high rate of successful closure of the tympanic membrane in normal ventilated middle ears, temporalis fascia grafts have been used for many years for reconstruction of the tympanic membrane. However, healing has a much poorer prognosis in high risk cases – a perforation larger than 50%, bilateral perforation, a revision surgery, a perforation draining at the time of surgery, and adhesive processes, all of which have been shown to be associated with increased failure rates using the traditional techniques.Cartilage was first used in middle ear procedures by Jansen<a class="elsevierStyleCrossRef" href="#bib0240">8</a> and Salen,<a class="elsevierStyleCrossRef" href="#bib0220">4</a> and has been used successfully since then. Cartilage tympanoplasty provides a better prognosis, probably due to the higher mechanical stability of the cartilage under negative pressure changes in the middle ear. The mechanical characteristics of cartilage have the advantage of high resistance to retraction and re-perforation. Cartilage is more rigid, has a constant shape and is firmer than fascia. It also lacks fibrous tissue, so that the post-operative dimensions remain the same. It has been shown in both clinical and experimental studies that cartilage is well taken up with minimal absorption and has long-term survival.<a class="elsevierStyleCrossRefs" href="#bib0295">19–21</a> The greatest advantage of the cartilage graft has been considered to be its very low metabolic rate. It is nourished largely by diffusion and becomes well incorporated in the tympanic membrane.<a class="elsevierStyleCrossRef" href="#bib0310">22</a> Human and animal studies have shown that although some softening occurs with time, the matrix of the cartilage remains intact, but with development of empty lacunae, showing degeneration of the chondrocytes.<a class="elsevierStyleCrossRefs" href="#bib0315">23,24</a>Although doubts are there regarding the sound conduction properties of cartilage due to its rigidity and thickness, several studies showed that the audiological outcomes with cartilage were not different than those with fascia.<a class="elsevierStyleCrossRefs" href="#bib0325">25,26,13</a> According to an experimental study by Zahnert, cartilage slices <500μm thick are similar to tympanic membrane in terms of their acoustic properties.<a class="elsevierStyleCrossRef" href="#bib0335">27</a>In our study, the graft take up rate for the temporalis fascia graft was 82.9%, whereas, for the island cartilage graft was 97.1% (p<0.05). This was found to be statistically significant and similar to a study conducted by Demirpehlivan et al.<a class="elsevierStyleCrossRef" href="#bib0340">28</a> (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The graft take rates for island cartilage graft were similar to other studies conducted by Kalcioglu et al.<a class="elsevierStyleCrossRef" href="#bib0345">29</a> (95%), Onal et al.<a class="elsevierStyleCrossRef" href="#bib0350">30</a> (93.2%), Karaman et al.<a class="elsevierStyleCrossRef" href="#bib0355">31</a> (97.29%), Gamra et al.<a class="elsevierStyleCrossRef" href="#bib0280">16</a> (97.7%), Altuna et al.<a class="elsevierStyleCrossRef" href="#bib0360">32</a> (92%), Chhapola et al.<a class="elsevierStyleCrossRef" href="#bib0365">33</a> (98.36%), Seta et al.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> (96.3%), Durán-Padilla et al.<a class="elsevierStyleCrossRef" href="#bib0375">35</a> (93.9%). Sozen et al.<a class="elsevierStyleCrossRef" href="#bib0380">36</a> reported graft take up rate of 100% and 88.5% using conchal and tragal cartilage respectively. Altuna et al.<a class="elsevierStyleCrossRef" href="#bib0385">37</a> reported a take up rate of 87% of island cartilage graft in revision cases. However, the graft take up result for temporalis fascia greatly varied, Kalcioglu et al.<a class="elsevierStyleCrossRef" href="#bib0345">29</a> (86.1%), Onal et al.<a class="elsevierStyleCrossRef" href="#bib0350">30</a> (89.6%), Gamra et al.<a class="elsevierStyleCrossRef" href="#bib0280">16</a> (96.9%), Chhapola et al.<a class="elsevierStyleCrossRef" href="#bib0365">33</a> (84.5%), Seta et al.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> (92.6%), Durán-Padilla et al.<a class="elsevierStyleCrossRef" href="#bib0375">35</a> (83.3%), Sozen et al.<a class="elsevierStyleCrossRef" href="#bib0380">36</a> (80.6%). This high graft failure could be attributed to shrinkage of the graft and inability of the thin temporalis fascia to resist resorption. All of the studies (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) show that cartilage tympanoplasty has higher graft survival rate than temporalis fascia.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In our study, the incidence of retraction of neotympanum using temporalis fascia graft was found to be 5.7% where as using cartilage graft, there was no retraction. Demirpehlivan et al.,<a class="elsevierStyleCrossRef" href="#bib0340">28</a> however, observed no incidence of retraction using temporalis fascia and island cartilage graft both. The incidence of retraction using temporalis fascia graft in other studies was, Kalcioglu et al.<a class="elsevierStyleCrossRef" href="#bib0345">29</a> (5.5%), Chappola et al.<a class="elsevierStyleCrossRef" href="#bib0365">33</a> (7.04%), Gamra et al.<a class="elsevierStyleCrossRef" href="#bib0280">16</a> (1%), Seta et al.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> (11%) as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. Thus, in high risk cases, cartilage graft has been found to be superior to temporalis fascia graft due to its rigid quality and its ability to resist resorption and retraction.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>In our study, the average air-bone gap closure was found to be 17.2±8dB for temporalis fascia and 19±10.9dB for island cartilage graft and the difference was not statistically significant (p>0.05). The air-bone gap closure obtained in our study was slightly higher than other studies but not statistically significant as in other studies (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). Therefore, the choice of graft material-temporalis fascia or island cartilage graft does not significantly affect the hearing outcome and cartilage graft has been found to be equivalent, if not superior, to temporalis fascia graft.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>This study compared the graft take rates and hearing improvements in high risk patients with subtotal perforation, using temporalis fascia graft and island cartilage graft. The drawback of majority of the studies carried out till date is that they were all retrospective studies. In this study, even though the sample size is small, the advantage of this study is that it is a prospective randomized study.Summary<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">•This prospective study compared island cartilage vs temporalis fascia graft 70 patients at high risk of graft failure.</li><li class="elsevierStyleListItem" id="lsti0020">•Graft take up rate was higher in the island cartilage group and there was no incidence of retraction of neotympanum in this group, thereby making island cartilage graft a suitable graft for high risk cases.</li><li class="elsevierStyleListItem" id="lsti0025">•There was a significant improvement in hearing using both temporalis fascia and island cartilage graft, but no significant difference in between the two groups.</li><li class="elsevierStyleListItem" id="lsti0030">•Therefore, island cartilage graft can be used in used in high risk cases without effecting audiometric results.</li></ul>FundingNone declared.Conflicts of interestNone declared." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1103365" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1043687" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1103364" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1043686" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Aims and objectives" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical procedure" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Summary" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-29" "fechaAceptado" => "2017-10-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1043687" "palabras" => array:3 [ 0 => "Cartilage" 1 => "Temporalis fascia" 2 => "Tympanoplasty" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1043686" "palabras" => array:3 [ 0 => "Cartílago" 1 => "Fascia de músculo temporal" 2 => "Timpanoplastia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Objective(1) To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty. (2) To compare the rate of postoperative retraction of neotympanum in both. MethodsA prospective study was conducted on 70 patients of ages ranging from 11 to 50 years with dry subtotal perforation. 35 underwent island cartilage tympanoplasty and 35 underwent type 1 tympanoplasty using temporalis fascia graft. Graft acceptance rates and post-operative audiograms were compared. ResultsAt one year follow up, the graft take-up rate for temporalis fascia and island cartilage graft were found to be 82.9% and 97.1% respectively, which was found to be statistically significant (p<0.05). In the temporalis fascia group, two out of 35 patients (5.7%) had retraction of the neo tympanum. There was no incidence of retraction using island cartilage graft. There was no significant difference in the postoperative air-bone gap gain between temporalis fascia graft and island cartilage graft. ConclusionIsland cartilage tympanoplasty shows a high degree of reliability in high risk cases. It has a higher graft take-up rate with no incidence of retraction of neotympanum. Moreover, it provided significant hearing improvement in our patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Objetivo1) Comparar los resultados del injerto y el resultado audiológico de la fascia del músculo temporal versus injerto de cartílago en isla en la timpanoplastia tipo 1, y 2) Comparar la tasa de retracción postoperatoria del neotímpano en ambos. MétodosSe realizó un estudio prospectivo en 70 pacientes de edades comprendidas entre los 11 y 50 años con perforación subtotal en seco. En 35 de ellos se realizó timpanoplastia con cartílago en isla y a los 35 restantes timpanoplastia tipo 1 mediante injerto de fascia de músculo temporal. Se compararon las tasas de aceptación del injerto y los audiogramas postoperatorios. ResultadosAl año de seguimiento, la tasa de toma del injerto de fascia de músculo temporal y el injerto de cartílago en isla fue del 82,9 y 97,1%, respectivamente, que resultó estadísticamente significativa (p<0,05). En el grupo de fascia de músculo temporal, 2 de 35 pacientes (5,7%) tuvieron una retracción del neotímpano. No hubo incidencia de retracción en el injerto de cartílago en isla. No hubo diferencia significativa en cuanto a la ganancia en el umbral diferencial de audición entre los injertos de fascia de músculo temporal y cartílago en isla. ConclusiónLa timpanoplastia con cartílago en isla muestra un alto grado de fiabilidad en casos de alto riesgo. Tiene una mayor tasa de aceptación del injerto, sin incidencias de retracción del neotímpano. Además, aportó una importante mejora de audición a nuestros pacientes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Age (in years) (n=70)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11–20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21–30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">31–40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">41–50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Temporalis fascia (n=35)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Graft take up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residual perforation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Island cartilage graft (n=35)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Graft take up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residual perforation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1887483.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics and graft take up results in our study." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-operative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post-operative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Temporalis fascia graft</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Air conduction threshold (average in db) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.9±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.7±4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Air-bone gap (in db) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.7±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Island cartilage graft</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Air conduction threshold (average in dB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.3±10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.7±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Air-bone gap (in dB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.5±10.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5±3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1887482.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of pre- and post-operative average air conduction threshold and air-bone gap using temporalis fascia graft and island cartilage graft in our study." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Graft take up</th><th class="td" title="table-head " align="left" valign="top" scope="col">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Temporalis fascia graft \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Island cartilage graft \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demirpehlivan et al.<a class="elsevierStyleCrossRef" href="#bib0340">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.06% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kalcioglu et al.<a class="elsevierStyleCrossRef" href="#bib0345">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onal et al.<a class="elsevierStyleCrossRef" href="#bib0350">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Karaman et al.<a class="elsevierStyleCrossRef" href="#bib0355">31</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.29% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamra et al.<a class="elsevierStyleCrossRef" href="#bib0280">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Altuna et al.<a class="elsevierStyleCrossRef" href="#bib0360">32</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chhapola et al.<a class="elsevierStyleCrossRef" href="#bib0365">33</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98.36% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seta et al.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Durán-Padilla et al.<a class="elsevierStyleCrossRef" href="#bib0375">35</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sozen et al.<a class="elsevierStyleCrossRef" href="#bib0380">36</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conchal cartilage: 100% Tragal cartilage: 88.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Altuna et al.<a class="elsevierStyleCrossRef" href="#bib0385">37</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1887485.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Graft take up results in various studies." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Retraction of neotympanum</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Temporalis fascia graft \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Island cartilage graft \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kalcioglu et al.<a class="elsevierStyleCrossRef" href="#bib0345">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chappola et al.<a class="elsevierStyleCrossRef" href="#bib0365">33</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.04% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demirpehlivan et al.<a class="elsevierStyleCrossRef" href="#bib0340">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamra et al.<a class="elsevierStyleCrossRef" href="#bib0280">16</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seta et al.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1887481.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Retraction of neotympanum in various studies." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Air-bone gap closure (db)</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Temporalis fascia graft \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Island cartilage graft \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kirazli et al.<a class="elsevierStyleCrossRef" href="#bib0390">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamra et al.<a class="elsevierStyleCrossRef" href="#bib0345">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ulku<a class="elsevierStyleCrossRef" href="#bib0395">39</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demirpehlivan et al.<a class="elsevierStyleCrossRef" href="#bib0340">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onal et al.<a class="elsevierStyleCrossRef" href="#bib0350">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.63±12.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.49±10.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sozen et al.<a class="elsevierStyleCrossRef" href="#bib0380">36</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conchal cartilage: 8.9 Tragal cartilage: 9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seta et al.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><15 in 66% patients <20 in 92% patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><15 in 61% patients <20 in 88% patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.2±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19±10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1887484.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of air-bone gap closure between temporalis fascia graft and island cartilage graft in various studies." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:39 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Funktionelle operation in mittelohr mit hilfedes frien spaltlappentransplantates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.L. Wullstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Ohren Nasen Kehlkopfheilkd" "fecha" => "1952" "volumen" => "161" "paginaInicial" => "422" "paginaFinal" => "423" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0210" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-auricular undersurface tympanic membrane grafting: a follow-up report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.E. Glasscock" 1 => "C.G. Jackson" 2 => "A.J. Nissen" 3 => "M.K. Schwaber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1982" "volumen" => "92" "paginaInicial" => "718" "paginaFinal" => "727" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7087638" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0215" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tympanic membrane plastic repair with temporalis fascia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Herman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hals Nas Ohrenh" "fecha" => "1960" "volumen" => "9" "paginaInicial" => "136" "paginaFinal" => "139" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0220" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tympanic membrane grafts of full thickness skin, fascia and cartilage with its perichondrium, an experimental and clinical investigation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Salen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Otolaryngol" "fecha" => "1968" "numero" => "Suppl. 244" "paginaInicial" => "5" "paginaFinal" => "73" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0225" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "L’impiego di lembi liberi di periostio nella tympanoplastica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Bocca" 1 => "C. Cis" 2 => "E. Zernotti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arch Ital Otol" "fecha" => "1959" "numero" => "Suppl. 40" "paginaInicial" => "205" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0230" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Closure of perforation of the tympanic membrane by vein grafts: a preliminary report of 20 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.G. Tabb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1288/00005537-196003000-00004" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1960" "volumen" => "70" "paginaInicial" => "271" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13836513" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0235" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dural homograft (alloplastic) myringoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.P. Albrite" 1 => "B.G. Leigh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1288/00005537-196610000-00006" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1966" "volumen" => "76" "paginaInicial" => "1687" "paginaFinal" => "1693" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5954194" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0240" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage-tympanoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Jansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1288/00005537-196310000-00006" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1963" "volumen" => "73" "paginaInicial" => "1288" "paginaFinal" => "1302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14073760" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0245" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myringoplasty using septum cartilage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Salen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Otolaryngol" "fecha" => "1963" "numero" => "Suppl. 188" "paginaInicial" => "82" "paginaFinal" => "91" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0250" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fascia and perichondrium atrophy in tympanoplasty and recurrent middle ear atelectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.A. Buckingham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/000348949210100907" "Revista" => array:6 [ "tituloSerie" => "Ann Otol Rhinol Laryngol" "fecha" => "1992" "volumen" => "101" "paginaInicial" => "755" "paginaFinal" => "758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1514753" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0255" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Milewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1288/00005537-199312000-00006" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1993" "volumen" => "103" "paginaInicial" => "1352" "paginaFinal" => "1356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8246654" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0260" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dimensional stability of free fascia grafts: an animal experiment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Indorewala" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200204000-00024" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2002" "volumen" => "112" "paginaInicial" => "727" "paginaFinal" => "730" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12150530" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0265" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Composite autograft ‘shield’ reconstruction of remnant tympanic membranes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.G. Duckert" 1 => "J. Müller" 2 => "K.H. Makielski" 3 => "J. Helms" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Otol" "fecha" => "1995" "volumen" => "16" "paginaInicial" => "21" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8579173" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0270" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hearing results after primary cartilage tympanoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Gerber" 1 => "J.C. Mason" 2 => "P.R. Lampert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200012000-00002" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2000" "volumen" => "110" "paginaInicial" => "1994" "paginaFinal" => "1999" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11129007" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0275" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hearing results with cartilage tympanoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.L. Dornhoffer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1997" "volumen" => "107" "paginaInicial" => "1094" "paginaFinal" => "1099" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9261014" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0280" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage graft in type 1 tympanoplasty: audiological and otological outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O.B. Gamra" 1 => "C. Mbarek" 2 => "K. Khammassi" 3 => "N. Methlouthi" 4 => "H. Ouni" 5 => "I. Hariga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-008-0645-5" "Revista" => array:6 [ "tituloSerie" => "Eur Arch Otorhinolaryngol" "fecha" => "2008" "volumen" => "265" "paginaInicial" => "739" "paginaFinal" => "742" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18351372" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0285" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Committee on Hearing and Equilibrium" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0194-5998(95)70103-6" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "1995" "volumen" => "113" "paginaInicial" => "186" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7675477" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0290" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage tympanopalsty: indications, techniques, and outcomes in a 1000-patient series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Dornhoffer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Laryngoscope" "fecha" => "2003" "volumen" => "113" "paginaInicial" => "1844" "paginaFinal" => "1856" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14603038" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028215004306" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0295" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autotransplantation and homotransplantations of cartilage in the guinea pig" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Loeb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Pathol" "fecha" => "1926" "volumen" => "2" "paginaInicial" => "111" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19969691" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0090825815008732" "estado" => "S300" "issn" => "00908258" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0300" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The fate of living and dead cartilage transplanted in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.A. Peer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Surg Gynecol Obstet" "fecha" => "1939" "volumen" => "68" "paginaInicial" => "603" "paginaFinal" => "610" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0305" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage homografts in the middle ear: a long term histological study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.G. Kerr" 1 => "J.E. Byrne" 2 => "G.D. Smyth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "1973" "volumen" => "87" "paginaInicial" => "1193" "paginaFinal" => "1199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4760609" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0310" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.M. Levinson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1987" "volumen" => "97" "paginaInicial" => "1069" "paginaFinal" => "1074" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3626732" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0315" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histologic study of homograft cartilages implanted in middle ear" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Yamamoto" 1 => "M. Iwanaga" 2 => "M. Fukumoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/019459988809800602" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "1988" "volumen" => "98" "paginaInicial" => "546" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3138610" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0320" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fate of cartilage material used in middle ear surgery light and electron microscopy study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Hamed" 1 => "M. Samir" 2 => "M. El Bigermy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Auris Nasus Larynx" "fecha" => "1999" "volumen" => "26" "paginaInicial" => "257" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10419032" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0325" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Composite autograft of tympanoplasty and tympanomastoid surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.Y. Adkins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1288/00005537-199003000-00007" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "1990" "volumen" => "100" "paginaInicial" => "244" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2308448" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0330" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage palisade tympanoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.G. Amedee" 1 => "W.J. Mann" 2 => "H. Riechelmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Otol" "fecha" => "1989" "volumen" => "10" "paginaInicial" => "447" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2610230" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0335" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experimental investigations of the use of cartilage in tympanic membrane reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Zahnert" 1 => "K.B. Huttenbrink" 2 => "D. Murbe" 3 => "M. Bornitz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Otol" "fecha" => "2000" "volumen" => "21" "paginaInicial" => "322" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10821543" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0340" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.A. Demirpehlivan" 1 => "K. Onal" 2 => "S. Arslanoglu" 3 => "M. Songu" 4 => "E. Ciger" 5 => "N. Can" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-010-1473-y" "Revista" => array:6 [ "tituloSerie" => "Eur Arch Otorhinolaryngol" "fecha" => "2011" "volumen" => "268" "paginaInicial" => "471" "paginaFinal" => "474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21267588" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0345" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage tympanoplasty with island technique: a comparison with the temporalis muscle fascia technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.T. Kalcioglu" 1 => "Y. Firat" 2 => "E. Selimoglu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int Adv Otol" "fecha" => "2009" "volumen" => "5" "paginaInicial" => "45" "paginaFinal" => "50" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0350" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional results of temporalis fascia versus cartilage tympanoplasty in patients with bilateral chronic otitis media" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Onal" 1 => "S. Arslanoglu" 2 => "M. Songu" 3 => "U. Demiray" 4 => "I.A. Demirpehlivan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0022215111002817" "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2012" "volumen" => "126" "paginaInicial" => "22" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22032518" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0355" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Composite cartilage island grafts in type 1 tympanoplasty: audiological and otological outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Karaman" 1 => "C. Duman" 2 => "H. Isildak" 3 => "O. Enver" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SCS.0b013e3181c36283" "Revista" => array:6 [ "tituloSerie" => "J Craniofac Surg" "fecha" => "2010" "volumen" => "21" "paginaInicial" => "37" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20061979" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0360" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miringoplastia con cartílago en isla Resultados anatómicos y funcionales de 122 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "X. Altuna" 1 => "J.J. Navarro" 2 => "Z. Martínez" 3 => "R. Lobato" 4 => "J. Algaba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otorri.2009.09.002" "Revista" => array:6 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2010" "volumen" => "61" "paginaInicial" => "100" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19897170" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0365" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cartilage perichondrium: an ideal graft material?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Chhapola" 1 => "I. Matta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12070-011-0306-7" "Revista" => array:6 [ "tituloSerie" => "Indian J Otolaryngol Head Neck Surg" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "208" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23998021" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0370" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type I tympanoplasty with island chondro-perichondral tragal graft: the preferred technique?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. De Seta" 1 => "D. De Seta" 2 => "E. Covelli" 3 => "M. Viccaro" 4 => "R. 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Island cartilage vs temporalis fascia in type 1 tympanoplasty: A prospective study

Cartílago en isla vs. fascia de músculo temporal en timpanoplastia tipo 1: un estudio prospectivo

Avani Jaina,

Corresponding author

avanijain87@hotmail.com

Corresponding author.

, Sunil Samdanib, Man Prakash Sharmab, Vinod Meenac

a Department of ENT, Lok Nayak Hospital, New Delhi, India

b Department of ENT, Sawai Man Singh Medical College and attached group of hospitals, Jaipur, Rajasthan, India

c District Hospital, Dausa, Rajasthan, India

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The term tympanoplasty was first used in 1952 by Wullstein<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> to describe the surgical techniques for reconstruction of the middle ear hearing mechanism that had been impaired or destroyed by chronic otitis media&#46; The rapid evolution of tympanoplasty as a routine surgical procedure has brought with it controversies and discussions over the procedure&#44; techniques and graft materials&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a> Various graft materials have been described since then such as temporal fascia&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a> perichondrium&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> periosteum&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> vein&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> dura mater<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> and cartilage&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;9</span></a> The most frequently used grafting material is temporal fascia graft&#44; due to the ease of its accessibility at the surgical site and the high graft take up rate in most of the normally ventilated middle ears&#46; However&#44; in conditions such as advanced middle ear pathology&#44; large perforations&#44; or retraction pockets&#44; temporalis fascia may have higher failure rates regardless of the surgical technique used&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#44;11</span></a> This is because the post-operative dimensions of temporal fascia are unpredictable as it is composed of irregularly arranged elastic fibers and fibrous connective tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> In such cases&#44; a more rigid grafting material such as cartilage is preferred because of its increased stability and resistance to middle ear pressure&#46; Due to the thickness and rigidity of cartilage&#44; conductive loss might be anticipated&#44; however&#44; several studies suggest the hearing results with cartilage to be no different than those for fascia&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#8211;16</span></a> Majority of the studies carried out earlier to evaluate the anatomic and audiological outcome of grafting by cartilage method were retrospective studies&#46; In this study we prospectively compared the hearing and graft take up results of tympanoplasty by temporalis muscle fascia and by island cartilage graft&#44; and also review the literature&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Aims and objectives</span><p id="par0010" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0015" class="elsevierStylePara elsevierViewall">To compare the results of graft take up and audiological outcomes of temporalis fascia versus island cartilage graft in type 1 tympanoplasty&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0020" class="elsevierStylePara elsevierViewall">To compare the rate of post-operative retraction of neotympanum in both&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The present study was conducted in 70 patients between 11 and 50 years of age&#46; The patients included were &#8211; cases of chronic suppurative otitis media with perforation involving &#62;50&#37; of tympanic membrane with intact ossicular chain&#46; The exclusion criteria was &#8211; perforation involving less than 50&#37; of tympanic membrane&#44; cholesteatoma&#44; ossicular chain immobility or defect in ossicles&#44; otorrhoea&#44; or sensorineural hearing loss&#46; Ethics committee approval was taken prior to commencing study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patients were divided by blocked randomization method into two groups &#8211; Group I&#58; Temporal fascia graft&#44; Group II&#58; Island cartilage graft&#46; Written informed consent was taken from all the subjects&#47;guardians prior to enrolling them in the study and the subjects were blinded&#46; The details of all the patients including name&#44; age&#44; sex&#44; address were documented on a specially prepared proforma&#46; A detailed history including duration and nature of symptoms&#44; history of previous surgery was taken&#46; Otomicroscopic examination was done in all patients prior to surgery and at 1 month&#44; 6 months and 1 year postoperatively&#46; A pure-tone audiometry was done within 1 week prior to surgery and 1 year postoperatively&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> The audiologist was also blinded&#46; Pre and post-operative four-tone pure tone average was calculated at frequencies &#8211; 0&#46;5&#44; 1&#44; 2&#44; 3<span class="elsevierStyleHsp" style=""></span>kHz&#46; Pre and post-operative air bone gap was calculated as the four-tone pure tone average for air conduction minus the same average for bone conduction&#46; Air bone gap closure was calculated by subtracting pre-operative air bone gap from post-operative air bone gap&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All the surgeries were performed by the same surgeon to avoid inter surgeon variability&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgical procedure</span><p id="par0040" class="elsevierStylePara elsevierViewall">All the patients were operated under local anesthesia except for children &#40;&#60;18 years&#41; who were operated under general anesthesia&#46; The patients were given pre medication before surgery to sedate the patient &#8211; Injection Pentazocine 30<span class="elsevierStyleHsp" style=""></span>mg and Injection Promethazine 25<span class="elsevierStyleHsp" style=""></span>mg&#46; All ears were infiltrated with a local anesthesia using 2&#37; lignocaine with 1&#58;80&#44;000 adrenaline&#46; Post auricular approach was used in all the patients&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the cases where temporalis fascia was used as a grafting material&#44; the graft was harvested from the temporalis muscle fascia&#44; using the same post auricular incision&#46; In the island cartilage group&#44; an incision was made over skin on the medial side of the tragus&#44; leaving a 2-mm strip of cartilage in the dome of the tragus for cosmesis&#46; Cartilage&#44; with attached perichondrium&#44; was dissected medially from the overlying skin and soft tissue&#46; The inferior cut was made as low as possible to maximize the length of harvested cartilage&#46; A flap of perichondrium was dissected off the convex surface of the tragal cartilage&#44; which would drape over the posterior canal wall&#46; Cartilage was removed peripherally in a piecemeal fashion to produce an island of cartilage&#46; The final shape of cartilage included a notch for manubrium mallei&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ossicular chain was systematically checked for any abnormalities or fixation&#46; Temporalis fascia graft was slid under &#40;medial to&#41; the tympanomeatal flap and the handle of malleus&#46; Island cartilage graft<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> was placed in an underlay fashion&#44; with the malleus fitting in the groove&#46; The cartilage was placed toward the promontory&#44; with the perichondrium immediately adjacent to the tympanic membrane remnant&#44; both of which were medial to the malleus&#46; The posterior flap of the perichondrium was draped over the posterior canal wall&#46; After the graft was placed&#44; the tympanomeatal flap was reposited and the external auditory canal was packed with gel foam soaked in antibiotic eardrops&#46; The post aural wound was closed in layers and mastoid bandage was applied on the ear&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients received a course of suitable broad spectrum antibiotics&#44; analgesic&#44; and decongestants for 2 weeks&#46; Sutures were removed on seventh postoperative day&#46; Thereafter&#44; all patients were called for regular follow up after 1 month&#44; then after 4&#8211;6 months and 1 year&#46; The condition of the neotympanum was assessed in terms of graft acceptance or failure&#44; any active disease&#44; signs of retraction&#46; Hearing assessment by pure-tone audiometry was done at 1 year of follow up&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The results were evaluated in the form of graft uptake and hearing outcome&#46; Healed neo-tympanic membrane which moved on seigelization was taken as successful graft take-up&#44; while any residual perforations or retraction of neotympanum were taken as failures&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The collected data was tabulated and statistical analysis was done using Statistical Package for Social Sciences &#40;SPSS&#41; for Windows&#46; Statistical analysis with the Student&#39;s <span class="elsevierStyleItalic">t</span>-test and Chi square test&#44; were used to examine these parameters with regards to graft take-up and hearing improvement and comparisons were made between the two patient groups&#46; The criteria for statistical significance was <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 70 patients of age ranging from 11 to 50 years with dry subtotal perforation were included in the study &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; There were 38 males and 32 females in the study&#46; The maximum numbers of patients were in the age group 11&#8211;20 years &#40;48&#46;6&#37;&#41;&#46; Out of the 70 patients with subtotal perforation&#44; temporalis fascia graft was used in 35 patients and island cartilage graft was used in 35 patients&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">At 1 year follow up&#44; the graft take up rate &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; for temporalis fascia and island cartilage graft were found to be 82&#46;9&#37; and 97&#46;1&#37; respectively&#44; which was found to be statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In patients with temporalis fascia graft&#44; 4 out of 35 patients &#40;11&#46;4&#37;&#41; had a small residual perforation in the anterior quadrant&#46; Whereas&#44; 2 out of 35 patients &#40;5&#46;7&#37;&#41; had a retraction of the neo tympanum&#46; The graft take up rate for the island cartilage group was 97&#46;1&#37;&#44; and only 1 out of 35 patients had a small residual perforation in the anterior quadrant&#46; There was no incidence of retraction using island cartilage graft&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study included 31 pediatric patients &#40;aged 11&#8211;18 years&#41; and 39 adults &#40;aged 19&#8211;50 years&#41;&#46; Out of the 31 pediatric patients&#44; temporalis fascia was used in 14 patients&#44; and island cartilage graft was used in 17 patients&#46; At 1 year follow up&#44; in pediatric patients&#44; the graft take up rate for temporalis fascia and island cartilage graft were found to be 71&#46;4&#37; &#40;10 out of 14 patients&#41; and 94&#46;1&#37; &#40;16 out of 17 patients&#41;&#46; Out of the 39 adult patients&#44; temporalis fascia graft was used in 21 patients and island cartilage graft was used in 18 patients&#46; At 1 year follow up&#44; in adult patients&#44; the graft take up rate for temporalis fascia and island cartilage graft were found to be 90&#46;5&#37; &#40;19 out of 21 patients&#41; and 100&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the temporalis fascia graft group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; the mean pre-operative and post-operative air conduction threshold was found to be 42&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>dB and 21&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8<span class="elsevierStyleHsp" style=""></span>dB respectively&#46; Its <span class="elsevierStyleItalic">p</span> value was calculated to be less than 0&#46;001 using paired <span class="elsevierStyleItalic">t</span>-test&#46; The mean pre and post-operative air-bone gap was found to be 28&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>dB and 11&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5<span class="elsevierStyleHsp" style=""></span>dB respectively&#46; Its <span class="elsevierStyleItalic">p</span> value was calculated to be less than 0&#46;001 using paired <span class="elsevierStyleItalic">t</span>-test&#46; Therefore&#44; there was a significant improvement in the average air conduction threshold and air-bone gap using temporalis fascia graft&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In the island cartilage graft group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; the mean pre-operative and post-operative air conduction threshold was found to be 47&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;3<span class="elsevierStyleHsp" style=""></span>dB and 25&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>dB respectively&#46; Its <span class="elsevierStyleItalic">p</span> value was calculated to be less than 0&#46;001 using paired <span class="elsevierStyleItalic">t</span>-test&#46; The mean pre and post-operative air-bone gap was found to be 32&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1<span class="elsevierStyleHsp" style=""></span>dB and 13&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7<span class="elsevierStyleHsp" style=""></span>dB respectively&#46; Its <span class="elsevierStyleItalic">p</span> value was calculated to be less than 0&#46;001 using paired <span class="elsevierStyleItalic">t</span>-test&#46; Therefore&#44; there was a significant improvement in the average air conduction threshold and air-bone gap using island cartilage graft&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">At 1 year follow up&#44; post-operative air-bone gap was found to be within 20<span class="elsevierStyleHsp" style=""></span>dB for 34 out of 35 patients using temporalis fascia graft and for 32 out of 35 patients using island cartilage graft&#46; The average air-bone gap closure was 17&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>dB and 19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;9<span class="elsevierStyleHsp" style=""></span>dB for temporalis fascia and island cartilage graft&#44; respectively&#46; Its <span class="elsevierStyleItalic">p</span> value was found to be not statistically significant&#46; Thus&#44; there was no significant difference in the hearing outcome between temporalis fascia graft and island cartilage graft&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Tympanoplasty is a surgical procedure used for eradicating chronic middle ear infection and for reconstructing the hearing mechanism&#46; Numerous surgical techniques and grafting materials have been used for reconstruction of the sound conducting mechanism&#46; The anatomic and audiological outcomes mostly depend on the properties of the graft materials such as skin&#44; fascia&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a> vein&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> dura mater&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> perichondrium&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> and cartilage&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Due to the ease of harvesting the graft with the same incision and the high rate of successful closure of the tympanic membrane in normal ventilated middle ears&#44; temporalis fascia grafts have been used for many years for reconstruction of the tympanic membrane&#46; However&#44; healing has a much poorer prognosis in high risk cases &#8211; a perforation larger than 50&#37;&#44; bilateral perforation&#44; a revision surgery&#44; a perforation draining at the time of surgery&#44; and adhesive processes&#44; all of which have been shown to be associated with increased failure rates using the traditional techniques&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cartilage was first used in middle ear procedures by Jansen<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> and Salen&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> and has been used successfully since then&#46; Cartilage tympanoplasty provides a better prognosis&#44; probably due to the higher mechanical stability of the cartilage under negative pressure changes in the middle ear&#46; The mechanical characteristics of cartilage have the advantage of high resistance to retraction and re-perforation&#46; Cartilage is more rigid&#44; has a constant shape and is firmer than fascia&#46; It also lacks fibrous tissue&#44; so that the post-operative dimensions remain the same&#46; It has been shown in both clinical and experimental studies that cartilage is well taken up with minimal absorption and has long-term survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#8211;21</span></a> The greatest advantage of the cartilage graft has been considered to be its very low metabolic rate&#46; It is nourished largely by diffusion and becomes well incorporated in the tympanic membrane&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> Human and animal studies have shown that although some softening occurs with time&#44; the matrix of the cartilage remains intact&#44; but with development of empty lacunae&#44; showing degeneration of the chondrocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Although doubts are there regarding the sound conduction properties of cartilage due to its rigidity and thickness&#44; several studies showed that the audiological outcomes with cartilage were not different than those with fascia&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">25&#44;26&#44;13</span></a> According to an experimental study by Zahnert&#44; cartilage slices &#60;500<span class="elsevierStyleHsp" style=""></span>&#956;m thick are similar to tympanic membrane in terms of their acoustic properties&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In our study&#44; the graft take up rate for the temporalis fascia graft was 82&#46;9&#37;&#44; whereas&#44; for the island cartilage graft was 97&#46;1&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; This was found to be statistically significant and similar to a study conducted by Demirpehlivan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The graft take rates for island cartilage graft were similar to other studies conducted by Kalcioglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> &#40;95&#37;&#41;&#44; Onal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> &#40;93&#46;2&#37;&#41;&#44; Karaman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> &#40;97&#46;29&#37;&#41;&#44; Gamra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> &#40;97&#46;7&#37;&#41;&#44; Altuna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> &#40;92&#37;&#41;&#44; Chhapola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> &#40;98&#46;36&#37;&#41;&#44; Seta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> &#40;96&#46;3&#37;&#41;&#44; Dur&#225;n-Padilla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> &#40;93&#46;9&#37;&#41;&#46; Sozen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> reported graft take up rate of 100&#37; and 88&#46;5&#37; using conchal and tragal cartilage respectively&#46; Altuna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> reported a take up rate of 87&#37; of island cartilage graft in revision cases&#46; However&#44; the graft take up result for temporalis fascia greatly varied&#44; Kalcioglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> &#40;86&#46;1&#37;&#41;&#44; Onal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> &#40;89&#46;6&#37;&#41;&#44; Gamra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> &#40;96&#46;9&#37;&#41;&#44; Chhapola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> &#40;84&#46;5&#37;&#41;&#44; Seta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> &#40;92&#46;6&#37;&#41;&#44; Dur&#225;n-Padilla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> &#40;83&#46;3&#37;&#41;&#44; Sozen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> &#40;80&#46;6&#37;&#41;&#46; This high graft failure could be attributed to shrinkage of the graft and inability of the thin temporalis fascia to resist resorption&#46; All of the studies &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; show that cartilage tympanoplasty has higher graft survival rate than temporalis fascia&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">In our study&#44; the incidence of retraction of neotympanum using temporalis fascia graft was found to be 5&#46;7&#37; where as using cartilage graft&#44; there was no retraction&#46; Demirpehlivan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> however&#44; observed no incidence of retraction using temporalis fascia and island cartilage graft both&#46; The incidence of retraction using temporalis fascia graft in other studies was&#44; Kalcioglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> &#40;5&#46;5&#37;&#41;&#44; Chappola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> &#40;7&#46;04&#37;&#41;&#44; Gamra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> &#40;1&#37;&#41;&#44; Seta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> &#40;11&#37;&#41; as shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; Thus&#44; in high risk cases&#44; cartilage graft has been found to be superior to temporalis fascia graft due to its rigid quality and its ability to resist resorption and retraction&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">In our study&#44; the average air-bone gap closure was found to be 17&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>dB for temporalis fascia and 19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;9<span class="elsevierStyleHsp" style=""></span>dB for island cartilage graft and the difference was not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The air-bone gap closure obtained in our study was slightly higher than other studies but not statistically significant as in other studies &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; Therefore&#44; the choice of graft material-temporalis fascia or island cartilage graft does not significantly affect the hearing outcome and cartilage graft has been found to be equivalent&#44; if not superior&#44; to temporalis fascia graft&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">This study compared the graft take rates and hearing improvements in high risk patients with subtotal perforation&#44; using temporalis fascia graft and island cartilage graft&#46; The drawback of majority of the studies carried out till date is that they were all retrospective studies&#46; In this study&#44; even though the sample size is small&#44; the advantage of this study is that it is a prospective randomized study&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Summary</span><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">This prospective study compared island cartilage vs temporalis fascia graft 70 patients at high risk of graft failure&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Graft take up rate was higher in the island cartilage group and there was no incidence of retraction of neotympanum in this group&#44; thereby making island cartilage graft a suitable graft for high risk cases&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">There was a significant improvement in hearing using both temporalis fascia and island cartilage graft&#44; but no significant difference in between the two groups&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Therefore&#44; island cartilage graft can be used in used in high risk cases without effecting audiometric results&#46;</p></li></ul></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;1&#41; To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty&#46; &#40;2&#41; To compare the rate of postoperative retraction of neotympanum in both&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective study was conducted on 70 patients of ages ranging from 11 to 50 years with dry subtotal perforation&#46; 35 underwent island cartilage tympanoplasty and 35 underwent type 1 tympanoplasty using temporalis fascia graft&#46; Graft acceptance rates and post-operative audiograms were compared&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At one year follow up&#44; the graft take-up rate for temporalis fascia and island cartilage graft were found to be 82&#46;9&#37; and 97&#46;1&#37; respectively&#44; which was found to be statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In the temporalis fascia group&#44; two out of 35 patients &#40;5&#46;7&#37;&#41; had retraction of the neo tympanum&#46; There was no incidence of retraction using island cartilage graft&#46; There was no significant difference in the postoperative air-bone gap gain between temporalis fascia graft and island cartilage graft&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Island cartilage tympanoplasty shows a high degree of reliability in high risk cases&#46; It has a higher graft take-up rate with no incidence of retraction of neotympanum&#46; Moreover&#44; it provided significant hearing improvement in our patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">1&#41;</span> Comparar los resultados del injerto y el resultado audiol&#243;gico de la fascia del m&#250;sculo temporal versus injerto de cart&#237;lago en isla en la timpanoplastia tipo 1&#44; y <span class="elsevierStyleItalic">2&#41;</span> Comparar la tasa de retracci&#243;n postoperatoria del neot&#237;mpano en ambos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo en 70 pacientes de edades comprendidas entre los 11 y 50 a&#241;os con perforaci&#243;n subtotal en seco&#46; En 35 de ellos se realiz&#243; timpanoplastia con cart&#237;lago en isla y a los 35 restantes timpanoplastia tipo 1 mediante injerto de fascia de m&#250;sculo temporal&#46; Se compararon las tasas de aceptaci&#243;n del injerto y los audiogramas postoperatorios&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Al a&#241;o de seguimiento&#44; la tasa de toma del injerto de fascia de m&#250;sculo temporal y el injerto de cart&#237;lago en isla fue del 82&#44;9 y 97&#44;1&#37;&#44; respectivamente&#44; que result&#243; estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En el grupo de fascia de m&#250;sculo temporal&#44; 2 de 35 pacientes &#40;5&#44;7&#37;&#41; tuvieron una retracci&#243;n del neot&#237;mpano&#46; No hubo incidencia de retracci&#243;n en el injerto de cart&#237;lago en isla&#46; No hubo diferencia significativa en cuanto a la ganancia en el umbral diferencial de audici&#243;n entre los injertos de fascia de m&#250;sculo temporal y cart&#237;lago en isla&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La timpanoplastia con cart&#237;lago en isla muestra un alto grado de fiabilidad en casos de alto riesgo&#46; Tiene una mayor tasa de aceptaci&#243;n del injerto&#44; sin incidencias de retracci&#243;n del neot&#237;mpano&#46; Adem&#225;s&#44; aport&#243; una importante mejora de audici&#243;n a nuestros pacientes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;in years&#41; &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">70&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>11&#8211;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>21&#8211;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>31&#8211;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>41&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Temporalis fascia &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">35&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Graft take up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residual perforation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Island cartilage graft &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">35&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Graft take up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residual perforation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics and graft take up results in our study&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-operative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post-operative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Temporalis fascia graft</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Air conduction threshold &#40;average in db&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Air-bone gap &#40;in db&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Island cartilage graft</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Air conduction threshold &#40;average in dB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Air-bone gap &#40;in dB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of pre- and post-operative average air conduction threshold and air-bone gap using temporalis fascia graft and island cartilage graft in our study&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at3"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Graft take up</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Temporalis fascia graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Island cartilage graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demirpehlivan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#46;06&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kalcioglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Karaman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#46;29&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Altuna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chhapola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&#46;36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dur&#225;n-Padilla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sozen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conchal cartilage&#58; 100&#37;<br>Tragal cartilage&#58; 88&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Altuna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Retraction of neotympanum</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Temporalis fascia graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Island cartilage graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kalcioglu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chappola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;04&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demirpehlivan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Air-bone gap closure &#40;db&#41;</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Temporalis fascia graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Island cartilage graft&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kirazli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gamra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ulku<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demirpehlivan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sozen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Conchal cartilage&#58; 8&#46;9<br>Tragal cartilage&#58; 9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15 in 66&#37; patients<br>&#60;20 in 92&#37; patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15 in 61&#37; patients<br>&#60;20 in 88&#37; patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Funktionelle operation in mittelohr mit hilfedes frien spaltlappentransplantates"
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                          "etal" => false
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                        "tituloSerie" => "Arch Ohren Nasen Kehlkopfheilkd"
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                        "volumen" => "161"
                        "paginaInicial" => "422"
                        "paginaFinal" => "423"
                      ]
                    ]
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                      "titulo" => "Post-auricular undersurface tympanic membrane grafting&#58; a follow-up report"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;E&#46; Glasscock"
                            1 => "C&#46;G&#46; Jackson"
                            2 => "A&#46;J&#46; Nissen"
                            3 => "M&#46;K&#46; Schwaber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1982"
                        "volumen" => "92"
                        "paginaInicial" => "718"
                        "paginaFinal" => "727"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7087638"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tympanic membrane plastic repair with temporalis fascia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Herman"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hals Nas Ohrenh"
                        "fecha" => "1960"
                        "volumen" => "9"
                        "paginaInicial" => "136"
                        "paginaFinal" => "139"
                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "Tympanic membrane grafts of full thickness skin&#44; fascia and cartilage with its perichondrium&#44; an experimental and clinical investigation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                  ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Otolaryngol"
                        "fecha" => "1968"
                        "numero" => "Suppl&#46; 244"
                        "paginaInicial" => "5"
                        "paginaFinal" => "73"
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "L&#8217;impiego di lembi liberi di periostio nella tympanoplastica"
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                          "etal" => false
                          "autores" => array:3 [
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                            2 => "E&#46; Zernotti"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Arch Ital Otol"
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                        "numero" => "Suppl&#46; 40"
                        "paginaInicial" => "205"
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                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                      "titulo" => "Closure of perforation of the tympanic membrane by vein grafts&#58; a preliminary report of 20 cases"
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                          "etal" => false
                          "autores" => array:1 [
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                    0 => array:2 [
                      "doi" => "10.1288/00005537-196003000-00004"
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                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1960"
                        "volumen" => "70"
                        "paginaInicial" => "271"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13836513"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dural homograft &#40;alloplastic&#41; myringoplasty"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;P&#46; Albrite"
                            1 => "B&#46;G&#46; Leigh"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1288/00005537-196610000-00006"
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                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1966"
                        "volumen" => "76"
                        "paginaInicial" => "1687"
                        "paginaFinal" => "1693"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5954194"
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage-tympanoplasty"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Jansen"
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                      "doi" => "10.1288/00005537-196310000-00006"
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                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1963"
                        "volumen" => "73"
                        "paginaInicial" => "1288"
                        "paginaFinal" => "1302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14073760"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myringoplasty using septum cartilage"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Salen"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Otolaryngol"
                        "fecha" => "1963"
                        "numero" => "Suppl&#46; 188"
                        "paginaInicial" => "82"
                        "paginaFinal" => "91"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0250"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fascia and perichondrium atrophy in tympanoplasty and recurrent middle ear atelectasis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;A&#46; Buckingham"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/000348949210100907"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Otol Rhinol Laryngol"
                        "fecha" => "1992"
                        "volumen" => "101"
                        "paginaInicial" => "755"
                        "paginaFinal" => "758"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1514753"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0255"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Milewski"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1288/00005537-199312000-00006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1993"
                        "volumen" => "103"
                        "paginaInicial" => "1352"
                        "paginaFinal" => "1356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8246654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0260"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dimensional stability of free fascia grafts&#58; an animal experiment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Indorewala"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00005537-200204000-00024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "2002"
                        "volumen" => "112"
                        "paginaInicial" => "727"
                        "paginaFinal" => "730"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12150530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "13"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Composite autograft &#8216;shield&#8217; reconstruction of remnant tympanic membranes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;G&#46; Duckert"
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                            2 => "K&#46;H&#46; Makielski"
                            3 => "J&#46; Helms"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Otol"
                        "fecha" => "1995"
                        "volumen" => "16"
                        "paginaInicial" => "21"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8579173"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0270"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hearing results after primary cartilage tympanoplasty"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Gerber"
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                            2 => "P&#46;R&#46; Lampert"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00005537-200012000-00002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "2000"
                        "volumen" => "110"
                        "paginaInicial" => "1994"
                        "paginaFinal" => "1999"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11129007"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hearing results with cartilage tympanoplasty"
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                          "autores" => array:1 [
                            0 => "J&#46;L&#46; Dornhoffer"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1997"
                        "volumen" => "107"
                        "paginaInicial" => "1094"
                        "paginaFinal" => "1099"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9261014"
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                          ]
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                      ]
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                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cartilage graft in type 1 tympanoplasty&#58; audiological and otological outcome"
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                          "etal" => true
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                            4 => "H&#46; Ouni"
                            5 => "I&#46; Hariga"
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                    0 => array:2 [
                      "doi" => "10.1007/s00405-008-0645-5"
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                        "tituloSerie" => "Eur Arch Otorhinolaryngol"
                        "fecha" => "2008"
                        "volumen" => "265"
                        "paginaInicial" => "739"
                        "paginaFinal" => "742"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18351372"
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                          ]
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                      ]
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                  ]
                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Committee on Hearing and Equilibrium"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0194-5998(95)70103-6"
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                        "tituloSerie" => "Otolaryngol Head Neck Surg"
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                        "volumen" => "113"
                        "paginaInicial" => "186"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7675477"
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                ]
              ]
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              "identificador" => "bib0290"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cartilage tympanopalsty&#58; indications&#44; techniques&#44; and outcomes in a 1000-patient series"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Laryngoscope"
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                        "paginaInicial" => "1844"
                        "paginaFinal" => "1856"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14603038"
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                          "pii" => "S0015028215004306"
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Autotransplantation and homotransplantations of cartilage in the guinea pig"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Loeb"
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                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Pathol"
                        "fecha" => "1926"
                        "volumen" => "2"
                        "paginaInicial" => "111"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19969691"
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                          "pii" => "S0090825815008732"
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                          "issn" => "00908258"
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              "identificador" => "bib0300"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The fate of living and dead cartilage transplanted in humans"
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                          "autores" => array:1 [
                            0 => "L&#46;A&#46; Peer"
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                        "tituloSerie" => "Surg Gynecol Obstet"
                        "fecha" => "1939"
                        "volumen" => "68"
                        "paginaInicial" => "603"
                        "paginaFinal" => "610"
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              ]
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                      "titulo" => "Cartilage homografts in the middle ear&#58; a long term histological study"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;G&#46; Kerr"
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                            2 => "G&#46;D&#46; Smyth"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Laryngol Otol"
                        "fecha" => "1973"
                        "volumen" => "87"
                        "paginaInicial" => "1193"
                        "paginaFinal" => "1199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4760609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;M&#46; Levinson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1987"
                        "volumen" => "97"
                        "paginaInicial" => "1069"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3626732"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histologic study of homograft cartilages implanted in middle ear"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Yamamoto"
                            1 => "M&#46; Iwanaga"
                            2 => "M&#46; Fukumoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/019459988809800602"
                      "Revista" => array:6 [
                        "tituloSerie" => "Otolaryngol Head Neck Surg"
                        "fecha" => "1988"
                        "volumen" => "98"
                        "paginaInicial" => "546"
                        "paginaFinal" => "551"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3138610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fate of cartilage material used in middle ear surgery light and electron microscopy study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Hamed"
                            1 => "M&#46; Samir"
                            2 => "M&#46; El Bigermy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Auris Nasus Larynx"
                        "fecha" => "1999"
                        "volumen" => "26"
                        "paginaInicial" => "257"
                        "paginaFinal" => "262"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10419032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Composite autograft of tympanoplasty and tympanomastoid surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;Y&#46; Adkins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1288/00005537-199003000-00007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "1990"
                        "volumen" => "100"
                        "paginaInicial" => "244"
                        "paginaFinal" => "247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2308448"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage palisade tympanoplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;G&#46; Amedee"
                            1 => "W&#46;J&#46; Mann"
                            2 => "H&#46; Riechelmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Otol"
                        "fecha" => "1989"
                        "volumen" => "10"
                        "paginaInicial" => "447"
                        "paginaFinal" => "450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2610230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Experimental investigations of the use of cartilage in tympanic membrane reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Zahnert"
                            1 => "K&#46;B&#46; Huttenbrink"
                            2 => "D&#46; Murbe"
                            3 => "M&#46; Bornitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Otol"
                        "fecha" => "2000"
                        "volumen" => "21"
                        "paginaInicial" => "322"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10821543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46;A&#46; Demirpehlivan"
                            1 => "K&#46; Onal"
                            2 => "S&#46; Arslanoglu"
                            3 => "M&#46; Songu"
                            4 => "E&#46; Ciger"
                            5 => "N&#46; Can"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00405-010-1473-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Arch Otorhinolaryngol"
                        "fecha" => "2011"
                        "volumen" => "268"
                        "paginaInicial" => "471"
                        "paginaFinal" => "474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21267588"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage tympanoplasty with island technique&#58; a comparison with the temporalis muscle fascia technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;T&#46; Kalcioglu"
                            1 => "Y&#46; Firat"
                            2 => "E&#46; Selimoglu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int Adv Otol"
                        "fecha" => "2009"
                        "volumen" => "5"
                        "paginaInicial" => "45"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional results of temporalis fascia versus cartilage tympanoplasty in patients with bilateral chronic otitis media"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Onal"
                            1 => "S&#46; Arslanoglu"
                            2 => "M&#46; Songu"
                            3 => "U&#46; Demiray"
                            4 => "I&#46;A&#46; Demirpehlivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0022215111002817"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Laryngol Otol"
                        "fecha" => "2012"
                        "volumen" => "126"
                        "paginaInicial" => "22"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22032518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Composite cartilage island grafts in type 1 tympanoplasty&#58; audiological and otological outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Karaman"
                            1 => "C&#46; Duman"
                            2 => "H&#46; Isildak"
                            3 => "O&#46; Enver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SCS.0b013e3181c36283"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Craniofac Surg"
                        "fecha" => "2010"
                        "volumen" => "21"
                        "paginaInicial" => "37"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20061979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Miringoplastia con cart&#237;lago en isla Resultados anat&#243;micos y funcionales de 122 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "X&#46; Altuna"
                            1 => "J&#46;J&#46; Navarro"
                            2 => "Z&#46; Mart&#237;nez"
                            3 => "R&#46; Lobato"
                            4 => "J&#46; Algaba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otorri.2009.09.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Otorrinolaringol Esp"
                        "fecha" => "2010"
                        "volumen" => "61"
                        "paginaInicial" => "100"
                        "paginaFinal" => "105"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19897170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage perichondrium&#58; an ideal graft material&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Chhapola"
                            1 => "I&#46; Matta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12070-011-0306-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Otolaryngol Head Neck Surg"
                        "fecha" => "2012"
                        "volumen" => "64"
                        "paginaInicial" => "208"
                        "paginaFinal" => "213"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23998021"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Type I tympanoplasty with island chondro-perichondral tragal graft&#58; the preferred technique&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; De Seta"
                            1 => "D&#46; De Seta"
                            2 => "E&#46; Covelli"
                            3 => "M&#46; Viccaro"
                            4 => "R&#46; Filipo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0022215113000121"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Laryngol Otol"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "354"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23433000"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage island versus temporalis fascia in high-risk tympanic perforation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;L&#46; Dur&#225;n-Padilla"
                            1 => "J&#46; Mart&#237;nez-Ch&#225;vez"
                            2 => "N&#46; Amador-Licona"
                            3 => "T&#46;A&#46; Pereyra-Nobara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Med Inst Mex Seguro Soc"
                        "fecha" => "2017"
                        "volumen" => "55"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S58"
                        "paginaFinal" => "S63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28212476"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is the tragal cartilage necessary for type 1 tympanoplasties&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Sozen"
                            1 => "Y&#46; Orhan U&#231;al"
                            2 => "H&#46;D&#46; Tansuker"
                            3 => "B&#46; Uslu Co&#351;kun"
                            4 => "A&#46; Yasemin Korkut"
                            5 => "B&#46; Dada&#351;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Craniofac Surg"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "280"
                        "paginaFinal" => "283"
                        "itemHostRev" => array:3 [
                          "pii" => "S0090825809009500"
                          "estado" => "S300"
                          "issn" => "00908258"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Island cartilage tympanoplasty in revision cases&#58; anatomic and functional results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46; Altuna"
                            1 => "J&#46;J&#46; Navarro"
                            2 => "J&#46; Algaba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00405-011-1875-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Arch Otorhinolaryngol"
                        "fecha" => "2012"
                        "volumen" => "269"
                        "paginaInicial" => "2169"
                        "paginaFinal" => "2172"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22146865"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hearing results after primary cartilage tympanoplasty with island technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Kirazli"
                            1 => "C&#46; Bilgen"
                            2 => "R&#46; Midilli"
                            3 => "F&#46; Og&#252;t"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otohns.2005.01.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "Otolaryngol Head Neck Surg"
                        "fecha" => "2005"
                        "volumen" => "132"
                        "paginaInicial" => "933"
                        "paginaFinal" => "937"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15944567"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation&#58; anatomic and audiologic results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;H&#46; Ulku"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Kulak Burun Bogaz Ihtis Derg"
                        "fecha" => "2010"
                        "volumen" => "20"
                        "paginaInicial" => "7"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20163331"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0749208109000850"
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Article information

ISSN: 00016519
Original language: English

DOI:10.1016/j.otorri.2017.10.004

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Year/Month	Html	Pdf	Total

2024 January	1	1	2
2023 March	0	1	1
2022 November	1	1	2
2021 March	0	11	11
2021 February	0	7	7
2021 January	0	17	17
2020 December	0	4	4
2020 November	0	9	9
2020 October	0	9	9
2020 September	0	12	12
2020 August	0	8	8
2020 July	0	9	9
2020 June	0	4	4
2020 May	0	10	10
2020 April	0	9	9
2020 March	22	28	50
2020 February	36	16	52
2020 January	23	9	32
2019 December	27	9	36
2019 November	22	7	29
2019 October	1	2	3
2019 August	1	0	1
2019 April	1	0	1
2019 March	1	0	1
2019 February	5	6	11
2019 January	4	2	6
2018 December	9	4	13
2018 November	21	11	32
2018 August	0	2	2
2018 July	0	1	1
2018 March	0	1	1

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