Endaural Over-Underlay Cartilage Tympanoplasty for Repair of Dry Subtotal Perforations

Ann Otol Rhinol Laryngol. 2021 Dec;130(12):1345-1350. doi: 10.1177/00034894211007218. Epub 2021 Apr 7.

Abstract

Objectives: We explored the auditory and anatomical success of grafting when the cartilage perichondrium (CP) was prepared using two different methods.

Methods: Patients with subtotal or total perforation underwent tympanoplasty with a CP graft. A V-shaped groove for the handle of the malleus was prepared for CP grafts in patients in group 1. Patients in group 2 did not have a groove on the graft. The anatomical success of the graft was evaluated as success, partial success, or failure. Results of auditory evaluations were compared between the two groups.

Results: A total of 195 patients were included in the study. The total CP graft integration rate was 96% for both groups. Significant changes were detected in all hearing criteria evaluated 12 months after surgery compared to the preoperative period (P < .05). There were no significant differences between the groups in terms of the relationship between graft technique and postoperative hearing results. However, rates of partial success were significantly higher for group 1 than group 2 (P = .033).

Conclusion: Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. Partial failures are rare, but when they occur, they most often involved anterior graft medialization. When a piece of cartilage is removed at the malleus interface there may be a higher rate of partial failure.

Keywords: cartilage grafts; graft integration; large/subtotal perforation; miscellaneous; tragal cartilage graft; underlay cartilage tympanoplasty.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Endoscopy / methods*
  • Fascia / transplantation*
  • Female
  • Hearing / physiology*
  • Humans
  • Male
  • Malleus / surgery*
  • Middle Aged
  • Postoperative Period
  • Prospective Studies
  • Single-Blind Method
  • Treatment Outcome
  • Tympanic Membrane / injuries
  • Tympanic Membrane / surgery*
  • Tympanic Membrane Perforation / diagnosis
  • Tympanic Membrane Perforation / physiopathology
  • Tympanic Membrane Perforation / surgery*
  • Tympanoplasty / methods*
  • Young Adult