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Introduction In conditions like recurrent perforations, atelectatic tympanic membrane and poor eustachian tube function, temporalis fascia graft fails to give the desired result. In such cases cartilage is used for tympanoplasty. It was demonstrated that if the thickness of cartilage is reduced to around 0.5 mm, the sound conduction is comparable to that of normal tympanic membrane with excellent mechanical stability. Aim To intra-operatively measure the mean thickness of tragal and conchal cartilage and compare it for age and sex variations. Material & methods A total of 114 tragal and conchal cartilage samples of 86 patients were included in the study. Thickness of cartilages was measured intra-operatively after removing the perichondrium from both sides. Results Out of 58 tragal cartilages, 32 were from males and 26 from females. Mean thickness was 1.18 ± 0.11 mm among males and 1.12 ± 0.14 mm among females. Out of 56 conchal cartilage taken, 29 were from males and 27 females. Mean thickness among males were 1.38 ± 0.13 mm and 1.35 ± 0.08 mm in females. In 28 patients both tragal and conchal cartilage was taken. Mean thickness of both tragal (1.22 mm) and conchal cartilage (1.36 mm) increased with increase in age. Among 16 males in whom both cartilages were taken, mean thickness of tragal cartilage was 1.25 ± 0.11 mm and conchal cartilage was 1.41 ± 0.12 mm. Similarly among 12 females where both cartilages were taken, mean thickness of tragal cartilage was 1.20 ± 0.13 mm and conchal cartilage was 1.35 ± 0.07 mm. Conclusion Sliced cartilage tympanoplasty is a relatively better technique. When using cartilage splitter to get sliced cartilage, ideally thickness of every graft should be known. As it is difficult to measure the exact thickness in every case, so knowing the mean for age and sex for cartilage thickness is important to have an idea of which plates to use for a successful outcome of slicing. We concluded that thickness of tragal cartilage is significantly less than the thickness of conchal cartilage. Also there is significant age related difference between mean thickness of cartilages, both for tragal and conchal cartilage. Surprisingly the difference between thickness in male and female is not statistically different.

Cartilage has shown to be a promising graft material to close tympanic membrane perforations. However, due to its rigid quality, doubts are raised regarding its sound conduction properties. It has been suggested that acoustic benefit may be obtained by thinning the cartilage. We describe our innovative method for harvesting tragal cartilage from the same endaural incision and also describe preparation of the graft by slicing it. We present our 3-year experience of shield cartilage type 1 tympanoplasty using sliced tragal cartilage–perichondrium composite graft. Aim The aim of this study was to prove the success rate of our technique of shield cartilage tympanoplasty using sliced tragal cartilage graft in terms of functional and anatomic results. Study design Retrospective analysis of type 1 cartilage tympanoplasties using sliced tragal cartilage was carried out in MIMER Medical College and Sushrut ENT Hospital during May 2005 to January 2008 with a minimum follow-up of 2 years. Method and materials A total of 223 ears were operated by our technique. Results The overall success rate of our technique was 98.20% in terms of perforation closure and air bone gap closure within 7.06 ± 3.39 dB. The success rates in the various age group are as follows: 11 to 20 years, 97.67%; 21 to 40 years, 99.12%; and 41 to 60 years, 96.96%. Conclusion Our technique of type 1 cartilage tympanoplasty achieves good anatomic and functional results.

Introduction: The influence of age on threshold changes of bone conduction after stapedectomy has not been thoroughly studied. Improvement of the Carhart notch by stapes surgery might be related to age as well as an increase in cochlear sensitivity to surgical trauma. Patients and Methods: A retrospective study on the outcome of stapedectomy was undertaken. The results of surgery performed on 387 ears in 315 patients for otosclerosis between 1962 and 1989 were obtained. Stapedectomy, performed by a single surgeon, consisted of total stapedectomy, seal of the oval window with tragal perichondrium, and insertion of a free tragal cartilage graft. Results: Analysis of bone conduction changes with stapedectomy shows an average improvement of 5 to 6 dB at 0.5, 1, and 2 kHz with best improvement at 2 kHz. At 4 kHz a mean decrease of 4 dB is recognized. The improvement of bone conduction at 2 kHz is 12 dB in patients younger than 30 years compared with 4 dB in patients older than 60 years (P < .05). The youngest group was improved by 2 dB at 4 kHz, whereas the oldest group deteriorated by 5 dB (P < .05). Age relationship was apparent in all 4 frequencies. Concluslons: With increasing age there is less improvement in bone conduction at 0.5, 1, and 2 kHz with correction of the Carhart notch and more deterioration at 4 kHz. The cochlear sensitivity to surgical trauma increases with age. In younger patients the preoperative bone conduction levels do not reflect the true cochlear reserve. Patients younger than 40 years of age might profit more from a partial or total footplate removal in stapedectomy, as this better corrects the Carhart notch. Patients older than 40 years of age might profit more from a stapedotomy as this better preserves high frequencies.

The isolated malleus-handle fracture is a rare ossicular injury and tends to be overlooked when the tympanic membrane appears normal. Various surgical attempts have been made to correct this fracture; however, these techniques largely relied on xenograft implantation materials; the autologous cartilaginous graft application has never been reported. Herein we describe a simple, rapid, and effective method that uses available tragal cartilaginous graft to repair an isolated malleus-handle fracture. Our approach offers a reliable choice to restore continuity of the ossicular chain and produce a more satisfying, subjective hearing ability in this uncommon fracture situation.