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Objectives: To evaluate the anatomic and functional outcomes of type1 tympanoplasty with endoscopic modified butterfly cartilage-perichondrium technique., Methods: In our modification, perichondrium was elevated circumferentially till the attached part of the composite graft was approximately same size and shape of the perforation, cartilage was trimmed based on the perforation but 0.5 mm larger. Cartilage portion of the graft was placed medial to the edge of the perforation, then perichondrium was rolled out and draped on the circumferential raw surface of remaining tympanic membrane around., Results: At 4 months postop, the anatomic integrity rate of the tympanic membrane perforation for small & medium sized perforation and large sized perforation group were 100 % and 94 % (p > 0.05). For the small & medium perforation group, the mean pre and 4 months postop ACs were 30 ± 8 dB and 18 ± 6.4 dB (p < 0.01). The mean pre and 4 months postop ABGs were 19 ± 11 dB and 9 ± 3 dB (p < 0.01). For the large perforation group, the mean pre and 4 months postop ACs were 43 ± 12.5 dB and 21.5 ± 7 dB (p < 0.01). The mean pre and 4 months postop ABGs were 34 ± 8.5 dB and 12.5 ± 6 dB (p < 0.01). The differences of mean 4 months postop ACs and mean 4 months postop ABGs between the two groups were not significant (p > 0.05)., Conclusions: Compared to the conventional inlay butterfly cartilage tympanoplasty technique, large or marginal perforations can be sealed more securely by this modification., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: We evaluated the graft success rate and hearing outcomes of endoscopic cartilage graft myringoplasty without tympanomeatal flap elevation used to repair posterior marginal perforations., Study Design: A prospective case series., Materials and Methods: A total of 31 patients with posterior marginal perforations who underwent endoscopic cartilage graft myringoplasty were included. The outcomes were the hearing gain and graft success rate at 6 and 24 months., Results: The graft success rate was 96.7% (30/31) at 6 months and 90.3% (28/31) at 24 months; 1 patient exhibited composite graft extrusion and lateralization in the region of the anterior annulus; a residual perforation was apparent. Reperforation occurred in 2 patients. The mean preoperative air-bone gap (ABG; 28.61 ± 3.14 dB) was significantly greater than the mean postoperative ABG (12.15 ± 3.98 dB; P < .05) at 6 months; however, there was no statistically significant difference between the post-6 months and post-24 months with regard to ABG values ( P = .871), ABG gain ( P = 0.648), or functional success rate ( P = .472). No significant graft blunting or atelectasis was noted during follow-up. The free perichondrium became fully integrated with the skin of the external auditory canal; the perichondrium could not be clearly distinguished endoscopically 4 to 8 weeks postoperatively. Computed tomography revealed well-pneumatized middle ear and mastoid cavity at postoperative 24 months., Conclusion: Endoscopic cartilage graft myringoplasty without tympanomeatal flap elevation reliably repairs posterior marginal perforations. The short- and long-term graft success rate is high, and the hearing results are satisfactory; the technique is minimally invasive.

Introduction: The external auditory canal (EAC) packing is widely used in otosurgery and is considered to promote hemostasis and to support tympanic membrane grafts. However, few studies have investigated the effects of packing removal time on healing., Objective: We investigated the effect of EAC packing duration on healing after endoscopic cartilage myringoplasty in patients with chronic tympanic membrane perforations (TMPs)., Materials and Methods: Patients with chronic TMPs who underwent endoscopic "push-through" cartilage myringoplasty were divided into early and late groups based on the length of time before EAC packing was removed. The graft success rate, eardrum appearance, and hearing gain were assessed 3 months after surgery., Results: The study included 137 patients. Three months after surgery, the graft success rate was 83.5% (66/79) in the early group and 94.8% (55/58) in the late group ( P = .042). The graft was displaced in 8 (10.1%) patients in the early group and in 1 (1.7%) patient in the late group ( P = .050). No epithelialization was found on the surface of the grafts in the early group, whereas epithelialization was nearly complete 4 weeks after surgery in the late group., Conclusions: Delaying removal of the EAC packing after endoscopic cartilage myringoplasty may promote tympanic membrane better healing and cartilage graft epithelialization and improve the appearance of the eardrum.

The purpose of this study was to compare the success rates and hearing outcomes of transcanal composite chondroperichondrial cartilage graft with that of underlay temporal muscle fascia (TMF) graft for myringoplasty. In this retrospective study, the medical records of patients who underwent type 1 myringoplasty between September 2015 and February 2018 at Otorhinolaryngology Department of Erzurum Ataturk University were reviewed. Demographic properties, preoperative otological findings, preoperative pure ton audiogram findings, postoperative pure ton audiogram findings, and duration of surgeries were reviewed from medical records. The patients with lack of one or more of these information at medical records or lost to at least 3 months of follow-up were excluded from the study. According to the graft material used in the operation, the patients were divided into 2 groups. The patients operated with cartilage graft by transcanal composite chondropericondrial cartilage graft myringoplasty (TCM) technique was regarded as first group, while patients operated with temporal fascia was regarded as the second group (TMF). Both groups were compared according to preoperative and postoperative air-bone gap (ABG), graft acceptance rate, and duration of operation using SPSS version 20.0 software. A total of 113 patients whose medical records met the inclusion criteria were included in the study. Of these, 59 underwent TCM and 54 underwent TMF myringoplasty. Tympanic membrane perforation closure success rate was higher in the cartilage group (94.9%) than in the fascia group (83.3%; P = .046). In the former, preoperative and postoperative ABG was 19.5 ± 5 and 10.8 ± 4.8 dB, respectively. In the latter, the corresponding values were 20.7 ± 5.4 and 11.5 ± 5.4 dB, respectively ( P < .05). Duration of surgery was 29.5 ± 3.4 minutes in the TCM group and 61.5 ± 6.0 minutes in the TMF group ( P < .05). Transcanal cartilage myringoplasty could be considered as an appropriate surgical option because of its simplicity, shorter operation time, and rapid patient recovery, with no significant difference in terms of hearing outcomes compared to temporal fascia.

Background: The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation., Objectives: To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation., Materials and Methods: In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months., Results: The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4-6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up., Conclusions: Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.

Objective: To investigate hearing and the take rate of crushed cartilage grafts in tympanoplasty., Methods: In this double-blinded, randomised, controlled trial, 46 patients with tympanic membrane perforation were enrolled. A conchal cartilage graft was used for reconstruction in both intervention and control groups. In the intervention group, crushed cartilage was used. The success rate and hearing results were ascertained every four months over a one-year follow-up period., Results: A total of 36 patients - 20 in the intervention group and 16 in the control group - completed one year of follow up. There were no statistically significant differences between the two groups in mean air-bone gap, bone conduction threshold, speech discrimination score or speech reception threshold., Conclusion: The reduction in living cells after crushed cartilage tympanoplasty may decrease the rigidity and the volume of the graft, but may not necessarily improve the hearing results.

Objectives: Inlay butterfly cartilage tympanoplasty (IBCT) is a simple grafting technique. Endoscopy facilitates visualization by eliminating blind spots. We analyzed the outcomes of IBCT using both endoscopic and microscopic approaches, and assessed how trainees perceived the educational opportunities afforded., Materials and Methods: Sixty patients who underwent IBCT were allocated to Group I (n = 30; microscopic IBCT) and Group II (n = 30; endoscopic IBCT) by the dates of their visits. Anatomical success was defined as an intact, repaired tympanic membrane; functional success was defined as a significant decrease in the air-bone gap. Postoperative discomfort was analyzed using a visual analog scale (VAS). Thirteen trainees completed structured questionnaires exploring anatomical identification and the surgical steps., Results: The surgical success rates were 96.7% in Group I and 100% in Group II. We found no between-group differences in the mean decrease in the air-bone gap or the extent of postoperative discomfort. Significant postoperative hearing improvements were evident in both groups. The mean operative time was shorter when the microscopic approach was chosen (17.7±4.53 vs. 26.13±9.94 min). The two approaches significantly differed in terms of the identification of external and middle ear anatomical features by the trainees, and their understanding of the surgical steps., Conclusion: Both endoscopic and microscopic IBCT were associated with good success rates. The endoscopic approach facilitates visualization, and a better understanding of the middle ear anatomy and the required surgical steps and thus is of greater educational utility., Competing Interests: The authors have declared that no competing interests existN/A.

Objective: To compare the graft success rates and hearing results of single-layered (composite island) grafting (SLG) vs double-layered (composite plus second layer of perichondrium) grafting (DLG) for over-under type 1 tympanoplasty techniques., Study Design: Retrospective chart review., Settings: Tertiary center otorhinolaryngology clinic., Subjects and Methods: Medical charts of the patients who underwent type 1 tympanoplasty via the microscopic technique by a single surgeon between 2015 and 2019 were analyzed., Results: A total of 48 patients were included. The DLG (n = 26) group had higher graft take rates as compared to the SLG group (n = 22) for all patients ( P = .038) and for moderate- to high-risk patients according to Middle Ear Risk Index (MERI) scores ( P = .029) but not for patients with mild disease ( P = .429) or myringosclerotic patients ( P = .242). The DLG group exhibited higher air-bone gap closure (C-ABG) values as compared to the SLG group for all patients ( P = .018). However, there was no noticeable difference in C-ABG values within the patients with successful grafting ( P = .217). Only graft success status had a significant effect on C-ABG values when the multivariate linear regression was performed. ( P = .016). Higher MERI scores and presence of myringosclerosis were related to the unsuccessful grafting ( P < .01)., Conclusion: DLG tympanoplasty is encouraged, especially for patients with higher MERI scores, to increase the graft success rates. Better hearing outcomes of DLG tympanoplasty were related to the higher graft success status of this technique; DLG had no additional hearing effect for patients with successful grafting. Higher MERI scores and presence of myringosclerosis were related to graft failure.

Objective: To compare surgical results of endoscopic myringoplasty using double layer cartilage-perichondrium grafts versus single fascia grafts., Study Design: Prospective, randomized, controlled., Setting: University-affiliated teaching hospital., Subjects and Methods: In total,134 patients who underwent endoscopic myringoplasty were included in this study. Patients in group A received a double layer tragal cartilage-perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air-bone gap (ABG) and the graft success rate., Results: The graft success rate was 98.5% (66/67) in the Group A and 94.0% (63/67) in the Group B at 6 months, the difference wasn't statistically significant (p = 0.362). However, the graft success rate was 97.0% (65/67) in the Group A and 85.1% (57/67) in the Group B at 12 months, the difference was statistically significant (p = 0.034). In addition, only one patient (1.49%) had small keratin pearls in the Group A, no patients developed cholesteatoma of middle ear in either group., Conclusions: The endoscopic double layer perichondrium-cartilage graft technique is feasible for repairing medium or larger perforations, it has a better long-term graft success rate and less operative time compared with the single layer fascia graft technique. However, long-term hearing outcomes were the same for the single and double layer closure techniques.

Objectives: Endoscopic type 1 tympanoplasty using cartilage grafts for repair of chronic tympanic membrane perforation is increasing. The aim of this study was to evaluate the results of endoscopic type 1 cartilage tympanoplasty in children., Materials and Methods: Patients under 18 years of age who underwent type 1 cartilage tympanoplasty between January 2013 and February 2019 were retrospectively evaluated. Anatomic success rate was calculated according to the intact status of the graft. Air conduction (AC), bone conduction (BC), air-bone gap (ABG) and hearing gain were calculated using pure tone audiometry tests at pre-operative, and 6th month postoperative period. Patients with postoperative ABG ≤20 dB were considered as functionally successful., Results: The study included 56 patients (6 bilateral) and 62 ears. The anatomic success rate of our study was 91.9% (57/62). Preoperative AC was 36.4 ± 6.5 (21-50) dB, BC was 7.8 ± 3.7 (5-25) dB, and ABG was 28.6 ± 6.9 (10-41) dB. Postoperative AC was 24.5 ± 8.8 (7-45) dB, BC was 7.6 ± 3.4 (5-19) dB, and ABG was 16.9 ± 7.4 (2-32) dB. There was no change in postoperative BC (p: 0.683), whereas AC, and ABG significantly decreased (p < 0.001). Mean hearing gain was 12.1 ± 6.2 (3-26) dB and the functional success rate was 72.5% (45/62)., Conclusion: Endoscopic type 1 cartilage tympanoplasty, a minimally invasive surgical procedure, provided successful functional and anatomical results at the pediatric population., Competing Interests: Declaration of competing interest All the authors of our work have their approvals for preparing this essay and sending it to you. None conflict of interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: To determine the effect of Körner's septum (KS) on graft success and hearing in patients who were treated with type 1 tympanoplasty., Study Design: An observational study., Place and Duration of Study: Department of Otorhinolaryngology, University of Health Sciences, Ankara Numune Training and Research Hospital, Turkey, from July 2013 to July 2018., Methodology: Patients undergoing type 1 tympanoplasty were divided into 2 groups as patients with KS and without KS (WKS), according to the findings of high-resolution computed tomography of the temporal bone. Two different grafts (fascia and cartilage) in two groups (KS and WKS) were compared for graft success rate of different graft materials and pre- and postoperative hearing levels. The effect of the presence of KS on hearing was examined., Results: The anatomical graft success rate of type 1 tympanoplasty was 75.9% in the KS group and 88.5% in the WKS group (p = 0.026). In the presence of KS, graft success rate decreased with the use of a fascia graft (p = 0.044). In the presence of KS, the use of cartilage graft did not affect functional hearing; whereas, poor functional outcomes were obtained in ears operated using a temporalis fascia graft in the KS group than in the WKS group (p = 0.003)., Conclusion: KS adversely affects graft success in type 1 tympanoplasty. Cartilage should be preferred as the graft material for patients with KS.

Purpose: We aimed to evaluate air-bone GAP (ABG), graft success and hearing gain according to the size and location of perforation in patients who underwent endoscopic transcanal type 1 cartilage tympanoplasty due to the tympanic membrane perforation and chronic otitis media., Methods: The 104 patients (52 male and 52 female) who underwent endoscopic transcanal type 1 cartilage tympanoplasty, were evaluated retrospectively. Tragal cartilage grafts were utilized in all patients. Perforation size/location, duration of surgery, pre-operative and post-operative (6th month) average ABG, and pure-tone audiometric results (at 500-1000-2000-4000 Hz) as well as overall graft success were evaluated., Results: The mean duration of surgery was 45.60 ± 17.39 min. Perforations were most frequently located in anterior quadrant with moderate sized. The post-operative air-conduction results were significantly improved at 500-1000-2000-4000 Hz frequencies. Similarly, pre-operative air-conduction pure-tone average (PTA) (35.36 ± 11.9 dB) was significantly decreased (22.34 ± 7.9 dB) after postoperative 6 months (p ≤ 0.001). The overall graft success rate was 93.2%. Moreover, pre-operative mean ABG (19.82 ± 7.4 dB) was significantly decreased (9.05 ± 4.3 dB) after postoperative 6 months (p ≤ 0.001)., Conclusions: Endoscopic transcanal type 1 cartilage tympanoplasty achieved a high graft success rate, and improved hearing results, regardless of the perforations' location and size. Endoscopic tympanoplasty provides high patient safety and comfort in middle-ear surgery by wide visualization, easy applicability, short-operation duration, low complication risk, and less invasive approach.

Background: There are no studies in the literature, comparing the functional and anatomical successes of the use of fascial and perichondrial grafts in endoscopic type 1 tympanoplasties., Objectives: To compare the anatomical and functional outcomes of grafting with the fascia of the temporalis muscle and with the perichondrium of the tragal cartilage in patients undergoing primary transcanal type 1 tympanoplasty with endoscopy., Methods: We enrolled a total of 151 patients (80 females and 71 males with a mean age of 26.0 ± 9.3 years in the age range between 18-57) with MERI scores ranging from 1 to 3 and who underwent a transcanal endoscopic type 1 tympanoplasty without tympanomeatal flap elevation. The patients were assigned to two groups according to the type of the graft used. The patients were assigned to either the tragal cartilage perichondrium group (Group A) or the fascia of the temporal muscle (Group B). The groups were compared according to the pre- and postoperative air-bone gaps and to the status of the tympanic membrane., Results: There were no statistically significant differences in the distribution of the age, gender, localization, MERI scores, the duration of the operation, and the size of the perforation (all p values> 0.05). The pre-operative air-bone gap values of Group A and B did not show a statistically significant difference (p = 0.073). The postoperative improvement in the air-bone gap value did not demonstrate a significant difference between Group A and B (p = 0.202). The graft retention rates were 94.9 and 97.2% in Group A and in Group B respectively. There were no statistically significant differences between the two groups in terms of the graft retention success rates (p = 0.743)., Conclusion: Perichondrium and fascia were suitable for use in endoscopic tympanoplasties.

Background: Acellular dermal allograft (AlloDerm) and cartilage perichondrium are two common materials used for repair of tympanic membrane perforations (TMPs). To date, comparative evaluations of their efficacy have rarely been reported. Aim/objectives: To compare anatomical and audiological outcomes between AlloDerm and cartilage perichondrium in type I tympanoplasty. Methods: A total of 61 patients of TMP were studied. In total, 27 patients (Group 1) underwent AlloDerm myringoplasty, and the remaining 34 patients (Group 2) underwent perichondrium myringoplasty. Operating time, closure rate and hearing gain were compared between Groups 1 and 2. Results: Successful closure rates at 6-month follow-up were 88.9% (Group 1) and 82.4% (group 2). The average improvement of air-bone gap (ABG) was 13.5 ± 11.8 dB for Group 1 and 13.1 ± 13.1 dB for Group 2. The difference in between preoperative and 6 months postoperative ABG values was statistically significant ( p  < .001). Conclusions and significance: Success rates and improvement of hearing level were similar for the AlloDerm (Group 1) and the cartilage perichondrium (Group 2) groups. However, AlloDerm requires shorter operative time and avoids the incisions in the harvest of allografts. Our results suggest that AlloDerm can be recommended as an attractive alternative to cartilage grafts.

The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer., Competing Interests: The authors have declared that no competing interests exist.

Background: Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques., Materials and Methods: A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement., Results: A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( P = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( P = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( P = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( P < .0001). Preoperative hearing levels ( P = .179), postoperative hearing ( P = .857), and decibels of hearing improvement ( P = .356) were the same for all 3 groups., Conclusion: Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air-bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) ( p  < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) ( p  = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) ( p  = .68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.

Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures. Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty. Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success. Results: Mean follow up time was 20.69 ± 5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69 ± 2.83 dB HL in group 1 and 7.98 ± 3.08 dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups ( p >.05). Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.

Objective: There are no direct comparisons between the success of collagen allografts versus traditional autografts for tympanic membrane (TM) repair. We sought to compare success rates in a large series of patients undergoing tympanoplasty using collagen allografts versus autologous tissues., Study Design: Retrospective review., Setting: Academic medical center., Subjects and Methods: Single institution retrospective chart review was performed for adult subjects with TM perforation undergoing tympanoplasty. Demographic, clinical, and surgical data were collected. Statistical analysis was completed using Rstudio. Each factor was examined to assess effect on graft success rate using logistic regression., Results: Two hundred sixty-five surgeries met criteria with four main grafting materials or combinations thereof. The overall graft success rate was 81.1% with failure rate of 18.9%. There was no significant association between failure rates and: age, sex, perforation cause, size, and location, primary or revision status, middle ear status (wet or dry), concomitant procedures (mastoidectomy or ossiculoplasty), presence of active cholesteatoma, or surgical technique. Although not statistically significant, the odds of success for perichondrium + cartilage were 7.5 times higher than collagen allografts (p = 0.07, 95% confidence interval [CI] = 0.81-69.6). The odds of success for the postauricular (odds ratio [OR] = 6.4) and transcanal approaches (OR = 24.8) were significantly greater than for endaural (p = 0.007 and p = 0.008, respectively)., Conclusion: In tympanoplasty surgeries performed on patients with TM perforation, we found no statistically significant difference in graft failure rates between collagen allograft and other grafting materials or combinations, though the higher odds ratio of success with cartilage + perichondrium may be clinically relevant.

Objective: The timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of this study was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and to evaluate the prognostic factors that may affect its success., Materials and Methods: A retrospective study of 42 pediatric patients who were younger than 18 years and underwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia from January 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and 18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type (central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia, perichondrium), length of follow up and surgical outcomes were collected., Results: The overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantly higher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group(p = 0.023). The functional success rate (postoperative air-bone gap<20 dB) obtained in the perichondrium group was 90.4% (19/21) and 85.7% (18/21) in the fascia group, respectively. After a mean follow-up of 27.5 ± 11.55 months, the mean hearing improvement was 11.26 ± 7.53 dBHL for overall the group. Presence of contralateral otitis media with effusion (OME) was found a risk for reperforation and bilateral perforations were negatively affected graft success rate (p < 0.01). Graft success did not affected by age, gender and type and location of perforation (p > 0.05)., Conclusion: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatric tympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be the first choice of graft material due to its high success rates. There were no significant differences between the fascia and perichondrium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations and contralateral OME, and should be treated with perichondrium or cartilage graft., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels., Methods: Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed., Results: One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively)., Conclusion: In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.

Objectives: To compare clinical and audiologic outcomes among patients who underwent myringoplasty with fat graft enriched with platelet-rich plasma and cartilage perichondrium graft., Study Design: Prospective randomized controlled study., Setting: Department of Otolaryngology-Head and Neck Surgery, Tanta University, Egypt., Subjects and Methods: The study comprised 50 patients who had tympanic membrane perforation of medium size (25%-50% of its surface area) without evidence of active otitis media or ossicular abnormalities and who had surgery between December 2016 and December 2017. Patients randomly underwent myringoplasty with fat graft enriched with platelet-rich plasma (group 1) or cartilage perichondrium graft (group 2)., Results: Twenty-five patients were included in each group. Rates of successful closure at 3-month follow-up were 88% (group 1) and 92% (group 2). The mean overall improvement in pure tone average was 18.08 dB (95% CI, 16.9-19.25) for group 1 and 18.24 dB (95% CI, 16.94-19.53) for group 2., Conclusion: Fat graft enriched with platelet-rich plasma can be recommended as an alternative choice for first-line treatment of medium-size central perforations of the tympanic membrane, with healing and hearing results comparable to those of conventional cartilage perichondrium myringoplasty.

Objectives: To compare the anatomical and functional outcomes of two different grafts which are used for the reconstruction of subtotal or total tympanic membrane perforations: the wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia (TF)., Methods: Ninety patients (94 ears) who underwent type 1 tympanoplasty for non-complicated chronic otitis media between March 2014 and June 2016 in a tertiary referral center were included in a randomized, controlled, prospective clinical trial. Tympanic membranes were reconstructed with the WsCCG or TF., Results: Outcomes of 91 surgeries performed on 87 adults (> 18 years of age) were evaluated in the study. Forty-three patients (44 ears) were included in the WsCCG group; 44 patients (47 ears) were included in the TF group. The mean post-operative follow-up was 14.9 months for the WsCCG group and 15.1 months for the TF group. There was no statistically significant difference in post-operative pure tone average (PTA) (p = 0.19), air-bone gap (ABG) (p = 0.64), PTA gain (p = 0.82) and ABG closure (p = 0.89) values between two groups. Graft success rates at 6 months after surgery were 82.9% (39/47) and 97.7% (43/44) for TF and WsCCG, respectively. At the first year, success rates were 85.1% (40/47) for TF and 97.7% (43/44) for WsCCG. A statistically significant difference was observed in graft success rates between two groups (p = 0.039)., Conclusions: Both TF and WsCCG lead to satisfactory functional results, but the WsCCG clearly leads to superior anatomical outcomes with a graft success rate of 97.7%. The WsCCG is a suitable graft for subtotal or total tympanic membrane perforations and has the advantages of being a one-piece, flexible, composite, and physically resistant graft.

Purpose: In 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort., Materials and Methods: Butterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap., Results: The reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%-100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB., Conclusions: The butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane., Objective: To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty., Methods: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results., Results: Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant., Conclusion: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to evaluate and compare myringoplasty results from two different consecutive series conducted at the Kuopio University Hospital during a four-decade period., Materials and Methods: We reviewed 315 patients (a total of 338 ears) who underwent myringoplasty at Kuopio University Hospital between the years 1986 and 2012. The results from this series were compared with those form a previously published series of 404 patients who underwent myringoplasty between 1970 and 1985 at the same institution., Results: Myringoplasty was considered to be successful whenever the tympanic membrane remained closed without atelectasis. The results were analyzed at the 1- and 3-year follow-up. The overall success rate after 1 year was 82.8% compared with 88% in the previous series. The success rate after 3 years was 87.4%. The best closure rate after 1 year (85.7%) was achieved with fascia grafts (n=272) and perichondrium (85.7%, n=14). The closure rate of 61.9% with the perichondrium/cartilage graft (n=21) and 71.0% with the fat graft (n=31) was statistically significantly lower (p < 0.05) compared with that with the fascia graft. The postoperative air-bone gap (0.5-4 kHz) was < 10 dB(HL) in 56.2% and < 20 dB(HL) in 79.6% cases compared with 61% and 87%, respectively, in previous series., Conclusion: Myringoplasty is a safe procedure with a reasonably high success rate. We observed a slight deterioration in the overall results compared with the previous series. This study highlights the importance of systematic quality control and the results and the need for follow-up of the learning curve after the introduction of new surgical techniques and materials.

This study aims to investigate the preoperative, postoperative airway hearing threshold levels, and perforation closure rates in patients who underwent primary tragal cartilage tympanoplasty. One hundred seventy-one patients who had chronic otitis media without cholesteatoma underwent primary tragal cartilage tympanoplasty with endaural approach by using underlay technique. Preoperative and postoperative airway hearing threshold levels at 500, 1000, 2000, 4000 Hz frequencies in 8 to 99 months' follow-up were found and compared with each other. Postoperative perforation closure rates were also investigated. At 500 Hz in 112 patients, at 1000 Hz in 106 patients, at 2000 Hz in 96 patients, and at 4000 Hz in 80 patients, more than 9.5 dB airway hearing gain was determined. The authors found their postoperative perforation closure rate as 84.8%. In conclusion, tragal cartilage tympanoplasty may be chosen as the primary operation technique in primary chronic otitis media patients and by this technique perforation closure rates are also acceptable in addition to satisfactory hearing gain.

Many techniques and graft materials have been used for the reconstruction of the tympanic membrane. We conducted a retrospective study to compare anatomic and functional outcomes of type 1 tympanoplasty that we performed with boomerang-shaped chondroperichondrial cartilage grafts (BSGs) and shield-shaped chondroperichondrial cartilage grafts (SSGs) in pediatric patients. Our study population was made up 121 patients-61 boys and 60 girls, aged 7 to 16 years (mean: 12.4)-who had undergone a type 1 tympanoplasty. Patients were divided into two groups according to the grafting technique used; there were 59 patients in the BSG group and 62 patients in the SSG group. Ear examinations were performed at postoperative months 3, 6, 12, and 24, and pure-tone average (PTA) for air-conduction threshold values and air-bone gaps (ABGs) were evaluated at 0.5, 1.0, 2.0, and 4.0 kHz at the same visits. We also investigated the impact of the graft material on functional graft success and intergroup differences (if any) in surgical success. Mean postoperative follow-up periods were 30.5 and 30.2 months in the BSG and SSG groups, respectively. We found that the success rates for tympanic membrane reconstruction were not significantly different in the two groups (91.5 and 88.7%). Postoperatively, the mean PTA and ABG values in both groups at 3, 6, 12, and 24 months were significantly lower than the preoperative values (p < 0.05). There were no significant differences in mean PTA values between the two groups at 3, 6, 12, and 24 months. However, the extent of the decrease in PTA values in the BSG group at 3 months was significantly greater than that of the SSG group (p < 0.05). There were no significant differences in mean ABG values between the two groups at 3, 6, and 12 months, but at 24 months, the value was significantly higher in the BSG group (p < 0.05). Finally, the extent of the decrease in ABG in the BSG group at both 3 and 6 months was significantly greater than that of the SSG group (p < 0.05). We conclude that the BSG procedure is a reliable and safe method of performing pediatric tympanoplasty.

Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small- and medium-sized perforations. There are some difficulties with application of conventional butterfly technique and it affects our success rate of graft healing. With some modifications of graft preparation we can make better success rates. The aim of this study was to present the new renovation of conventional method, describe about what kind of changes we made and its technical facilities about the procedure. The study design is a prospective case series. This study was carried out on 18 patients who underwent inlay butterfly cartilage tympanoplasty with the new technique for anterior and inferior perforations at an otolaryngology department of a tertiary medical center between November 2015 and August 2016. Patients were followed with otoscopy and audiometry, and graft healing's success. Anatomic closure at 6th month after tympanoplasty was found in all 18 patients. There was no incidence of cartilage graft rejection or displacement. Preoperative mean PTA was 27.7 dB, which improved 6 months after surgery to 10.5 dB (the average value of hearing thresholds at 0.5, 1, 2 and 4 kHz). Butterfly cartilage tympanoplasty technique is safe and efficient in terms of both anatomical closure of the defect and improvement in hearing. We believe with this new technique, we facilitate this procedure in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.

Introduction: Same-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications., Objective: To evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations., Methods: From February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5cm×1.5cm cartilage seemed to be enough for tympanoplasty in both sides., Results: Nine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88dB preoperatively to 9.16dB postoperatively (p<0.05)., Conclusion: Bilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications., (Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Myringoplasty is one of the basic procedures in otologic surgery, and is important to achieve good hearing outcome. The temporal fascia is most widely used and considered to be a stable graft in this procedure, although 10-20% of patients develop reperforation after surgery, which is often hard to repair, even by revision surgery. We herein conducted revision myringoplasty using a cartilage graft to repair postoperative reperforation in 7 patients (8 ears) with chronic otitis media. The patients were 3 males and 4 females, aged 13-80 years with an average of 53.9 years. A cartilage graft was harvested from the tragus, sliced in 0.3 mm thickness with perichondrium attached on one side, and trimmed into an appropriate shape and size. The graft was then underlaid beneath the perforation and fixed with fibrin glue. The operation was Wullstein type I tympanoplasty in 5 ears and myringoplasty in 3 ears, using the temporal fascia in 7 ears and subcutaneous tissue in 1 ear. The postoperative follow-up period ranged from 16 to 44 months with an average of 30.0 months. Perforation of the tympanic membrane was successfully closed in 7 ears (87.5%). Hearing outcome was judged successful in 5 ears (62.5%) according to the criteria of the Otological Society of Japan (postoperative hearing level < 30 dB, hearing gain > 15 dB, or postoperative air-bone gap < 15 dB). These results indicate that cartilage is a stable and reliable graft material for revision myringoplasty to repair postoperative reperforation in patients with chronic otitis media.

Background: To assess, analyze and compare the results of graft uptake using Tragal Cartilage-Perichondrium Composite (TCPC) graft with Temporalis Fascia (TF) graft in patients who undergoing surgery for chronic otitis media - squamous type., Methods: Patients aged 13 years and above with diagnosis of chronic otitis media - squamous type undergoing modified radical mastoidectomy, either primary or revision surgery with grafting of tympanic membrane (TM) and patients undergoing excision of postero-superior retraction pocket (PSRP) were included in this study. Patients were divided in two groups: Group A-patients undergoing TCPC graft and Group B -patients undergoing TF graft. Graft uptake results were assessed between 8-12 weeks of surgery., Results: In both Groups there were 30 patients each. In Group A successful graft uptake was seen in 27 patients (90 %) and failure of graft uptake was seen in 3 patients(10 %). In Group B successful graft uptake was seen in 28 patients (93.3 %) and failure in 2 patients (6.67 %).Out of the total 60 patients, 11 patients had PSRP. All 6 patients with PSRP in Group A had successful graft uptake and no retraction. Among the 5 patients with PSRP in Group B all patients had sucessful graft uptake, however, in 2 patients retraction of the tympanic membrane was seen similar to the preoperative findings., Conclusions: There was no statistical difference (p = 0.433) between the use of temporalis fascia or tragal cartilage perichondrium in patients undergoing surgery for chronic otitis media - squamous type.

Objective: To evaluate the effectiveness of type 1 tympanoplasty with one-piece composite cartilage-perichondrium (CCP) grafts compared to temporalis fascia (TF) grafts for tympanic membrane (TM) closure and hearing improvement in adult patients with a subtotal TM perforation and chronic otitis media (COM)., Data Sources: PubMed, Embase, Cochrane Library., Review Methods: A systematic search was conducted. Relevance and validity of selected articles were assessed. Studies that scored moderate or high on relevance were included, and relevant data for both outcomes were extracted. For the outcome of TM closure, absolute risk differences (RD), relative risks, and number needed to treat with their respective 95% confidence intervals were calculated when possible., Results: We retrieved 3,783 unique studies. Ten studies satisfied the eligibility criteria. Four studies of moderate validity showed RD ranging from 0.08 to 0.13 in favor of the CCP graft compared to the TF graft for TM closure 1 year or more postoperatively, but this was not statistically significant. Five studies of moderate to high validity showed no clinically relevant difference in hearing improvement between both intervention groups at a minimum follow-up of 3 months. The relative air-bone gap closure ranged from 5.7 to 11.5 dB in the TF group and from 8.9 to 12.7 dB in the CCP group., Conclusions: There is no evidence of superiority of one-piece CCP grafting over TF grafting in type 1 tympanoplasty regarding complete closure of a subtotal perforated TM 1 year or more postoperatively or hearing improvement at a minimum of 3 months follow-up. Laryngoscope, 126:1662-1670, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: This study presents results for a pediatric series of tympanoplasty using the butterfly-cartilage technique, with comparison to literature reports., Methods: A retrospective study included patients aged between 2 and 12 years receiving tympanoplasty performed by a single senior surgeon in our department between 2003 and 2012, for whom pre- and postoperative tympanum imaging was complete. Results were analyzed at a minimum 10 months' follow-up in terms of graft healing and auditory data, with pre- and postoperative audiograms and calculation of mean hearing loss., Results: Twenty-eight tympanoplasties were performed in 27 children: 16 males, 11 females; in 1 case, perforation was bilateral. Perforation location was inferior or antero-inferior in 14 cases (50%), antero-superior in 9 (32.1%) and anterior in 5 (17.9%). Perforation size on otoscopy ranged from 11.1% to 36.4% of tympanum area (mean, 26.3%). Mean follow-up was 25 months. Closure of the perforation was achieved in 87.7% of cases. Mean hearing loss was 20.2dB (range, 10-31.25dB) preoperatively and 14dB (range, 5-31.25dB) postoperatively., Discussion: We analyze our results and compare them with the international literature to refine indications for this technique of tympanic repair., Conclusion: Tympanoplasty using the butterfly-cartilage technique was reliable and easy to perform. It should be included in the therapeutic armamentarium for moderate non-marginal tympanic perforation. In the present series, the technique was reserved to perforations involving less than 40% of tympanum area., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate the reconstruction method of lateral attic wall with tragal cartilage and temporalis fascia graft. And analyze the postoperative result of its clinical application., Method: From Jan 2005 to Jul 2014, 45 patients whose middle ear disease were limited to attic received this surgery in our department. Among 31 cases of cholesteatoma otitis media and 14 cases of external auditory canal cholesteatoma were included. In order to expose the attic fully, we operated epitympanotomy through retroauricular incision and then removed the scutum and lateral attic bone wall. After eliminating the lesions, we reconstructed the lateral attic bone wall with tragal cartilage, covered the cartilage with temporalis fascia and then repaired the tympanic membrane and external ear canal skin. After surgery, all patients were followed up at 10 days, 1 month, 2 months, 6 months and 1 year., Result: Two months after surgery, 45 patients' achieved one-stage wound healing. Six months later, all of the patients' operation area had epithelized completely. After 1 year, 37 patients had recovered the normal shapes and stable audition; 7 cases patients have different level tympanic membrane retraction; 1 patient suffered from tympanic membrane retraction and recurrent cholesteatoma., Conclusion: With regard to the lesion limited to the attic, we can remove it by operating epitympanotomy through retroauricular incision, and then reconstruct the lateral attic wall with tragal cartilage and temporalis fascia. By the support of the cartilage, we can keep the epitympanic aeration, reduce the retraction of pars flaccida membrana tympani, and maintain the fundamental shape of lateral attic wall.

Background: In children, the success of myringoplastywith temporalis fascia is lower compared to adults and cartilage as an alternative graft material has shown higher success rate., Objective: To compare results of myringoplasty using tragal cartilage palisades with the use of temporalis fascia in children with large tympanic membrane perforations., Materials and Methods: This is a prospective and randomized study conducted in children of age 6-14 years with large tympanic membrane perforation of more than two quadrants. Status of graft at or around 6 weeks after surgery was used as morphological outcome measure. Pre- and postoperative audiograms were compared to evaluate audiological outcome in two groups., Results: Forty seven out of 55 patients completed follow-up. The graft uptake rate in the cartilage palisades and temporalis fascia myringoplasty group was 91.3% (21/23) and 83.33% (20/24), respectively; the difference was not statistically significant (P=0.666). The mean preoperative air-bone gaps (ABG) in cartilage palisades and temporalis fascia group were 36.2±8.9dB and 33.8±7.5dB, the difference was not statistically significant (P=0.412). Similarly, the postoperative ABG in cartilage palisades and temporalis fascia group were 25.1±12.2dB and 17.2±9.2dB, respectively, the difference was statistically significant (P=0.040). The gap closure was 11.0dB in palisades group and 16.8dB in fascia group, but it was not significant (P=0.133)., Conclusion: In our study of pediatric myringoplasty, the morphological and functional outcomes in both cartilage palisades and temporalis fascia groups were comparable., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

As a graft material cartilage produces an excellent anatomical result with a low risk of re-perforation. However, there is a controversy among surgeons regarding its sound conduction properties, due to the thickness and stiffness of the cartilage. The aim of this study was to evaluate results of cartilage type I tympanoplasty and to compare anatomic and audiologic results in pediatric and adult patients. Patients with chronic otitis media who underwent cartilage type I tympanoplasty were evaluated retrospectively. Patient age, gender, pre and postoperative hearing levels, surgical technique and postoperative complications were recorded. Hearing outcomes of the patients were measured with tonal audiometry by comparing the pre and postoperative hearing threshold calculated at 0.5, 1, 2, and 4 kHz. Graft success rates and hearing outcomes of the pediatric and adult patients were compared. Of the 136 patients included in the study, 58 were male and 78 were female. The average age was 25.03. Forty-five patients were ≤16-year old and 91 patients were >16-year old. Intact graft was determined in 41 of 45 pediatric patients and 85 of 91 adult patients at the last follow-up visit. The overall graft success rate was 92.6 %. The mean pre and postoperative pure-tone average was 34.8 ± 8.5 and 23.4 ± 9.1 dB in adult patients, and 30.6 ± 7.7 and 17.8 ± 7.8 dB in pediatric patients. Cartilage graft provides a quite satisfactory anatomical result and perfect stability. Hearing outcomes of cartilage tympanoplasty are also acceptable in both children and adult patients.

To evaluate the success rate and the surgical procedure of two different transcanal myringoplasty techniques using the Tutopatch(®) (Tutogen Medical, Inc., Alachua, FL, USA), a xenograft produced from bovine pericardium or the butterfly, an inlay tragal cartilage autograft. This is a retrospective study. We studied all cases of transcanal myringoplasty with Tutopatch and butterfly, performed by the same surgeon between April 2005 and May 2013. Perforations were secondary to chronic otitis media without cholesteatoma, perforation post ventilation tube or trauma. They were not exceeding one-third of the tympanic membrane surface for the Tutopatch and one quarter for the butterfly. We evaluated the anatomical success rate, complications and postoperative hearing results in both techniques. A total of 106 myringoplasties were performed: 66 with Tutopatch and 40 with butterfly with a mean follow-up of 16.5 and 5.2 months, respectively. Successful closure rates of Tutopatch and butterfly were 75.8% (P < 0.0001) and 85.0% (P < 0.0001), respectively. Myringitis controlled with topical antibiotics treatment occurred in 8 (12.1%) and 5 (12.5%) cases. Eighty percent of patients with Tutopatch had a mean residual air-bone gap within 10 dB, compared to 85.0% in patients with butterfly. When anatomically feasible, a transcanal approach myringoplasty with a Tutopatch(®) graft or butterfly appears to provide good anatomical and functional results. We show that both techniques provide good anatomical and functional results. The butterfly has the advantage to use an autograft, which is surgically easier because it does not require tympanomeatal flap elevation. We recommend the butterfly technique for non-marginal perforation not exceeding one quarter of the tympanic membrane after excision of the perforation edge and Tutopatch for bigger perforation or when standard autografts are not available. Myringitis is the only described complication without specific incidence.

Objectives: This study aims to investigate the prevalence of myringosclerosis in tragal perichondrium (TP) and temporalis fascia (TF) grafts after myringo-/tympanoplasty., Patients and Methods: Thirty patients, who were diagnosed with non-suppurative chronic otitis media and administered myringo-/tympanoplasty under general anesthesia using TP or TF as grafting material in our clinic between January 2012 and May 2013, were recruited in this retrospective case-control study. Patients were divided into two groups according to used graft material as group 1 (TP) (9 males, 6 females; median age 35.4 years; range 20 to 62 years) and group 2 (TF) (7 males, 8 females; median age 39.8 years; range 19 to 63 years). Occurrence of myringosclerosis on the intact tympanic membrane grafts was evaluated postoperatively by the same surgeon under surgical microscope., Results: Postoperative myringosclerosis was detected in six patients (40%) in TP group and 13 patients (86.7%) in TF group., Conclusion: Prevalence of myringosclerosis on graft materials used in myringo-/tympanoplasty was lower in TP group compared to TF group. We believe that this may be due to different vascular structures of different graft tissues and that the low predisposition of perichondrium towards development of myringosclerosis can be considered as an advantage for this graft. We hope that this study adds a new dimension to etiopathogenesis of myringosclerosis and assists otologists in the prevention and treatment of this lesion.

Introduction: Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed., Objective: To prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty., Methods: The medical records of 87 patients (48 males and 39 females; mean age, 27.3±11.2 years; range, 14-43 years) with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach., Results: The overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27±12.35 dB, and the postoperative air bone gap was 27.58±9.84 dB. The mean postoperative follow-up period was 15.3 months (range: 7-21 months)., Conclusion: If cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results., (Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air-bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8%) air-bone gaps were ≥ 16 dB; after operating using the TwBSCPG technique, the air-bone gaps decreased to 0-10 dB in most patients (77.8%). In the TwBSCPG patients, the mean preoperative air-bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air-bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air-bone gap compared to that preoperatively (p = 0.000, z = -8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft lateralization due to placement of the graft under the manubrium mallei. Given these benefits, the TwBSCPG technique seems to be a good alternative for grafting in tympanoplasties.

Objective: For tympanoplasty, the most common grafting materials are the temporalis fascia or perichondrium; however, both require incision of the canal skin, which carries a risk of morbidity and the need for postoperative care. Inlay butterfly cartilage tympanoplasty, by which the perforation edges are refreshed and a cartilage is inserted through the perforation without canal incision, makes the graft easy, and reduces operating and recovery time. We analyze the outcome of inlay butterfly cartilage tympanoplasty., Materials and Methods: This study included 112 patients who underwent tympanoplasty from January 2011 to August 2012. Patients were divided into 2 groups: patients who underwent inlay butterfly cartilage tympanoplasty (Group I, n = 56) and patients who underwent conventional underlay tympanoplasty using the temporalis fascia (Group II, n = 56). Anatomic success was defined as an intact, repaired tympanic membrane, and functional success was defined as a significant decrease in the air-bone gap at the end of follow-up. Perioperative pain was analyzed using a visual analogue scale (VAS). Surgical success, functional success, perioperative pain, and operating time were evaluated and compared., Results: The surgical success rate was 96.4% in Group I and 91.1% in Group II (p = 0.435). The mean air-bone gap decrease was 7.9 ± 2.2 dB in Group I and 8.9 ± 3.2 dB in Group II (p = 0.426). Group I showed a lower VAS score for pain (1.5 ± 1.2) and a shorter operation time (25.6 ± 8.5 min) compared with those of Group II (4.9 ± 1.7, 48.6 ± 19.5 min, respectively) (p < 0.01)., Conclusion: Inlay butterfly cartilage tympanoplasty is compatible with the conventional underlay technique in both anatomic and functional success rates. Its simplicity, shorter operation time, and rapid recovery time could make it an attractive surgical option.

So far, comparative studies have shown no significant audiological difference between cartilage and fascia grafts. In this retrospective study, the Turkish scientists E E Callioglu et al. examined next audiological results and morphological results after surgical cartilage and fascial tympanoplasty in patients with comparable preoperative hearing and middle ear pathology.

The aim of this study was to report our experience with cartilage tympanoplasty (CT) in smokers and compare it with that of non-smokers using a retrospective chart review at a tertiary referral center. Between September 2008 and September 2010, cartilage tympanoplasty was performed in 52 patients. Among them, 27 were active smokers and 25 former or non-smokers. The entire tympanic membrane was replaced with conchal cartilage, shaped either as a shield for cases with intact canal wall mastoidectomies, or crashed for cases with canal wall down procedures. The mean post-operative follow-up was 12 months (range 6-18 months). A complete pre- and post-operative audiologic evaluation was obtained in all patients. Graft take was successful in all patients. The overall average pre-operative and post-operative pure tone average air-bone gaps (PTA-ABG) was 52.2 dB ± 17.7 dB and 35.4 dB ± 17.9 dB, respectively, with an overall improvement of 16.8 dB (p < 0.001). A post-operative PTA-ABG of 25 dB or less was achieved in 39 (75 %) patients (p < 0.001). In smokers, the hearing improvement was 17.6 dB (p < 0.001) with a PTA-ABG of 25 dB or less in 19 (70 %). In non-smokers, the average hearing improvement was 16.8 dB (p < 0.0005) with a post-operative PTA-ABG of 25 dB or less in 19 (76 %), (p < 0.001). The results showed that the CT technique is a very effective procedure for smokers. Excellent graft take and satisfactory hearing results can be accomplished regardless of smoking habits.

Anterior tympanic perforations are actually the most difficult to close and a number of different techniques exist. This article represents the author's surgical procedure for type I tympanoplasties (myringoplasties) for this kind of perforation using the tragal cartilage and the perichondrium after preparation (revival, cleaning) of the perforation edge with a laser. This technique does not use a skin incision of external auditory meatus, when this one is large.

The aim of this study was to compare the hearing results and graft integration rates in patients undergoing myringoplasty for the reconstruction of the tympanic membrane, with the use of either cartilage or temporalis muscle fascia (TMF). A systematic literature review in Medline and other database sources up to February 2012 was carried out, and the pooled data were meta-analyzed. Twelve studies were systematically analyzed. One represented level I, one level II and ten level III evidence. The total number of treated patients was 1,286. Cartilage reconstruction was used in 536, TMF in 750 cases. Two level III studies showed a significant difference between the pre- and postoperative air-bone gap closure, in favor of cartilage grafting. The mean graft integration rate was 92.4 % in the cartilage group and 84.3 % in the TMF group (p < 0.05). The rates of re-perforations were 7.6 and 15.5 %, respectively (p < 0.05). Among the other complications of type I tympanoplasty, retraction pockets, otitis media with effusion, anterior blunting, and graft lateralization were usually surgically managed, whereas most of the rest were minor and could be dealt with conservatively. The graft integration rate in myringoplasty is higher after using cartilage, in comparison with fascia reconstructions (grade C strength of recommendation), and the rate of re-perforation is significantly lower. Although cartilage is primarily used as grafting material in cases of Eustachian tube dysfunction, adhesive otitis media, and subtotal perforation in everyday surgical practice, a wider utilization for the reconstruction of the tympanic membrane in myringoplasties can be recommended.

The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients with low middle ear risk index (MERI). In this retrospective study, 63 patients that underwent type 1 tympanoplasty with chondroperichondrial island graft between July 2009 and November 2010 were compared with 45 patients in whom temporal muscle fascia was used. Patients in both groups had low MERI values varying between 1 and 3. Five and nine patients underwent masteidectomy in cartilage and fascia group, respectively. Mean duration of follow-up was 11.9 ± 3.7 (5-17) months. Mean value was calculated at pre-operative and post-operative hearing threshold 0.5, 1, 2, 4 kHz, and air bone gap (ABG) gain was compared in both cartilage and fascia groups. when pre-operative and post-operative ABG gain were compared, significant decrease was seen in ABG levels (p < 0.001). However, no significant difference was seen in ABG gain values (p = 0.608), which was 10.1 ± 7.00 dB in cartilage group and 10.8 ± 5.38 dB in fascia group. In both groups, age, sex, and the addition of mastoidectomy procedure had no significant effect on ABG gain and success. Cartilage is a graft material that may be preferred without concern about the effects on hearing results, especially, in patients with low MERI values. The addition of mastoidectomy had no impact on the outcome of operation and audiological results. However, further studies with larger case series may be carried out to further clarify the issue.