Although the temporalis fascia has been widely used since 1957 as a graft in tympanoplasty, the utility of cartilage in middle ear reconstructive surgery is becoming apparent. Autogenous cartilage contributes minimally to an inflammatory tissue reaction and is incorporated in the middle layer of the tympanic membrane (TM) giving a firm scaffolding and resistance for infection during the healing period.
Via a transcanal approach without raising a posterior tympanomeatal flap and after freshening of the edge of the TM perforation , a disc of tragal cartilage-perichondrium composite graft was applied medially to repair the defect in 64 patients . They all had dry central perforation of the small - to - medium sized category with conductive hearing loss no greater than 35 dB in any
frequency at the time of surgery.
Anatomically, the success rate in terms of" graft take " was 95.3 % and functionally the postoperative air-bone gap was reduced to less than 10 dB in 87.5 % and to less than 20dB in 98% at the end of the follow-up period (longest follow-up, 30 month; shortest follow-up, 6 month; average follow -up, 16 months).
These results demonstrate that the described technique is efficient and effective to close a subgroup of non- marginal TM perforations. The post - operative patient comfort and the cost-effectiveness of the technique show additional advantage. Tragal cartilage was found to be an excellent graft material and its use has made a significant improvement in the TM reconstruction procedure. Cartilage should be used more widely in tympanoplasty.