Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

“…The 97 per cent closure rate presented compares well to the 84-95 per cent rate in over-under temporalis fascia grafts, [20][21][22] and the rate of 88-98 per cent in other over-under cartilage tympanoplasty procedures. 3,4,6,[11][12][13][14] This was reliable in younger patients as well, though we avoided performing tympanoplasty on young patients with active Eustachian tube dysfunction. The closure rate presented in this article is likely due to the use of cartilage for grafting material, the placing of the graft snugly onto the malleus and the addition of the cartilage shim, which, when required, brings the graft in contact with the native tympanic membrane.…”

“…28 Comparing our findings of high frequency loss to the literature is challenging. Concurrent articles on cartilage tympanoplasty frequently report hearing thresholds or averages using the highest frequency of 2000 Hz, 3,5,13,29 3000 Hz 1 , 8,28,[30][31][32] or 4000 Hz. 2,4,6,12,14,15,[33][34][35][36] Were we to narrow our reporting to these same levels or simply present a pure tone average, the high frequency loss presented here would have been missed, since statistical significance was only noted at 4000, 6000 and 8000 Hz.…”

“…1 Various techniques of cartilage tympanoplasty have been proposed. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] We use an over-under technique, where the cartilage-perichondrial island graft is placed lateral to the malleus and medial to the annulus. We also use a cartilage shim between the native tympanic membrane and the cartilage graft when the graft does not make contact with the tympanic membrane, and we believe this additional step is unique.…”

“…We have found overunder cartilage tympanoplasty to be a flexible and versatile approach in addressing the tympanic membrane, but the available articles on this only briefly describe the approach. [2][3][4][5][6][10][11][12][13][14][15] The objectives of this article are to describe the technique we use for the microscopic over-under cartilage tympanoplasty and to report the hearing outcomes and complications. We hypothesised that hearing would be shown to improve across the hearing spectrum and that reperforation would be rare.…”

Self-Expandable Retainer for Endoscopic Visualization in the External Auditory Canal: Proof of Concept in Human Cadavers

“…The cartilaginous portion of the EAC is often pushed posteriorly using the shaft of the endoscope. Certain techniques such as the Tarabichi's stitch can be used to straighten the EAC and increase the working space for the endoscope [9,10].…”