Endoscopic Underlay Tympanoplasty Type 1: Ring-Shaped Versus Wheel-Shaped Composite Cartilage-Perichondrium Graft

Abstract

Background: Previously a techniques variety have been described and are currently utilized in tympanoplasty type 1, involving sandwich, underlay, overlay, plugging, rosette and pegging. The operative material and technique choice for tympanoplasty persists controversial. Aim: We aimed to evaluate the wheel-shaped cartilage-perichondrium composite graft and functional and anatomical outcomes of ring in endoscopic tympanoplasty type I for repairing of large and subtotal perforation. Methods: This prospective comparative study was carried out on fifty chronic suppurative otitis media patients tubotympaic type with large and subtotal tympanic membrane (TM) perforation. The participants were assigned randomly into two groups: Group A included 25 patients who were subjected to endoscopic tympanoplasty type 1 ringshaped composite cartilage perichondrium graft. Group B contained 25 patients who were subjected to endoscopic tympanoplasty wheel-shaped composite cartilage-perichondrium graft. Results: Post-operative pure tone audiometry (PTA) test in ring-shaped graft group was 20.2 ± 2.5, while in wheelshaped graft group was 19.36 ± 2.53 with no statistically significant difference (p= 0.244) between the two groups. Conclusion: Our study found that while both ring and wheel-shaped cartilage-perichondrium composite grafts can achieve successful graft acceptance, the wheel-shaped graft showed a significantly greater postoperative improvement in hearing outcomes, a higher rate of TM regeneration, and comparable graft success rates. Additionally, the choice of graft shape played a pivotal role in optimizing surgical outcomes, particularly in cases with significant perforation size. Our study highlighted the potential advantages of wheel-shaped grafts in enhancing hearing improvement and TM regeneration for patients with CSOM.