Fascia Versus Cartilage Graft in Type I Tympanoplasty

Abstract

Various materials such as fascia, perichondrium, and cartilage have been used for reconstruction of the tympanic membrane in middle ear surgery. Because of its stiffness, cartilage is resistant to resorption and retraction. However, cartilage grafts result in increased acoustic impedance, the main limitation to their use. The aim of this study was to compare the hearing results after cartilage tympanoplasty versus fascia tympanoplasty. This study included 114 patients without postoperative tympanic membrane perforation who underwent tympanoplasty type I between 2007 and 2010, 31 with fascia and 83 with cartilage. Preoperative and 1 year postoperative air-bone gap (ABG) and postoperative gain in ABG at frequencies of 0.5, 1, 2, and 3 kHz were assessed. Both groups were statically similar in terms of the severity of middle ear pathology and the preoperative hearing levels. Overall, postoperative successful hearing results showed 77.4% of the fascia group and 77.1% of the cartilage group. Mean postoperative gains in ABG were 9.70 dB for the fascia group and 9.78 dB for the cartilage group. These results demonstrate that hearing after cartilage tympanoplasty is comparable to that after fascia tympanoplasty. Although cartilage is the ideal grafting material in problematic cases, it may be used in less severe cases, such as in type I tympanoplasty, without fear of impairing hearing.

Comparison of cartilage with temporalis fascia tympanoplasty: A meta‐analysis of comparative studies

“…A total of 37 articles were finally included in our meta‐analysis, resulting in a pooled population of 3,606 patients: 1,795 undergoing cartilage tympanoplasty and 1,811 undergoing fascia tympanoplasty. There were 11 PCSs, three of which were randomized .…”

“…There were 11 PCSs, three of which were randomized . The remaining 26 comparative studies were retrospective . Three prospective studies and 12 retrospective studies were considered as low‐bias studies (see the online Supporting Table SI about the characteristics of the included studies).…”

“…Data regarding postoperative mean ABG ( Fig. 4) were available for 20 included studies (6 prospective studies 19,22,23,26,28,29 and 14 retrospective studies 32,34,39,[41][42][43][44][45][46][47]49,[52][53][54] ). Because there were two prospective studies with a low risk of bias, we did not perform the meta-analysis in this subset.…”

“…In addition, the RD was nonsignificant (0.02 and 0.01, respectively) in the subsets of PCSs and RCSs. A total of 14 eligible studies 19,22,34,39,[41][42][43][45][46][47]49,[52][53][54] were assessed for SMD of postoperative ABG. The analysis showed no significant SMD between the cartilage graft and TF graft (P 5 0.25).…”

Endoscopic butterfly graft myringoplasty in small to medium perforation in adolescent chronic otitis media: our experience in 15 cases

“…The thickness of cartilage gives a theoretical audiological disadvantage over thinner graft materials such as fascia or perichondrium but clinical studies fail to demonstrate such disadvantage. 7,8 The use of cartilage and perichondrium island graft, palisade technique and other have shown consistent healing results, the concern that the stiffness and mass of the cartilage graft may affect hearing results has not been proven so far. 9 Our study also did not show any negative impact of cartilage as a graft material on hearing measured six months post-operatively.…”