Endoscopic closure of tympanic membrane anterior perforation using a strip-type chondroperichondrial graft

Endoscopic Broad Palisade Cartilage Graft Without Raising a Tympanomeatal Flap in the Repair of Subtotal Perforation

Objective: This study evaluated the outcome of a broad palisade cartilage graft in the repair of subtotal perforation. Study Design: Prospective case series. Materials and Methods: This was a prospective study of 43 patients with subtotal perforations who underwent an endoscopic broad palisade cartilage graft procedure that did not include raising a tympanomeatal flap. The patients were followed up for 6 months. Results: The 43 patients (43 ears) included in this study had a mean operation time of 38.6 ± 7.4 minutes. Five (11.6%) patients were lost to follow-up; 38 (88.4%) completed the 6 month follow-up. The graft success rate in the latter was 92.1% (35/38). Audiological testing showed no sensorineural threshold shift. The mean preoperative air-bone gap (ABG) was 28.4 ± 5.1 dB, while the mean ABG at 6 months postoperatively was 13.6 ± 3.1 dB; the difference between these values was significant (P < .05; paired samples t test). According to the audiometry assessment, the successful surgery rate (postoperative ABG ≤ 20 dB) was 89.5% (34/38). No graft-related complications (eg, graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. However, granular myringitis with minimal moistness but without infection was noted in 5.3% (2/38) of the patients. Conclusions: In the repair of subtotal perforation, an endoscopic broad palisade cartilage graft, performed without raising a tympanomeatal flap, is simple and feasible, resulting in a high graft success rate and good hearing restoration.

Endoscopic Perichondrium-Cartilage Myringoplasty With Preserving of Anterior Margins and Tuck Grafts for Repairing Anterior Perforation With 3 year Followup

OBJECTIVE

The objective of this study was to evaluate the graft outcomes of endoscopic perichondrium-cartilage myringoplasty with preserving of anterior margins for repairing anterior perforation with 3 year followup.

STUDY DESIGN

Prospective case series.

SETTING

Tertiary university hospital.

MATERIALS AND METHODS

We performed a prospective study in 47 patients with anterior perforation who underwent perichondrium-cartilage myringoplasty with preserving of anterior margins and tuck grafts. The operation time, graft success rate, hearing outcome, and complications were evaluated at 6 months and 3 years after surgery.

RESULTS

A total of 47 ears with anterior marginal perforation were included in the study. The perforation size was subtotal in 2 (4.3%) eras, large in 11 (23.4%) ears, medium in 27 (57.4%) ears, and small in 7 (14.9%). The mean operation time was 41.2 ± 5.4 minutes. All patients completed 6 months of follow-up. Residual perforation was observed in 2 patients with medium perforations, the graft success rate was 95.7% (45/47). The mean preoperative and postoperative AC PTAs were 38.1 ± 7.3 dB and 25.4 ± 4.6 dB (P < .05), while the mean preoperative and postoperative BC PTAs were 9.0 ± 4.6 dB and 9.6 ± 1.9 dB (P = .672). The functional success was 91.5% (43/47). None of the patients reported sensorineural hearing loss, altered taste, facial nerve palsy, vertigo, or tinnitus during the follow-up period. In addition, 34 (72.3%) patients completed 3 years followup and performed temporal bone CT examination, the mean followup time was 39.1 ± 2.7 months, CT revealed the well pneumatization of mastoids and middle ear.

CONCLUSIONS

Endoscopic perichondrium-cartilage myringoplasty with preserving of anterior margins and tuck grafts is a safe, suitable, and reliable method for repair of anterior perforation with few risk of anterior blunting and lateralization.