Comparison of otological and audiological outcome of type-I tympanoplasty using composite tragal perichondrium and temporalis fascia as graft


  • Nitin Sharma Department of ENT, Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan, India
  • Pritosh Sharma Department of ENT, Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan, India
  • Prateek Sharma Department of ENT, Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan, India
  • Kumar Gourav Department of Audiology and Speech Therapy, Geetanjali Medical College, Udaipur, Rajasthan, India
  • V. P. Goyal Department of ENT, Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan, India



Tympanoplasty, Cartilage, Temporalis fascia, Composite tragal perichondrium


Background: The most frequently used technique for the repair of TM perforation is underlay grafting of temporalis fascia in normally ventilated middle ears. In advanced middle ear pathology, large perforations, atelectatic drum or retraction pockets, temporalis facia may cause higher failure rates. In such cases, a more rigid grafting material such as cartilage is preferred because of its increased stability and resistance to middle ear pressure even in cases with chronic eustachian tube dysfunction.

Methods: This is a prospective randomized study design on comparison of temporalis fascia and cartilage as graft in patients of CSOM with subtotal perforation. 80 patients, divided randomly into two groups with equal patients, with tragal cartilage (group 1) and temporalis fascia (group 2) as graft. Follow up done at post-operative 3rd week and 3rd month for graft acceptance as well as graft health. Audiometric evaluation was conducted at 3rd month. The data obtained was subjected to appropriate statistical analysis using SPSS version 20.  

Results: Graft uptake rate in group1 and 2 was 93.75% and 90%. The mean AB gap improved in group1from 36.38±6.10 dB to 18.13±5.84 dB. Similarly in group 2 it improved from 28.73±5.82 dB to 15.23±8.14 dB; showed statistically highly significance in both groups (p<0.001).

Conclusions: Composite tragal perichondrium graft delivers an excellent audiologic outcome comparable to temporalis fascia graft specially where medialization of graft is expected. It gives ENT surgeons a reliable armamentarium in tympanoplasties for subtotal perforation.


Buckingham RA. Fascia and perichondrium atrophy in tympanoplasty and recurrent middle ear atelectasis. Ann Otol Rhinol Laryngol. 1992;101:755-8.

Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope. 1993;103:1352-6.

Indore Nvala S. dimensional stability of free fascia grafts: an animal experiment. Laryngoscope. 2002;112(4):727-30.

Levinson RM. Cartillage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope. 1987;97:1069-74.

Duckert LG, Mi1ler J, Makielski KH, Helms J. Composite autograft, shield reconstruction of remnant tympanic membranes. Am J Otol. 1995;16:21-6.

Gerber MJ, Mason JC, Lampert PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope. 2000;110(12):1994-9.

Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997;107(8):1094-9.

Gamra OB, Mbarek C, Khammassi K, Methlouthi, N Ouni H, Hariga I, et al. Cartilage graft in type I tympanoplasty: audiological and ontological outcome. Eur Arch Otorhinolaryngol. 2008;265:739-42.

Jansen C. Cartilage- tympanoplasty. Laryngoscope 1963;73:1288-302.

Salen B. Myringoplasty using septum cartilage. Acta Otolatynaol. 1963;188:82-91.

Arnadee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol. 1989;10:447-50.

Desarda KK, Bhisegaonkar DA, Gillo S. Tragal perichondium and cartilage in reconstructive tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2005;57(1):9-12.

Kazikdas KC, Onal K, Boyraz 1, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol. 2007;264:985-9.

Khan MM, Parab SR. Primary cartilage tympanoplasty: our technique and results. Am J Otolaryngol. 2011;321(5):381-7.

Mohamad Q, Khan I, Hussain SSM. Otology and Neurotology, Inc. Is Cartilage Tympanoplasty More Effective Than Fascia Tympanoplasty? A Systematic Review. Otol Neurotol. 2012;33:699-705.

Kulkarni S, Kulkarni V, Burse K, Sancheti V, Roy G. Cartilage Support for Fascia Graft in Type I Tympanoplasty Indian J Otolaryngol Head Neck Surg. 2014;66(3):291–6.

Verma R, Mathur N. Cartilage tympanoplasty for management of tympanic membrane perforation: A comparison with temporalis fascia graft technique. 2017: 72-78.

Mahmood Shishegar, Abolhasan Faramarzi, Ayeh Taraghi. A Short-term Comparison Between Result of Palisade Cartilage Tympanoplasty and Temporalis Fascia Technique. Iranian Journal of Otorhinolaryngol. 2012;24(3):68.

Kyrodimos E, Sismanis A, Santos D. Type III cartilage "shield" tympanoplasty: an effective procedure for hearing improvement. Otolaryngol Head Neck Surg. 2007;136(6):982-5.

Kumar R, Suman RK, Garje YA, Rao SP. Comparative Study of Underlay Tympanoplasty with Temporalis Fascia and Tragal Perichondrium. IOSR-JDMS. 2014;13(5):89-98.

Sirena E, Carvalho B, Buschle M. Tympanoplastia myringoplasty type I and in residency surgical results and audiometric. Int Arch Otolaryngol. 2010;14 (4):60-5.

Singh S. Role of tragal cartilage and perichondrium in middle ear reconstruction. J Dental Med Sci. 2017;16(10):63-6.

Dabholkar JP, Vora K, Sikdar A. Comparative study of underlay tympanoplasty with temporalis fascia and tragal perichondrium. Indian J Otolaryngol Head Neck Surg. 2007;59:116-9.

Parida PK, Singh S, Sohal B, Singh B. Prospective study of myringoplasty using different approaches. Indian J Otolaryngol Head Neck Surg. 2012;61:297-300.

Cavaliere M, Mottola G, Rondinelli M, Iemma M. Tragal cartilage in tympanoplasty: anatomic and functional results in 306 cases. Acta Otorhinolaryngol Ital. 2009;29(1):27-32.

Chhapola S, Matta I. Cartilage perichondrium: An ideal graft material? Indian J Otolaryngol Head Neck Surg. 2012;64(3):208–13.

Ozbek C, Ciftçi O, Tuna EE, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol. 2008;29(5):679-83.






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