Composite chondro-perichondrial clip myringoplasty: our experience


  • Shrikrishna B. H. Department of Otolaryngology and Head & Neck Surgery, Navodaya Medical College, Raichur (Karnataka), India
  • Jyothi A. C. Department of Otolaryngology and Head & Neck Surgery, Navodaya Medical College, Raichur (Karnataka), India



Tympanic membrane, Myringoplasty, Grafts, Perichondrium, Cartilage, Otitis media


Background: There are several studies on the efficacy of the commonly used temporalis fascia for myringoplasty where the temporalis fascia is placed by underlay method after incising external canal wall skin. This study was conducted assess the success rate and efficacy of use of a composite chondro-perichondrial graft in a combined overlay-underlay fashion where the external canal wall is not incised.

Methods: A prospective study was conducted where 30 cases of non-marginal perforation of tympanic membrane were properly selected based on the inclusion criteria. All the 30 cases underwent myringoplasty using composite chondro-perichondrial graft harvested from tragal cartilage and placed in a combined overlay-underlay fashion.  

Results: There was complete closure of the perforation in 27 of the total 30 cases. Also there was reduction in the air-bone gap post-operatively in all the 27 cases with complete closure of the tympanic membrane perforations.

Conclusions: Composite chondro-perichondrial clip myringoplasty is an effective method of closing non-marginal perforations of the tympanic membrane.

Author Biography

Jyothi A. C., Department of Otolaryngology and Head & Neck Surgery, Navodaya Medical College, Raichur (Karnataka), India




Prescott CAJ, Robartes WJ. Tympanoplasty surgery at the Red Cross War Memorial Children’s Hospital: 1986-1988. Int J Pediatr Otorhinolaryngol. 1991;21:227-34.

Kessler A, Potsic WP, Marsh RR. Type I tympanoplasty in children. Arch Otolaryngol Head Neck Surg. 1994;120:487-90.

Francois M, Juvanon JM, Contencin P, et al. Myringoplastie chez l’enfant. Ann Otolaryngol Chir Cervicofac. 1985;102:321-7.

Lau T, Tos M. Tympanoplasty in children: an analysis of late results. Am J Otol. 1986;7:55-9.

Ophir D, Porat M, Marshak G. Myringoplasty in the paediatric population. Arch Otolaryngol Head Neck Surg. 1987;113:1288-90.

Glasscock, ME, Shambaugh GE. Surgery of the Ear. In: Pathology and Clinical Course of Inflammatory Disease of the Middle Ear. 5th Ed. 2006;21:428-9.

Parelkar K, Nagle S, Jagade M, Thorawade V, Khairnar P, Attakil A, et al. Triple-c Cartilage Tympanoplasty: Case Series. International Journal of Otolaryngology and Head & Neck Surgery. 2015;4:26-31.

Fernandes SV. Composite Chondro-perichondrial Clip Tympanoplasty: The Triple-C Technique. Otolaryngology Head and Neck Surgery. 2003;128:267-72.

Farrior JB. Risks and complications of tympanoplasty. In: Wiet RJ, eds. Ear and Temporal Bone Surgery. Minimizing Risks and Complications. New York, NY: Thieme; 2006: 58–70.

Wehrs RE. Grafting techniques. Otolaryngol Clin North Am. 1992;32:443–55.

Merchant SN. Ossiculoplasty and tympanoplasty in chronic otitis media. In: Nadol JB, McKenna MJ, eds. Surgery of the Middle Ear and Temporal Bone. Philadelphia: Lippincott Williams and Wilkins; 2005: 305-324.

Ozgursoy OB, Youralmaz I. Fat graft myringoplasty: a cost effective but underused procedure. J Laryngol Otol. 2005;119:277-9.

Eavey RD. Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope. 1998;108:657-61.

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

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

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

Yung M. Cartilage Tympanoplasty: Literature Review. The Journal of Laryngology & Otology. 2008;122:663-72.

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

Borkowski G, Sudhoff H, Luckhaupt H. Autologous perichondrium-cartilage graft in the treatment of total and subtotal perforations of the tympanic membrane. Laryngorhinootologie. 1999;78:68-72.

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

Adkins WY. Composite autograft for tympanoplasty and tympanomastoid surgery. Laryngoscope. 1990;100:244-7.

Ghanem MA, Monroy A, Alizadeh FS, Nicolau Y, Eavey RD. Butterfly Cartilage Graft Inlay Tympanoplasty for Large Perforations. Laryngoscope. 2006;116:1813-6.

Tos M. Cartilage Tympanoplasty: Classifications of Methods—Techniques—Results. 1st Edition. Thieme; 2009.

Gierek T, Slaska-Kaspera A, Majzel K, Klimczak-Gotqb L. Results of Myringoplasty and Type I Tympanoplasty with the Use of Fascia, Cartilage and Perichondrium Grafts. Otolaryngologia Polska. 2004;3:529-33.

Couloigner V, Baculard F, El Bakkouri W, Viala P, Francois M, Narcy P, et al. Inlay Butterfly Cartilage Tympanoplasty in Children. Ontology Neurotology. 2005;26:247-51.

Goodhill V. Tragal perichondrium and cartilage in tympanoplasty. Arch Otolaryngol. 1967;85:480-91.

Glascock ME, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope. 1982;92:718-27.

Milewski CH. Fascia or perichondrium/cartilage in tympanoplasties. A comparative study regarding hearing results and recurrence of perforations in 1529 cases. In: Tos M, Thomsen J, Peitersen E, editors. Cholesteatoma and mastoid surgery. Amsterdam: Kugler & Ghedini Publications; 1989: 1113-1114.






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