Published: 2021-01-25

The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

Apoorva Kumar Pandey, Ajaz U. Haq, Sharad Hernot, Madhuri Kaintura, Aparna Bhardwaj, Fatma Anjum, Akanksha Bisht, K. S. Negi


Background: The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.

Methods: This prospective non-controlled, non-randomized  study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups:  revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears .  Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and p<0.05 was considered statistically significant for the hearing outcomes.  

Results: Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (p<0.05). Best take up rates were observed in atelectatic and tympanosclerotic group i.e., 100% and 96.55% respectively.

Conclusions: This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.


Cartilage tympanoplasty, Chronic suppurative otitis media, Intact canal wall mastoidectomy, Middle ear, Tragal cartilage; Tympanic membrane

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Tan HE, Maria PLS, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD. Type I tympanoplasty meta-analysis: a single variable analysis. Otol Neurotol. 2016;37:838-46.

Uslu C, Tek A, Tatlipinar A, Kilicarslan Y, Durmus R, Ayogredik E, et al. Cartilage reinforcement tympanoplasty: otological and audiological results. Acta Oto-Laryngologica. 2010;130: 375-83.

Austin DF. Reporting results in tympanoplasty. Am J Otol. 1985;6: 85-8.

Toss M. History of cartilage tympanoplasty. In: Tos M ed. Cartilage tympanoplasty. 1st edn. New York: Thieme; 2009:1-9.

Migirov L, Volkov A. Influence of coexisting myringosclerosis on myringoplasty outcomes in children. J Laryngol Otol. 2009;123:969-72.

Dornhoffer J. Cartilage tympanoplasty: indications, technique, and outcomes in a 1000 patient series. Laryngoscope. 2003;113:1844-56.

Dornhoffer JL. Cartilage tympanoplasty. Otolaryngol Clin N Am. 2006;39:1161-76.

Kalra VK, Yadav SPS, Verma M, Singh B, Goel A. Treatment of tympanic membrane retraction pockets by excision and cartilage tympanoplasty: A prospective study. Indian J Otolaryngol Head Neck Surg. 2018;70:392-4.

Ghosh D, Das A, Sayan H, Sengupta A. Maximising graft take-up in type I tympanoplasty using peripheral cartilage ring and perichondrium. Indian J Otolaryngol Head Neck Surg. 2018;70:290-4.

Celik H, Samim E, Oztuna D. Endoscopic “push-through” technique cartilage myringoplasty in anterior tympanic membrane perforations. Clin Exp Otorhinolaryngol. 2015;8:224-9.

Sahan M, Derin S, Deveer M, Saglam O, Cullu N, Sahan L. Factors affecting success and results of cartilage-perichondrium island graft in revision tympanoplasty. Int Adv Otol. 2014;10:64-7.

Bonne RT, Gardner EK, Dornhoffer JL. Success of cartilage grafting in revision tympanoplasty without mastoidectomy. Otol Neurotol. 2004;25:678-81.

Ruhl CM, Pensak ML. Role of aerating mastoidectomy in non-cholesteatomatous chronic otitis media. Laryngoscope. 1999;109:1924-7.

Pradhan P, Lal P. Cartilage palisade grafting in retrograde canal wall down mastoidectomy: a review of 80 cases. Otolaryngol. 2017;7:302.

Caylan R, Titiz A, Falcioni M, De Donato G, Russo A, Tarbon A, et al. Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg. 1998;118:709-13.

Vrabec JT, Deskin RW, Grady JJ. Meta-analysis of pediatric tympanoplasty. Arch Otolaryngol Head Neck Surg. 1999;125(5):530-4.

Murbe D, Zahnert T, Bornitz M, Hutenbrink K. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope. 2002;112(10):1769-76.

Mohamad SH, Khan I, Hussain SSM. Is cartilage tympanoplasty more effective than fascia tympanoplasty. Otol Neurotol. 2012;33(5):699-705.

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

Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of ontological, surgical and patient-related factors in determining success in myringoplasty. Clin Otolaryngol. 2005;30:115-20.

Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg. 2008;139:386-90.

Bernal-Sprekelsen M. Cartilage palisade tympanoplasty. In: Hildeman H, Sudhoff H, eds. Middle ear surgery. New York: Springer-Verlag; 2006:44-8.

Solmaz F, Akduman D, Haksever M, Gundogdu E, Yanilmaz M, Mescioglu A. The audiological and take results of perichondrium attached cartilage island graft in tympanoplasty. Acta Otorhinolaryngol Ital. 2016;36:275-81.

Yurttas V, Yakut F, Kutluhan A, Bozdemir K. Preparation and placement of cartilage island graft in tympanoplasty. Br J Otorhinolaryngol. 2014;80:522-6.

Aidonis I, Robertson TC, Sismanis A. Cartilage shield tympanoplasty: A reliable technique. Otol Neurotol. 2005;26: 838-41.

Yilmaz MS, Guven M, Kayabasoglu, Akidil O, Kaymaz R. Anatomic and functional results of cartilage type I tympanoplasty in children and the evaluation of the success of surgery with parental perceptions. Turk Arch Otolaryngol. 2014;52:7-11.

Nevoux J, Roger G, Chauvin P. Cartilage shield tympanoplasty in children. Arch Otolaryngol Head Neck Surg. 2011;137:24-9.