Functional and anatomical outcomes following cartilage myringoplasty


  • Nidhi S. Mohan Department of ENT, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
  • Annapurna S. Mushannanavar Assistant Professor
  • Raveendra P. Gadag Department of ENT, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
  • Manjunath Dandinarasaiah Department of ENT, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India



Myringoplasty, Cartilage, Tympanoplasty


Background: Myringoplasty using cartilage graft is being popular in recent years because of its better graft uptake and optimal hearing outcome. Thickness plays an important role in achieving optimal hearing outcome and although studies have shown 0.5 mm thickness to give better hearing results, concrete studies are lacking.

Methods: A prospective study was conducted in the department of otorhinolaryngology at a tertiary-referral-hospital in North-Karnataka; India between January-December 2019, on 25 patients of chronic otitis media; mucosal inactive or quiescent with conductive hearing loss and intact ossicular chain who underwent cartilage myringoplasty using conchal cartilage of 0.5 mm thickness. Follow-up was done at 3, 4½ and 6 months postoperatively to assess graft uptake. Hearing assessment was performed at the end of 6 months postoperative period with pure-tone audiometry.

Results: The preoperative mean pure tone average was 33.64±9.42 dB which improved to 22.56±7.41 dB at 6 months. At 3 months and 4½ months, there were 21casess (84%) of complete graft uptake, 3 cases of partial graft uptake (12%) and one case of total graft rejection (4%). Whereas, at 6 months postoperative period complete graft uptake was seen in 22 cases (88%) with 1 case of total rejection (4%) and 2 cases of partial uptake (8%).

Conclusions: Cartilage myringoplasty using 0.5 mm thickness conchal cartilage offers good hearing outcome in addition to significant graft uptake. As the conchal cartilage can be easily harvested from the site of incision for the surgery it can be an important primary alternative to temporalis fascia.


Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol Head Neck Surg. 2010;62(4):421-6.

Mudry A. History of myringoplasty and tympanoplasty type I. Otolaryngol Head Neck Surg. 2008;139(5):613-4.

Wullstein H. Theory and practice of tympanoplasty. The Laryngoscope 1956;66(8):1076-93.

Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R. Comparison of cartilage with temporalis fascia tympanoplasty: A meta-analysis of comparative studies. Laryngoscope. 2017;127(9):2139-48.

Zahnert T, Hüttenbrink KB, Mürbe D, Bornitz M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol. 2000;21(3):322-8.

Aslıer YNG, Gürkan S, Aslıer M, Kirkim G, Güneri EA, Ikiz A. Sound energy absorbance characteristics of cartilage grafts used in type 1 tympanoplasty. Auris Nasus Larynx. 2018;45(5):985-93.

Abdelhameed W, Rezk I, Awad A. Impact of cartilage graft size on success of tympanoplasty. Braz J Otorhinolaryngol. 2017;83(5):507-11.

Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT. Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol. 2016;82(6):695-701.

Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997;107(6):1094-9.

Dornhoffer JL. Cartilage tympanoplasty. Otolaryngologic Clin N Am. 2006;39(6):1161-76.

Bhardwaj B, Singh J. Comparative Study of Hearing Improvement of Type 1 Tympanoplasty Using Temporalis Fascia and Conchal Cartilage as Graft Material. Indian J Otolaryngol Head Neck Surg. 2019;71(2):1174-8.

Lee CF, Chen JH, Chou YF, Hsu LP, Chen PR, Liu TC. Optimal graft thickness for different sizes of tympanic membrane perforation in cartilage myringoplasty: a finite element analysis. Laryngoscope. 2007;117(1):725-30.

Gamra OB, Mbarek C, Khammassi K, Methlouthi N, Ouni H, Hariga I et al. Cartilage graft in type I tympanoplasty: audiological and otological outcome. Eur Arch Otorhinolaryngol. 2008;265(7):739-42.

Onal K, Arslanoglu S, Songu M, Demiray U, Demirpehlivan IA. Functional results of temporalis fascia versus cartilage tympanoplasty in patients with bilateral chronic otitis media. J Laryngol Otol. 2012;126(1):22-5.

Shakya D, Nepal A. Long-term results of type I tympanoplasty with perichondrium reinforced cartilage palisade vs temporalis fascia for large perforations: A retrospective study. J Otol. 2021;16(1):12-7.

Nemade SV, Shinde KJ, Sampate PB. Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique. Auris Nasus Larynx. 2018;45(3):440-46.

Kim MB, Park JA, Suh MJ, Song CI. Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty. Auris Nasus Larynx. 2019;46:167-71.

Erden B, Gülşen S. Evaluation of Surgical and Audiological Outcomes of Push-Through Myringoplasty and Underlay Cartilage Tympanoplasty in Repairing Anterior Tympanic Membrane Perforations. J Craniofac Surg. 2020;31(6):1709-12.






Original Research Articles