Comparative study of temporalis fascia graft versus cartilage shield tympanoplasty

Gaurav Chhabra, Amresh K. Saxena, Sanjay Kumar


Background: The objective of the study was to demonstrate the comparative study in terms of graft uptake rate & hearing gain between cartilage shield tympanoplasty and temporalis fascia tympanoplasty in patients with moderate/ large/subtotal perforation.

Methods: Cartilage shield tympanoplasty and temporalis fascia tympanoplasty were conducted in Group A and Group B, respectively, each containing 30 patients with moderate/large/subtotal perforations. Pure tone audiogram (PTA) was performed preoperatively and at postoperative visit i.e. at 12th month, a greater than 10-dB closure of air bone gap (ABG) was considered significant.  

Results: The graft uptake rates were 93.33% and 86.67% in Group A and Group B, respectively, at the end of 10th week. In total, 90% in Group A and 88% in Group B had significant improvement in hearing (ABG ≥10 dB) at 12th week of surgery.

Conclusions: Conchal cartilage is a possible graft material for cartilage shield tympanoplasty, especially in moderate, large & subtotal perforation, as it is showed superior autograft as compared to temporalis fascia, not only because of better graft uptake rate and less partial failure but also due to the comparable hearing improvement in terms of mean AB gap in both types of graft materials.


Cartilage, Temporalis fascia, Tympanoplasty

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Levinson RM. Cartilage-Perichondrial Composite Graft Typanoplasty in the Treatment of Posterior Marginal and Attic Retraction Pockets. Laryngoscope. 1987;97:1069-74.

Wullstein HL. Funktionelle operation im mittelohr mit hilfe des freien spaltlappentransplantates. Arch Ohren-Nasen-u.Kehlkopfh. 1952;161:422–35.

Zöllner F. The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol. 1955;69:657–9.

Salen B. Tympanic Membrane Grafts of Full Thickness Skin, Fascia and Cartilage with Its Perichondrium, an Experimental and Clinical Investigation. Acta Oto-Laryngologica. 1968;244:5-73.

Tabb HG. Closure of perforations of the tympanic membrane by vein grafts: a preliminary report of 20 cases. Laryngoscope. 1960;70:271–4.

Salen B. Tympanic membrane grafts of full-thickness skin, fascia and cartilage with its perichondrium, an experimental and clinical investigation. Acta Otolaryngol Suppl Stockh. 1968;(244):5–73.

Nissen AJ, Nissen RL, Yonkers AJ. Ahistorical review of the use of bone and cartilage in otologic surgery. Ear Nose Throat J. 1986;65:493–6.

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

Vashishth A, Mathur NN, Choudhary SR, Bhardwaj A. Clinical advantages of cartilage palisades over temporalis fascia in type I tympano- plasty. Auris Nasus Larynx. 2014;41(5):422–7.

Güneri EA, Ikiz AO, Erdağ TK, Sütay S. Cartilage tympanoplasty: indications, techniques, and results. J Otolaryngol Head Neck Surg. 2009;38(3):362–8.

Demirpehlivan IA, Onal K, Arslanoglu S, Songu M, Ciger E, Can N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Otorhinolaryngol. 2011;268(3):471–4.

Yetiser S, Hidir Y. Temporalis Fascia and Cartilage-Perichondrium Composite Shield Grafts for Reconstruction of the Tympanic Membrane. Annals Otol Rhinol Laryngol. 2009;118:570-4.

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

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.