Comparative Study of Temporalis Fascia and Tragal Cartilage Grafts Used in Myringoplasty

context: Tympanoplasty is a surgical procedure to repair tympanic membrane perforation and reconstruct the tympanic membrane and hearing, commonly done after chronic suppurative otitis media and trauma. Aims: To comparatively study the graft uptake in patients undergoing type 1 tympanoplasty using temporalis fascia vs sliced tragal cartilage Settings and Design: The study was a prospective case-control study carried out in the department of ENT, D.Y.Patil medical college, Pimpri Methods and Material: 50 patients undergoing tympanoplasty were divided into 2 groups randomly and operated using Temporalis fascia(TF) in 25 patients and Sliced tragal cartilage(STC) graft in the rest 25 patients. All cases were operated under local anesthesia. A post aural approach was implemented for the surgery. 25 patients were subjected to tympanic membrane repair with temporalis fascia graft and the remaining 25 with Tragal cartilage graft. For tragal cartilage graft incision was taken over the undersurface of the tragus and the obtained tragal cartilage was sliced to a thickness of 0.5 to 1.0 mm. Results: The mean duration of symptoms was 12.72 and 15.84 months in groups A and B respectively. A successful graft uptake was noted in 21(84%) patients in the TF group whereas it was noted in 24 patients in the STC group (96%). There was permanent perforation noted in 4 (16%) patients in the TF group and 1 (4%) patient in the STC group. The difference was non-significant with a P-value of 0.157 Conclusions: In the clinical study performed, postauricular tympanoplasty using the Sliced tragal cartilage was associated with better graft uptake and hence can be regularly employed for tympanic membrane repair compared to Temporalis fascia.

Objective:Fascia or cartilage can be used as grafts in tympanoplasty; however, the disadvantage of cartilage is that it causes stiffness and rigidity in the newly formed tympanic membrane. The aim of this study was to compare the long-term high-frequency tympanometry and audiometry outcomes of tympanoplasty using cartilage and fascia.Methods:Forty patients in whom tragal cartilage was used in type 1 tympanoplasty and 40 patients in whom temporal muscle fascia was used were included in the study. The preoperative and postoperative audiometries of the two groups were compared. Postoperative high-frequency tympanometry (224, 668, 800, and 1000 Hz) and air volume, compliance, and pressure differences of the two groups were also compared.Results:The mean age of the patients was 31.3±4.5 year. The success rates were 96% in the cartilage group and 92% in the fascia group. In the fascia group, the preoperative mean air bone gap was 27.9±97 decibels (dB), and the postoperative mean air bone gap was 19.1±7.6 dB. The postoperative mean air bone gap improvement was 8.8±9.9 dB; the difference was statistically significant. In the cartilage group, the preoperative mean air bone gap was 28.2±9.6 dB, and the postoperative mean air bone gap was 17.2±10.5 dB. The postoperative mean air bone gap improvement was 10.9±10.3 dB; the difference was statistically significant. When postoperative mean air bone gap improvement was compared, there was no statistical difference between the two groups. When high-frequency tympanogram values were compared, there were no significant differences between the two groups at 224, 668, 800, or 1000 Hz frequencies in terms of air volume, compliance, or pressure values.Conclusion:The use of temporal muscle fascia and cartilage in tympanoplasty is statistically similar when compared in terms of tympanic membrane repair, hearing gain, air volume, pressure, and compliance. For this reason, cartilage graft can easily be preferred in tympanoplasty, especially in revision cases and adhesive otitis media, without fear of stiffness or rigidity effects.

To compare the graft success and hearing results in patients who underwent cartilage island graft (CIG) myringoplasty and temporal muscle fascia graft (TFG) myringoplasty. Retrospective clinical study. Ankara Numune Training and Research Hospital, Otolaryngology Clinic, Ankara, from January 2013 to January 2018. Patients who underwent cartilage island graft myringoplasty and temporal muscle graft myringoplasty for chronic non-suppurative otitis media were inducted. Age, gender, preoperative audiologic examination results, postoperative audiologic examination, perforation site, graft material, preoperative microscopic examination and graft success were documented. A total of 116 patients were included in the study. The mean age of the patients was 35 ±15.3 years. Fifty-four patients were females and 62 were males. Temporal muscle fascia graft was applied to 68 (58.6%) patients, while cartilage graft was applied to 48 (41.4%) patients. The success rate of graft was found to be 80.2% (55 cases with graft success) in TFG; whereas, this rate was found to be 93.8% (45 cases with graft success) in CIG group. Cartilage island graft material had a better graft success in terms of graft endurance (p = 0.048). There was no statistically significant difference between the two graft materials in terms of postoperative hearing success (p = 0.29). Cartilage island grafts can be preferable for myringoplasty operations.

Background: Chronic otitis media (COM) is characterized by recurrent ear discharge and hearing loss secondary to tympanic membrane perforation. Type 1 tympanoplasty is the reconstruction of a perforated tympanic membrane with an intact and mobile ossicular chain. Among various autologous graft materials, temporalis fascia and tragal cartilage are commonly used. Objectives: The study determined to compare the hearing outcomes between tragal cartilage-perichondrium graft and temporalis fascia graft in type 1 tympanoplasty. Methodology: A quasi-experimental study included 60 cases of inactive chronic otitis media which was carried out in a tertiary care center. They were allocated into two groups of 30 patients each and were subjected to tympanoplasty using either tragal cartilage-perichondrium (group A) or temporalis fascia graft (group B) from 1st July 2022 to 30th June 2023. Results: In both groups, there was a statistically significant improvement in terms of mean air conduction threshold and a decrease in mean ABG postoperatively. The PTA changes in terms of success (P>0.05) showed no statistically significant difference between the groups. Conclusion: Both temporalis fascia and tragal cartilage-perichondrium are suitable graft materials for type 1 tympanoplasty and hearing gain through the tragal cartilage-perichondrium graft was better than the temporalis fascia.

Repairing nasal septal perforations (NSPs) is a complex procedure involving various surgical techniques, with success rates that vary significantly. As the size of the perforation increases, the surgical challenge intensifies and success rates tend to decline. This highlights the need for more effective and reliable repair methods. The aim of this study is to evaluate the effectiveness of a three-layer sandwich technique using a polydioxanone (PDS) plate, tragal cartilage, and temporalis fascia in repairing medium- and large-sized NSPs. Between March 2022 and November 2024, 21 patients who underwent surgery for nasal septal perforation at our clinic were evaluated. Of these patients, 6 had medium-sized perforations (11-20 mm), while 15 had large perforations (> 20 mm). In all cases, the perforation was repaired using a combination of a PDS plate, tragal cartilage, and temporalis fascia grafts. The patients were followed for an average of 8 months postoperatively. Complete closure of the perforation was defined as the criterion for surgical success. Complete closure of the septal perforation was achieved in 18 out of 21 patients (85.7%). Two patients experienced partial closure, yet both reported symptomatic improvement. No major postoperative complications were observed during the follow-up period. The surgical technique utilizing a combination of PDS plate, tragal cartilage, and temporalis fascia appears to be a reliable method for the repair of medium and large septal perforations, with a high success rate and a low risk of complications. Compared to techniques described in the existing literature, this approach offers significant advantages in terms of structural support and mucosal healing.

To systematically review the results of type 1 tympanoplasties with temporalis fascia (TF) vs cartilage grafts in patients with chronic otitis media. Eligible studies were identified from PubMed, Ovid, and EMBASE databases prior to November 2021. We analyzed the pure tone audiometry (PTA) and air-bone gap (ABG) data as continuous variables, and the success rate was analyzed as a dichotomous variable. Forty-four studies, including 4582 patients, were eligible. The cartilage graft overall morphologic success rate was higher than that of the TF grafts (P < .001). In the palisade (P < .004) and island grafts (P < .001) subgroups, the analysis was significantly different. However, there was no significant difference in the inlay butterfly grafts subgroup. For hearing outcomes, the analysis revealed that TF grafts had a smaller mean post-operative ABG (P = .009). However, the subgroup analysis showed no significant difference in the mean post-operative ABG. For PTA, there was no significant difference in hearing improvement. However, the palisade cartilage graft subgroup resulted in a better hearing outcome than the TF graft subgroup in terms of the mean post-operative PTA (P = .007). There was no significant difference in the functional success rate or mean ABG gain. Cartilage grafts have a better success rate than TF grafts in tympanoplasty. Both cartilage and TF tympanoplasty provided similar improvements in hearing outcome, while TF grafts generated a better outcome in post-operative ABG and palisade cartilage grafts in post-operative PTA. This may be related to the biological characteristics of the grafts. Further thorough studies need to be conducted.

BackgroundThe purpose of this study is to evaluate and compare surgical and hearing outcomes of tympanoplasty using temporalis fascia graft and tragal cartilage with or without mastoidectomy in children with tubotympanic chronic suppurative otitis media.Two hundred children with chronic suppurative otitis media of tubotympanic type with perforation were included in this prospective randomized study. They were divided randomly into four equal groups according to operation done. Group I underwent tympanoplasty using temporalis fascia graft with cortical mastoidectomy, while in the second group, tragal cartilage was used as a graft with mastoidectomy. Groups III and IV were done without mastoidectomy, with tragal cartilage for group III and temporalis fascia for group IV. One-year follow-up was done for all patients to evaluate graft success (means without perforation nor retraction). Audiological evaluation was done for all children preoperatively and 6 months postoperatively for patients with successful graft uptake.ResultThere were 170 patients (85%) with graft success postoperatively. Tympanoplasty using temporalis fascia graft showed highly statistically significant difference (P < 0.001) when compared to tragal cartilage as regards hearing improvement in patients with successful graft uptake, while there is no statistically significant difference as regards graft uptake (P = 0.039). Also, there is no statistically significant difference between different techniques with or without mastoidectomy (P = 0.165).ConclusionTympanoplasty using temporalis fascia without cortical mastoidectomy is the surgery of choice in children between 10 and 16 years old with tympanic membrane perforation as it showed highly statistically significant difference when compared to tragal cartilage graft as regards hearing improvement, with no statistically significant difference regarding successfully graft uptake.

Background: The prevalence of chronic otitis media in the Armed Forces is high. Moreover, management of high-risk perforation and atelectatic ear is an even greater challenge. It is necessary to assess the most viable management approach to achieve an optimal outcome. Aims and Objectives: We aimed to compare anatomical and audiological results in tympanoplasty for high-risk perforation and atelectasis using perichondrium-cartilage island (PCI) graft with temporalis fascia (TF) graft. Materials and Methods: A retrospective study was carried on 110 patients. Fifty-four patients and 56 patients underwent PCI graft and TF tympanoplasty, respectively. Postoperative graft integration rates and hearing outcomes were compared. Chi-square test was carried out to compare postoperative graft uptake. Postoperative audiological outcomes were compared using t-tests. Results: At 2-year follow-up, the graft take-up rate for PCI graft and TF graft was 96.29% and 82.14%, respectively (statistically significant). In the TF group, 17.86% had reperforation and recurrence of retraction pockets. In the PCI group, 3.71% had recurrent perforation. Furthermore, there was a statistically significant in the postoperative long-term improvement in pure-tone average air-bone gap in the cartilage island graft group (15.01 ± 3.53 db vs. 21.96 ± 4.09 db, P &lt; 0.05). Conclusion: PCI graft achieves better morphological and audiological results in comparison to TF graft in high-risk perforation and atelectatic ears. It has a higher graft integration rate and better long-term audiological outcomes.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy. The purpose of this study was to compare graft acceptance and auditory outcomes of tympanoplasty using cartilage versus temporalis fascia as graft material.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study included 40 consecutive cases of chronic otitis media in a tertiary care centre randomised in two groups of 20 patients each to be subjected to tympanoplasty using either tragal cartilage-perichondrium or temporalis fascia graft from January 2011 to November 2012. Graft uptake rates and subjective as well as objective hearing improvement at 2 months and 6 months postoperative follow-up were compared. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of presentation was 34.4 years (range 15-60 years). At 2 months post operatively, the graft uptake was better with tragal cartilage group (95%) than temporalis fascia (90%), while at the end of 6 months graft uptake was better with temporalis fascia (75%) compared to tragal cartilage (70%). Hearing improvement was better for tragal cartilage group compared to the temporalis fascia group at both 2 months and 6 months follow-up. The subjective improvement in hearing at the end of 6 months was also better for tragal cartilage- perichondrium group than the temporalis fascia group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both temporalis fascia and tragal cartilage–perichondrium are suitable graft materials for tympanoplasty. Graft uptake was superior with temporalis fascia, while hearing improvement was better with tragal cartilage- perichondrium, although the results were not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

INTRODUCTION The trend of same sitting bilateral myringoplasty has been sparkling the Otolaryngologists interest to go either microscopically or endoscopically as per the surgeon’s skill and comfort as unilateral myringoplasty would lead to considerable increase in operation cost, time and discomfort to the patient. MATERIAL AND METHODS This prospective, observational study was held in the Department of Otorhinolaryngology and Head and Neck Surgery (ORL-HNS), Universal College of Medical Sciences-Teaching Hospital (UCMS-TH). There were 30 patients with age range of 8-50 years. All cases were done under general as well as local anesthesia. Tragal cartilage and the temporalis fascia graft were used as a graft material. Graft uptake results were assessed after 12 weeks and the intraoperative and postoperative complications were observed. RESULTS 12 (40%) were male and 18 (60%) female. 15 (50%) patients had temporalis fascia graft and other 15 (50%) patients had tragal cartilage graft. 1 patient in each (fascia/cartilage) had a residual peroration in the subsequent operated side. The graft uptake success rate was 96.7% in both the temporalis fascia graft and the tragal cartilage graft myringoplasties with statistically significant association between type of graft and outcome (p=0.976. There were no significant complications observed during the 3 months follow up except the discomfort due to the bilateral mastoid dressing. CONCLUSION It is a safe, minimally invasive, and satisfactory procedure with a favourable and similar graft uptake success rate with the advantages of cost reduction, single anesthesia exposure, a low rate of postoperative complications and better cosmesis.

Objective: Chronic suppurative otitis media (CSOM) often necessitates surgical intervention, with tympanoplasty being a key procedure to restore hearing. The choice of graft material-sliced tragal cartilage versus temporalis fascia remains controversial due to potential differences in acoustic transmission and graft resilience. Methods: This prospective cohort study included 48 patients with CSOM, randomly assigned to receive either tragal cartilage or temporalis fascia grafts. Outcomes measured were hearing improvement and graft uptake, assessed through audiometric testing and otoscopic evaluations. Results: Both groups showed significant improvements in hearing postoperatively, with no statistically significant difference in hearing gain (P=0.3064). Graft uptake rates were comparable, with a non-significant lower reperforation rate in the cartilage group (P=0.551). Conclusion: The study supports the use of either sliced tragal cartilage or temporalis fascia as effective materials for tympanoplasty, offering substantial hearing improvement and reliable graft uptake.

This study aims to compare the efficacy of cartilage and temporalis fascia grafts in endoscopic tympanoplasty, focusing on graft uptake success rates and postoperative hearing outcomes. A prospective interventional randomized study was conducted from 2022 to 2024 in a tertiary care hospital, involving 60 patients aged 18-60 years with chronic otitis media (COM), tubotympanic type of disease. Patients were randomly divided into two groups: 30 underwent tympanoplasty with temporalis fascia grafts, and 30 received cartilage grafts. All surgeries were performed endoscopically using the transcanal approach. Graft uptake success was assessed postoperatively at 1, 3, and 12 weeks. Hearing outcomes were evaluated by comparing preoperative and postoperative air-bone gap (ABG) and pure-tone average (PTA) values at 500Hz, 1kHz, 2kHz, and 3kHz. Cartilage grafts provide superior structural stability and higher graft uptake success rates, while temporalis fascia grafts offer marginally better short-term hearing outcomes. Both materials significantly improve hearing, but cartilage exhibits greater resistance to re-perforation and long-term durability. The choice of graft material should be tailored to patient-specific factors for optimal surgical success and auditory restoration.

Conclusions: Tympanoplasty using cartilage grafts has a better graft take rate than that using temporalis fascia grafts. There are no significant differences between cartilage grafts and temporalis fascia grafts for hearing outcomes. Contrary to the sliced cartilage sub-group, full-thickness cartilage grafts generate better hearing outcomes than temporalis fascia grafts.Objective: Tympanic membrane perforation can cause middle ear relapsing infection and lead to hearing damage. Various techniques have been applied in order to reconstruct the tympanic membrane. Recently, cartilage grafts and temporalis fascia grafts have been widely used for tympanic membrane closure. A systemic review and meta-analysis was carried out based on published retrospective trials that investigated the efficacy of cartilage grafts and temporalis fascia grafts in type 1 tympanoplasty. Both graft take rates and mean AIR-BONE-GAP gains were analyzed.Methods: Cochrane Library, PubMed, and Embase were systematically searched. After a scientific investigation, we extracted the relevant data following our selection criteria. Odds ratio (OR) of graft take rates and mean difference (MD) of AIR-BONE-GAP gains were calculated within 95% confidence intervals.Results: Eight eligible articles with 915 patients were reviewed. The pooled OR for graft take rate was 3.11 (95% CI =1.94–5.00; p = 0.43) and the difference between the two groups was significant, which means that the cartilage grafts group got a better graft take rate than the temporalis fascia grafts group. The pooled MD for mean AIR-BONE-GAP gain was 1.92 (95% CI = −0.12–3.95; p < 0.000 01) and the difference was not significant. However, in the full thickness cartilage grafts sub-group, the pooled MD for mean AIR-BONE-GAP gains was 2.56 (95% CI =1.02–4.10; p = 0.14) and the difference was significant, which means that the full thickness cartilage grafts sub-group got a better hearing outcome than the temporalis fascia grafts group. On the contrary, the pooled MD of sliced cartilage grafts sub-group was 0.12 (95% CI = −0.44–0.69; p = 0.61) and there was no significant difference between the sliced cartilage grafts and temporalis fascia group.

Introduction:This study is about the comparison between endoscopic cartilage with perichondrium myringoplasty and endoscopic temporalis fascia myringoplasty in patients with inactive chronic suppurative otitis media.Aim: To compare the outcome of myringoplasty with temporalis fascia and cartilage along with perichondrium as graft material. Materials and Methods:This procedure in terms of comparison between pre-operative and post-operative hearing improvement, graft material, graft uptake, reperforation, and rejection in carefully selected patients.To compare the therapeutic outcome, improvement in hearing and perforation closure using Tragal cartilage with perichondrium and temporalis fascia as graft material in myringoplasty, a sample size of 90 Patients with a clinical diagnosis of chronic suppurative otitis media (inactive), were enrolled in the study. Observation and Result:After obtaining consent from patient, each patient preoperatively monitored for thorough otoscopic examination and pure tone audiometry.And they were divided into two groups; Group A -temporalis fascia graft and Group Bcartilage graft.Post operatively all the operated patients were asked to follow-up for 6 months.And each patient were postoperatively examined for otoscopic examination and pure tone audiometry. Conclusion:The result was statistically correlated and the final report came as both the surgeries were equally effective in successful closure of the perforation and there was statistically significant change in hearing ability among post-operated cartilage group with clinical improvement in hearing , as well as the reduction in airbone gap and less number of reperforation than the temporalis fascia group.

Parchment thin skin is a common problem associated with secondary rhinoplasty. When such skin is present, the underlying osseocartilaginous skeleton often becomes visible. Although many techniques have been used to treat the condition, we have found that an onlay graft of temporalis fascia is a most satisfactory method to cover the underlying osseocartilaginous framework or cartilage grafts. Temporalis fascia grafts have been advocated for this purpose in closed rhinoplasty; however, precise placement of the graft is difficult because the graft rolls. On the other hand, when used in open rhinoplasty, the graft may be placed accurately and secured under direct vision. This paper presents our experience with temporalis fascia grafts in open secondary rhinoplasties. Six female patients ages 31 to 57 underwent open secondary rhinoplasty. Five patients also had autologous cartilage grafts. Our average follow-up was 24 months; the minimum was 1 year, and the longest 7 years. All patients had excellent dorsal contours and osseocartilaginous irregularities were not observed. One patient developed a culture-proven nasal infection that responded successfully to antibiotics without removal of the fascia or cartilage graft, a result unlikely to occur when alloplastic materials are used. Biopsy of the temporalis fascia and cartilage grafts was obtained in one patient 12 months after placement. Microscopic examination confirms the long term viability of both grafted tissues, inasmuch as the temporalis fascia was vascularized and normal chondrocytes were present in the cartilage grafts. In summary, we have found that temporalis fascia grafts are a very satisfactory method for managing thin skin in open secondary rhinoplasty.