Comparison of Temporalis Fascia and Full-Thickness Cartilage Palisades in Type-I Underlay Tympanoplasty for Large/Subtotal Perforations.

Abstract

To demonstrate surgical techniques and to compare the anatomical and functional outcomes between temporalis fascia and cartilage palisade grafting in type-I underlay tympanoplasty in patients with large/subtotal perforation. Temporalis fascia and cartilage palisade grafting were conducted in Group A and Group B, respectively, each containing 30 patients with large/subtotal perforations. Pure tone audiogram (PTA) and speech reception thresholds (SRT) were performed preoperatively and at each postoperative visit; i.e. at the end of Month 1,3,6, and 24. A 10-dB closure of air bone gap (ABG) and a 10-dB improvement in SRT were considered significant. The graft uptake rates were 80% and 96.7% in Group A and Group B, respectively, at the end of 24 months. In total, 90% of Group A and 88% in Group B had significant improvement in hearing (ABG ≥10 dB). The mean improvement in SRT in the fascia and cartilage groups was 10 dB and 9 dB, respectively. Seventy-five percent of patients in Group A and 60% of patients in Group B had a significant gain in SRT. Although both temporalis fascia and cartilage palisades can effectively be used for tympanic membrane (TM) grafting in difficult perforations, the latter is considered to be the better autograft, not only because of superior graft uptake but also because it results in a comparable hearing outcome.