Optimal Graft Thickness for Different Sizes of Tympanic Membrane Perforation in Cartilage Myringoplasty: A Finite Element Analysis

Abstract

The purpose of this study was to determine, using finite element analysis, the optimal graft thickness for cartilage myringoplasty in patients with different sizes of tympanic membrane (TM) perforations. We developed a cartilage plate-TM-coupled model using high-resolution computed tomography and finite element analysis. The geometric models of the perforated TM were generated using Patran and ANSYS software. Three different sizes of TM perforations (15%, 55%, and 85%, representing small, medium, and large perforations, respectively) were created in the pars tensa. A cartilage plate was used to repair the eardrum perforation, and the new TM-cartilage coupled complex was loaded into our three-dimensional biomechanical model for analysis. The frequency-amplitude responses for different cartilage thicknesses were compared with those for natural TM. Our results show that, first, in cases with 85% perforation, the frequency-amplitude responses that were most similar to natural TM at lower frequencies were for graft thicknesses of 0.2 mm and for 0.1 mm at higher frequencies. Second, in cases with 55% posterior perforation of the TM, assessment of the predicted vibration amplitude of different thicknesses of the cartilage plate showed that a cartilage plate of less than 0.2 mm had a frequency response function similar to that of a natural TM in umbo and stapes footplate displacement. Finally, for a central perforation involving 15% of the TM, a cartilage plate of less than 1.0 mm showed a frequency response function similar to that of TM in umbo and stapes-footplate displacement. On the basis of our biomechanical analysis, the optimal thickness of a cartilage graft for myringoplasty appears to be 0.1 to 0.2 mm for medium and large TM perforations. For small perforations, a cartilage of less than 1.0 mm is a good compromise between mechanical stability and low acoustic transfer loss.