The Effect of Perforation Size and Site on Graft Success and Hearing in Cartilage Tympanoplasty with Mastoidectomy

Abstract

Objective: Chronic otitis media (COM) treatment aims to obtain a dry middle ear mucosa as much as possible with medical treatment and to closure the perforation in the tympanic membrane with the help of various graft materials after the eradication of the disease. In the presence of perforation, the surface area of the tympanic membrane is decreases, which causes a decrease in the sound pressure in the middle ear and adversely affect hearing. At present, there is no globally accepted standardization of factors affecting anatomical success of the graft and hearing outcomes. In this study, the effect of perforation size and site in the tympanic membrane on anatomic success and hearing was investigated in cases where autogenic composite tragal cartilage graft material was used.Methods: The patients were classified in groups with respect to the perforation site (central or marginal) and size (large if the perforation comprised more than 50% of the membrane area, and small if it comprised less) in the tympanic membrane. Anatomical success and preoperative–postoperative mean air bone gap pure tone average (ABG PTA) values of the graft were separately calculated for each group, and the ratios were compared.Results: In 69 patients who underwent Type 1 tympanoplasty with mastoidectomy, 48 tympanic membrane perforations were central, 21 were marginal, 46 were small, and 23 were large. Graft anatomic success rates were 91.7% in the central group, 66.7% in the marginal group, 89.1% in the small group, and 73.9% in the large group. The anatomical success of the central group was found to be significantly higher than that of the marginal group. No difference was found between the small and large groups. When the effect on hearing was calculated, the postoperative hearing levels were significantly better in the central group.Conclusion: Perforation size had no effect on the anatomical success and hearing level of the graft, while the perforation site affected both the anatomical success of the graft and the hearing level.