Fascia Tympanoplasty Research Articles

Platelet rich fibrin augmented tympanoplasty versus cartilage tympanoplasty: a randomized clinical trial.

The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts.

A narrative review of the management of pars flaccida tympanic membrane retractions without cholesteatoma.

Review the effectiveness of surgical and non-surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Narrative review. ENT and otology services worldwide. Patients with non-cholesteatoma tympanic membrane retractions. Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Few high-quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence.

Comparative Study of Temporalis Fascia Graft versus Cartilage Shield Tympanoplasty in Chronic Otitis Media - Mucosal Type

Introduction: Tympanoplasty is the procedure of choice for surgical correction of tympanic membrane perforation triggered by either chronic otitis media or trauma. Various types of autologous grafts have been used to close tympanic membrane perforations among which temporalis fascia and tragal cartilage are preferred, due to their anatomic proximity, ease of harvesting and suppleness.
 Aims: To compare clinical and audiological outcomes of type 1 tympanoplasty where temporalis fascia and tragal cartilage were used as the graft material.
 Methods: A prospective study was conducted on 50 patients of ages ranging from 10 to 50 years with Chronic Otitis Media - Mucosal. All the patients underwent type 1 tympanoplasty and were categorized into Group-A (Temporalis fascia graft) and Group-B (Cartilage graft), each group comprising of 25 patients. Graft uptake rate, hearing gain and air bone gap closure were compared between the groups in 4 and 8 weeks after surgery.
 Results: Out of total 50 patients, 20 were male and 30 were female. The average age of the patients was 28.20 years. The total hearing gain in the whole series was 14.94 dB while the total air bone gap closure was 14.78 dB respectively. The difference between pre and post-operative hearing was statistically significant for both air bone gap and air conduction, (P<0.05) in the whole series. There was 15.56 dB improvement in mean hearing threshold and 15.64 dB mean air bone gap closure in the fascia group, compared to 14.32 dB improvement in mean hearing and 13.92 dB mean air bone gap closure in the cartilage group. Graft uptake rate in the temporalis fascia group was 84% and the cartilage group was 92 % with significant difference in the graft uptake rate between the groups.
 Conclusion: The graft uptake rate and hearing results of tragal cartilage are comparable to those of temporalis fascia. Cartilage tympanoplasty has a higher graft uptake rate with low failure rate and also shows a high degree of reliability in high risk cases. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome post-operatively. Thus, cartilage tympanoplasty is recommended as an alternative option.

A Prospective Randomised Comparative Study Between Cartilage and Fascia Tympanoplasty in a Tertiary Care Hospital to Look for Better Alternative in High Risk Cases.

CSOM patients are most commonly managed surgically by type I tympanoplasty using either cartilage shield technique or underlay grafting technique. In our study, we have compared the graft uptake and hearing results of type I tympanoplasty using temporalis fascia and cartilage shield, and also reviewed the literature regarding the results of these two methods. 160 patients aged between 15 and 60 years were randomized into two groups of 80 patients each, with odd numbers subjected to conchal or tragal cartilage shield grafting in group I, while in group II with even numbers, the patients underwent temporalis fascia grafting by underlay technique. Three months post-surgery, the graft uptake was seen in 76 patients (95%) in the cartilage shield group as compared to 58 patients (72.5%) in the temporalis fascia group, which was statistically significant between the two groups [Fisher's exact value = 0.000]. The uptake rate was much higher in cartilage shield graft as compared to fascia graft even in complicated cases like revision tympanoplasty (TP), discharging ear, subtotal perforation and retracted/adhered TP. Also, the hearing improvement in fascia and cartilage shield group was not statistically significant comparing pre- and post-operative patients, indicating that there was not much difference in audiological outcomes between the two groups. We advocate the use of cartilage shield graft as a substitute for fascia graft in all feasible cases as well as in complicated situations to improve the success rate of type I tympanoplasty, without compromising on the hearing improvement, as seen in our study. The online version contains supplementary material available at 10.1007/s12070-022-03175-1.

Comparison of Graft Uptake and Post Operative Hearing between Cartilage Rim Augmented Fascia and Temporalis Fascia Tympanoplasty

Comparison of Graft Uptake and Post Operative Hearing between Cartilage Rim Augmented Fascia and Temporalis Fascia Tympanoplasty

Comparison of Inlay Cartilage Butterfly and Underlay Temporal Fascia Tympanoplasty.

ObjectiveTo systematically review the results of inlay cartilage butterfly tympanoplasty and standard underlay temporal fascia tympanoplasty for anatomic and functional end points.Data SourcesPubMed, Embase, MEDLINE, and Virtual Health Library (VHL/Lilacs) databases were searched from inception through April 2, 2021. No restrictions on language, publication year, or publication status were applied.Review MethodsThe meta-analysis included data from articles that met inclusion criteria and were extracted by 2 authors independently. The PRISMA statement was followed. Risk of Bias 2.0 and Newcastle-Ottawa Scale were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap.ResultsTen studies were included, 9 cohort studies and 1 randomized clinical trial, with 577 patients. The graft take rate was 82.8% in the butterfly cartilage inlay tympanoplasty group and 85.2% in the temporal fascia underlay tympanoplasty group (relative risk, 1.01; 95% CI, 0.93-1.11; I2 = 42%, P = .08). The air-bone gap reduction ranged from 6.1 to 11.28 in the butterfly cartilage inlay group and from 5.2 to 12.66 in the temporal fascia underlay group, with a mean difference between groups of −2.08 (95% CI, −3.23 to −0.94; I2 = 58%, P = .04), favoring temporal fascia underlay.ConclusionThe 2 tympanoplasty techniques analyzed here produced similar results in terms of successful reconstruction of the tympanic membrane and reduction in the air-bone gap. Neither age nor follow-up length of time influenced outcomes.

Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge and perforation. It is the commonest ear problem in adult and children. Most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. Inactive mucosal variety of COM presents with the perforation in tympanic membrane with non-inflamed middle ear mucosa. The treatment of inactive mucosal variety of COM is Type 1tympanoplasty. It can be done by conventional temporalis fascia or cartilage graft. Both have some merits and demerits. Objective: To compare the the outcomes between reinforcement cartilage graft and temporalis fascia graft in type -1 tympanoplasty. Methods: 86 (43 patients in each group) patients with COM (inactive mucosal) who were admitted in the department of Otolaryngology – Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2018 to June 2019, and had fulfilled the inclusion and exclusion criteria were selected for the study. History, examinations, investigations were done. All patients underwent type 1 tympanoplasty. Prior to surgery relevant investigations were done and informed written consent was taken from all patients. In Group-A reinforcement cartilage tympanoplasty cases and in Group-B temporalis fascia tympanoplasty cases were placed. Post-operative graft uptake rate and hearing gain were compared in two groups Results: The surgical outcomes between reinforcement cartilage tympanoplasty in comparison with temporalis fascia tympanoplasty showed no significant difference of graft uptake rate and hearing gain. Conclusion: Cartilage tympanoplasty has been practised for reconstruction of perforated tympanic membrane in COM since long with variable results. Graft uptake rate in cartilage reinforcement is comparatively better than temporalis fascia graft. So, reinforcement cartilage graft can be adopted as an alternative to temporalis fascia graft in type- I tympanoplasty. Bangladesh J Otorhinolaryngol 2021; 27(2): 104-110

Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media.

To study the efficacy of interlay cartilage rim augmented fascia tympanoplasty in mucosal chronic otitis media. A retrospective, observational study was conducted in a tertiary care hospital including charts of patients spanning a duration of one year, where 15 patients diagnosed with chronic otitis media-mucosal disease with large and subtotal perforations (with or without ossicular erosion), and had undergone interlay cartilage rim augmented fascia tympanoplasty, were analysed for morphological and functional improvement following surgery. Pre- and post-operative otomicroscopic examination and pure tone audiometry findings were the parameters considered. 86.6% had a well-healed, non-retracted, undisplaced mobile neotympanum, 6.7% who underwent a type III (minor columella) tympanoplasty had a medialised neotympanum and 1 subject (6.7%) who underwent a type I tympanoplasty had a residual pinpoint perforation which healed with conservative management. The overall morphological success rate was 93.3%. The mean hearing gain following surgery was 20.84dB with a minimum gain of 10dB and a maximum gain of 30dB. The mean air-bone gap closure gain achieved was 19.2dB with a minimum gain of 6.4dB and a maximum gain of 30dB. The interlay cartilage-fascia rim augmentation tympanoplasty is a novel, effective graft model suggested for large and sub-total central perforations. Future randomized studies with a larger sample size could be performed with longer follow-up to assess the outcome of this technique.

Comparison of results between cartilage tympanoplasty and temporalis fascia tympanoplasty.

Objectives: To compare the results after performing cartilage tympanoplasty and temporalis fascia tympanoplasty. Study Design: Analytical/Observational study. Setting: Two different hospitals. Social Security Landhi Hospital Karachi and Al-Tibri Medical College & Hospital Malir Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations after taking antibiotics. Age ranges between 18 to 40 years. Patients were divided into two groups, group-I and group-II. In group-I, temporalis fascia tympanoplasty performed under microscope with post aural approach and in group-II, tragal cartilage tympanoplasty performed with the oto-endoscope via permeatal approach. Observed and compare the results of both procedure after 1 day, after 1 week, after 1 month and after 2 months. Variables were bleeding, pain, hearing assessment with pure tone audiometry (PTA) in which air conduction, bone conduction and air-bone gap (AB-gap) measured, Vomiting, vertigo and duration of surgery. Weber test done in all patients on very next day after surgeries in both groups to exclude the damage of vestibulo-cochlear system. Integrity of grafted tympanic membrane examined with oto-endoscope. Results: Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Vomiting and vertigo not found after tympanoplasty in both groups which indicate the safety of vestibular system. There was no blood soaked guaze seen after tympanoplasty in group-II (cartilage tympanoplasty). Bleeding was less in group-II as compare to group-I. 37 patients out of 38 had intact grafted tympanic membrane in group-I while all (38) patients had intact grafted tympanic membrane in group-II. Mean duration of surgery was 65.1 +3.7 minutes in group-II (cartilage tympanoplasty) and mean duration of surgery was 82.0 + 5.6 minutes in group-I (temporalis fascia tympanoplasty). P value was <0.001 is significant. Duration of surgery was less in group-II. Hearing was also improved in both groups after tympanoplasty. Post-operated AB-gap reduction seen in all patients of both groups. Conclusion: Results of both temporalis fascia and cartilage tympanoplasty were almost same but cartilage tympanoplasty is better because it consumed less time, less post-operated bleeding and perception of pain were also less.

Half Disc Cartilage Tympanoplasty: A Newer Technique Versus Temporalis Fascia Tympanoplasty-Retrospective Analysis.

Tympanoplasty is a surgical procedure performed for the closure of tympanic membrane perforation. The present study was conducted to compare the outcomes of a newer technique of cartilage tympanoplasty which the author has named as half disc cartilage tympanoplasty and temporalis fascia tympanoplasty in the following areas-the improvement in hearing, frequency specific improvement in hearing, graft uptake rate. Retrospective study was conducted in the Department of Otorhinolaryngology Rajagiri Hospital from February 2018 to February 2020. 40 patients with moderate central, subtotal and anterior perforation were included in the study. 20 patients (group A) underwent tympanoplasty with temporalis fascia graft and 20 patients (group B) underwent tympanoplasty with temporalis fascia and cymba concha with perichondrium as the support in the anterior half. Both groups were compared for the improvement in hearing and frequency specific improvement in hearing. Follow up period for the study was 6months. Chi square and t tests were used to assess association and as tests of significance. In our present study hearing improvement following half disc cartilage tympanoplasty was better than temporalis fascia tympanoplasty. In post half disc cartilage tympanoplasty and post temporalis fascia tympanoplasty hearing gain was maximum in low frequencies. Half disc cartilage tympanoplasty is superior to temporalis fascia tympanoplasty in terms of hearing gain. Low frequency hearing shows significant improvement following tympanoplasty.

Is Cartilage a Better Option than Temporalis Fascia for Grafting in Type 1 Tympanoplasty?: An Institutional Study.

Chronic suppurative otitis media (CSOM) is one of the important health problems in our country. The present study was conducted to compare Cartilage and Temporalis Fascia as graft material for Type 1 Tympanoplasty for CSOM. The study was conducted toassess hearing outcome as average AB Gap closure respect to age of the patient and size of perforation, to evaluate Graft uptake with both grafting material and with respect to size of perforation and to find the complication rate. Prospective Comparative study was conducted on 60 patients of CSOM divided in two groups and randomly selected for cartilage Typanoplasty and Temporalis Fascia Tympanoplasty. Hearing result are compared pre and post operative. Group 1(cartilage): Average AB Gap closure was 55% for Small CP, 50% for Moderate CP, 40% for Large CP, 38% for Subtotal CP. In Group 2(Temoralis Fascia): Average AB Gap closure was 81% for Small CP, 72% for Moderate CP, 64% for Large CP, 52% for Subtotal CP. In Group 1, 46% and in Group 2, 69% Average closure of AB gap observed at 12weeks post operatively. The p value for our study was found to be < 0.05, which statistically indicates better hearing outcome with TF graft. Cartilage is an excellent grafting material because of its accessibility, resistance to negative pressure and high graft uptake rate. Temporalis Fascia is easily available with similar thickness to TM. It showed inferior morphological uptake rate compared to cartilage though functional gain was better.

Is cartilage shield tympanoplasty better than fascia tympanoplasty

&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 in tympanoplasty. The aim of the study was to compare the graft uptake rates and hearing results in case of temporalis fascia and cartilage in type 1 tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 400 cases with large, subtotal and total perforation were considered in the study. All the selected patients were divided into two groups. Group A in which temporalis fascia graft was used and including 200 cases and cartilage graft was used in Group B patients including 200 cases. Pure tone audiometry was performed preoperatively and postoperatively at 6 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The graft uptake rate was more than 90 percent and more than 80 percent in Group B respectively at the end of 14 week. There was no statistical difference in hearing improvement in both the groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Tragal cartilage graft can be used in cartilage tympanoplasty especially in moderate, large and subtotal perforations. The graft has better uptake rate, less graft failure and hearing improvement results were comparable to temporalis fascia graft.&lt;/p&gt;

Comparative study of cartilage tympanoplasty with temporalis fascia tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of our study is comparison of effectiveness of cartilage (conchal or tragal) tympanoplasty with temporalis fascia tympanoplasty in terms of graft uptake and audiological outcomes. Help of following databases were taken: MEDLINE, emedicine, Google scholar, and the PubMed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We studied the outcome of two different type of graft material (cartilage and temporalis fascia). Who underwent type 1 tympanoplasty at department of otorhinolaryngology, RUHS College of Medical Sciences, Jaipur from November 2015 to November 2018. Total 80 patients were divided in two groups, 40 patients underwent cartilage grafting while 40 patient’s tympanoplasty was done using temporalis fascia graft. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The successful graft uptake rate for the fascia group was 90%, and that for the cartilage group was 97.5%. Though initial audiological improvements were better in fascia graft group, long term results were similar in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The use of cartilage tympanoplasty has similar outcomes to temporalis fascia grafting for audiological purpose. But successful uptake rate is better for cartilage as it is elastic, more resistant to resorption and retraction from more negative middle ear pressure.&lt;/p&gt;

Palisade cartilage fascia tympanoplasty: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cartilage tympanoplasty is one of the procedures performed for treatment of tympanic membrane perforation, more so in those cases associated with eustachian tube dysfunction, or failed previous temporalis fascia type 1 tympanoplasty. Palisade cartilage tympanoplasty, initially described by Heerman utilizes strips of conchal cartilage to reconstruct the tympanic membrane.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study which was presented with 64 patients who underwent palisade cartilage- fascia type I tympanoplasty and compared their hearing outcome after three years of post-operative period. Indication to perform a cartilage-fascia tympanoplasty was either an atelectatic middle ear or large perforation of the drum or residual or recurrent perforation following previous temporalis fascia myringoplasty. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average pre-operative hearing loss was 37.38±15.04 dB, while post-operative hearing loss was 20.47±8.85 dB, giving an average gain of 17.03 dB. Of 64 patients, 93.7% patients had fully healed neotympanum.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Palisade cartilage fascia tympanoplasty is an effective method to ensure graft uptake and at the same time achieve competitive hearing gain. The reliability of this technique lies in its use for recurrent and residual perforations of the tympanic membrane as well as in cases associated with eustachian tube dysfunction.&lt;/p&gt;

Is Cartilage Shield Tympanoplasty better than Fascia Tympanoplasty

Background Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy in Tympanoplasty. The aim of the study was to compare the graft uptake rates and hearing results in case of temporalis fascia and cartilage in type 1 tympanoplasty Material and Method A total of 400 cases with large, subtotal and total perforation were considered in the study. All the selected patients were divided into two groups. Group A in which temporalis fascia graft was used and including 200 cases and cartilage graft was used in group B patients including 200 cases. Pure tone audiometry was performed preoperatively and postoperatively at 3 months, 6 months and 12 months. Results The graft uptake rate were more than 90 percent and more than 80 percent in group B respectively at the end of 14 week Conclusion From our study we came to the conclusion that both cartilage shield graft and temporalis fascia graft can be used as graft materials independently in Tympanoplasty. But the results of our study suggest that cartilage shield Tympanoplasty can be considered as the first line treatment in chronic otitis media especially with moderate/large/subtotal perforations with good success rate and hearing improvement.

Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results.

Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ± 6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.

Is Cartilage Shield Tympanoplasty better than Fascia Tympanoplasty

Background Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy in Tympanoplasty. The aim of the study was to compare the graft uptake rates and hearing results in case of temporalis fascia and cartilage in type 1 tympanoplasty Material and Method A total of 400 cases with large, subtotal and total perforation were considered in the study. All the selected patients were divided into two groups. Group A in which temporalis fascia graft was used and including 200 cases and cartilage graft was used in group B patients including 200 cases. Pure tone audiometry was performed preoperatively and postoperatively at 3 months, 6 months and 12 months. Results The graft uptake rate were more than 90 percent and more than 80 percent in group B respectively at the end of 14 week Conclusion From our study we came to the conclusion that both cartilage shield graft and temporalis fascia graft can be used as graft materials independently in Tympanoplasty. But the results of our study suggest that cartilage shield Tympanoplasty can be considered as the first line treatment in chronic otitis media especially with moderate/large/subtotal perforations with good success rate and hearing improvement.

A comparison of graft uptake and hearing improvement in endoscopic cartilage tympanoplasty and endoscopic emporalis fascia tympanoplasty

A comparison of graft uptake and hearing improvement in endoscopic cartilage tympanoplasty and endoscopic emporalis fascia tympanoplasty

DOUBLE ANTERIOR TEMPORALIS FASCIA MYRINGOPLASTY IN LARGE CENTRAL TYMPANIC PERFORATION

ABSTRACT Objective: This study aimed to study double anterior temporalis fascia myringoplasty in primary safe large central tympanic perforation regarding graft uptake and hearing gain. Methods: The present work included the study of fourteen (14) patients who presented with symptoms suggestive of chronic suppurative otitis media (CSOM) to E.N.T. outpatient clinic, Zagazig university hospitals. All patients were suffering from mucosal type of CSOM and the tympanic membrane perforations are of large size; subtotal perforation. Temporalis Fascia Tympanoplasty type I operation was performed for all patients with double anterior layer technique. Results: This study included Fourteen (14) patients suffering from mucosal type of CSOM. They included 5 males (35%) and 9 female (65%). The age of patients at the time of presentation was maximum of 37 years and minimum of 12 years with a mean of 23.71 years. The main presenting symptom was hearing impairment in all the fourteen (100%) patients. Ear discharge was the second common presenting symptom. The rate of success in our fourteen cases was 100% in our study, the audiometric tests performed at the 3rd postoperative month revealed that the mean air-bone gap decreased by 20±1dB. Key words; Underlay tympanoplasty, Over-underlay tympanoplasty, Large perforation

Comparative study of temporalis fascia graft versus cartilage shield tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to demonstrate the comparative study in terms of graft uptake rate &amp;amp; hearing gain between cartilage shield tympanoplasty and temporalis fascia tympanoplasty in patients with moderate/ large/subtotal perforation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 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 12&lt;sup&gt;th&lt;/sup&gt; month, a greater than 10-dB closure of air bone gap (ABG) was considered significant. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 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.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Conchal cartilage is a possible graft material for cartilage shield tympanoplasty, especially in moderate, large &amp;amp; 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.&lt;/p&gt;