Cartilage Tympanoplasty: Indications, Techniques, and Results

Objective: To present our experience with cartilage grafts in ear surgery and review the indications and techniques. Design: Retrospective clinical evaluation. Setting: There were 25 ears of 23 patients in our series, with a mean follow-up of 24.7 months (range 12-53). Methods: The surgerieswere eight type I tympanoplasties, four type III tympanoplasties without mastoidectomy, and four canal wall up and nine canal wall down tympanomastoidectomies with ossicular reconstruction. Nine total ossicular replacement prostheses and eight partial ossicular replacement prostheses were used in the ossicular reconstructions. Fourteen cartilage grafts were harvested from the concha and 11 from the tragus; the grafting technique was total cartilage plate in 18 ears, cartilage shield in 6 ears, and palisade in 1 ear. Main Outcome Measures: Otomicroscopic, otoendoscopic, and audiologic examinations before and after the surgeries. Results: There were no cases of graft loss, and no perforations were observed. The postoperative hearing was stable in 9 ears (36%) and improved in 16 ears (64%), with a mean postoperative hearing gain of 20 dB (range 10-40 dB). We concluded that cartilage grafts are ideal in cases of retraction and adhesion, as well as sclerosis, atrophy, and infection. Conclusions: Cartilage can be used as a total, shield, or palisade graft in ear surgery. These grafts are stable and reliable, and the postoperative hearing results are as good as or even better than fascia grafting.