Results of Endoscopic Transcanal Tympanoplasty with Inlay Tragus Cartilage Graft

By June 7, 2019

Madruga,Thais1; Nogueira-Neto, Francisco1; Suzuki, Flavia1;  Onishi, Ektor Tsuneo1; Testa, Jose Ricardo1
1 Universidade Federal de São Paulo – UNIFESP

Tympanoplasty is the procedure aimed to recover the tympanic membrane, restoring its protection to the middle ear and sound conduction mechanism. It can be performed using several different grafts and approaches. The aim of this study was to determine the rate of total graft integration (TGI) and auditory results of endoscopic transcanal myringoplasty with inlay tragus cartilage graft.

This is a retrospective case review conducted in a tertiary referral center. Patients with central tympanic membrane perforations and no ossicular chain impairment who underwent endoscopic transcanal tympanoplasty with butterfly inlay tragus cartilage graft were included. Patients were evaluated for the rate of graft take and their auditory parameters were compared preoperatively and postoperatively, using paired T-Student test.

We report 200 endoscopic tympanoplasties with butterfly cartilage. TGI was obtained in 182 (91%) and re-perforations occurred in 18 (9%). Preoperative air-bone auditory gap was on average 18 (standard deviation [SD] = 8,9) and postoperative was 11 (SD=10), p=0,0005. Preoperative Speech Recognition Threshold (SRT) was on average 35 (SD=13,5) and postoperative was 27 (SD=14,4), p=0,0002. Preoperative tritonal average of 500, 1000 and 2000Hz thresholds was 33 (SD=14,3) and postoperative was 24 (SD=15), p=0,0002. There was a concern that cartilage grafts strength and stiffness could have negative impact on sound conduction, however literature shows similar anatomical and functional results between butterfly cartilage tympanoplasties and conventional underlay cartilage or fascia tympanoplasties.

Endoscopic transcanal tympanoplasty with inlay cartilage graft presented TGI rate of 91% and auditory parameters improved significantly after surgery.