Cartilage and tympanoplasty

Area of Science:

• Otolaryngology
• Surgical Innovation
• Regenerative Medicine

Background:

• Tympanic membrane (TM) reconstruction traditionally uses fascia or perichondrium.
• Recurrence of retraction pockets and cholesteatoma remain challenges in TM surgery.
• Existing techniques for blunting and lateralization have variable outcomes.

Purpose of the Study:

• To evaluate the efficacy of cartilage tympanoplasty compared to traditional grafts.
• To assess morphological and hearing outcomes in various TM conditions.
• To compare recurrence rates in cholesteatoma surgery using different cartilage reinforcement strategies.

Main Methods:

• Retrospective comparison of 80 patients with cartilage TM reinforcement versus 100 patients with fascia/perichondrium.
• Analysis of retraction pocket recurrence rates at 3 years post-surgery.
• Evaluation of cartilage tympanoplasty with skin grafting for severe blunting/lateralization.
• Assessment of 390 adult patients undergoing staged canal wall up (ICW) cholesteatoma surgery with varying cartilage reinforcement and ossiculoplasty techniques.

Main Results:

• Cartilage reinforcement showed significantly lower retraction pocket recurrence (8% partial, 0% total) compared to fascia/perichondrium (24%).
• Cartilage tympanoplasty with skin graft yielded good results in 3 of 6 cases of severe blunting/lateralization.
• Removing the malleus and total TM cartilage reinforcement in ICW cholesteatoma surgery statistically reduced recurrence rates.
• The described cartilage tympanoplasty technique with hydroxylapatite prosthesis provided good hearing results.

Conclusions:

• Cartilage tympanoplasty, particularly with total TM reinforcement, is superior in preventing retraction pocket recurrence.
• This technique offers a viable solution for severe TM blunting and lateralization.
• Modified ICW cholesteatoma surgery using complete cartilage TM reinforcement and malleus removal improves recurrence rates and hearing outcomes.