Tragal cartilage in tympanoplasty: anatomic and functional results in 306 cases

Cartilage is the grafting material of choice in advanced disorders of the middle ear while the indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Aim of the present study was to report personal experience with "tragal cartilage shield" tympanoplasty. The study focused on 306 adult patients (236 primary procedures and 70 revisions from January 2003 to June 2007). Mean post-operative follow-up was 37 months (range 1-66). The following parameters were evaluated: graft take, change between the pre- and post-operative pure-tone average air-bone gap (PTA-ABG), post-operative complications. Graft take was achieved in 304 patients (99.35%) and there were no immediate post-operative complications. The overall average pre-operative pure-tone average air-bone gap was 43.79 +/- 7.07 dB, whereas the post-operative (1 year after surgery) pure-tone average air-bone gap was 10.43 +/- 5.25 dB (p < 0.0001). Statistically significant improvement was observed up to 5 years after surgery. This study reveals that tragal cartilage shield tympanoplasty is a reliable technique, in fact it has a high degree of graft take and hearing results are satisfactory. Furthermore, the cartilage is a satisfactory grafting material because it is easily accessible, easy to adapt, resistant to negative middle ear pressures, stable, elastic, well tolerated by the middle ear, resistant to resorption. Therefore, we also recommend its use in less severe middle ear disorders, in which the functional outcome is more essential.