Butterfly Cartilage Inlay Technique for Repairing Small to Large Tympanic Membrane Perforations

This study compared the anatomical and functional outcomes of butterfly cartilage inlay tympanoplasty between small and medium-to-large tympanic membrane (TM) perforations.

We retrospectively evaluated 50 patients (50 ears) who underwent butterfly cartilage inlay tympanoplasty between 2017 and 2023. Perforation sizes were quantitatively measured using ImageJ and categorized into small (< 20%, n = 28) and medium-to-large-sized (≥ 20%, n = 22) groups. Graft success, operative time, complications, and preoperative and postoperative hearing thresholds were evaluated.

The graft success rate was high and comparable between the small and medium-to-large groups (92.9% vs. 86.4%; p = 0.643), as was the median operative time (32.0 vs. 30.5 min; p = 0.531). Both groups achieved significant postoperative reductions in the air-bone gap (ABG) (p < 0.001). The medium-to-large group demonstrated a significantly greater improvement in ABG (ΔABG) than the small group (-7.5 dB vs. 0 dB; p = 0.002). Perforation size was negatively correlated with ΔABG (r = -0.403, p = 0.003) but not with operative time (p = 0.31).

The butterfly cartilage inlay technique achieved high graft success and favorable functional outcomes for both small and medium-to-large TM perforations. It remained surgically efficient and feasible under local anesthesia, regardless of perforation size.

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