Tragal perichondrium and cartilage in reconstructive ear surgery

Area of Science:

• Otolaryngology
• Surgical Reconstruction
• Auditory Health

Background:

• Reconstruction of the tympanic membrane and ossicular chain is crucial for restoring hearing.
• Tragal perichondrium and cartilage offer a versatile autologous graft material.
• Previous methods for canal wall defects and ossicular reconstruction have varying success rates.

Purpose of the Study:

• To evaluate the efficacy of tragal perichondrium and cartilage grafts in various ear reconstruction procedures.
• To assess graft survival and hearing outcomes in myringoplasty and tympanoplasty.
• To present a novel technique for posterior canal wall reconstruction after mastoidectomy.

Main Methods:

• Performed 255 ear operations: 108 myringoplasties, 137 tympanoplasties with ossicular reconstruction, and 10 tympanoplasties with posterior canal wall reconstruction.
• Utilized tragal perichondrium and cartilage grafts, often en bloc.
• Employed nine different methods for ossicular reconstruction and a specific technique for canal wall defects.

Main Results:

• Myringoplasty: 92% graft survival, 76% hearing within 10 dB of bone conduction at one year.
• Tympanoplasty: 91% graft success, 78% hearing within 10 dB of bone conduction at one year.
• Posterior canal wall reconstruction: 8/10 cases had intact drum and canal wall, 9/10 achieved hearing within 10 dB.

Conclusions:

• Tragal perichondrium and cartilage are effective autografts for myringoplasty and tympanoplasty, offering good graft survival and hearing improvement.
• The presented technique for posterior canal wall reconstruction shows promising results for complex cases.
• Speech reception threshold analysis suggests a more nuanced view of functional hearing gain than pure-tone air-bone gap.