Author(s): Sanjana V. Nemade. Jyoti P. Dabholkar
Background- Although temporalis fascia is the commonly used graft material for tympanic membrane reconstruction, cartilage–perichondrium graft is the material of choice for the reconstruction of the atelectatic tympanic membrane, recurrent perforations, subtotal and total perforations. Stiffness of cartilage graft is always the concern for the audiological outcome of the surgery. In our study, we used temporalis fascia and the cartilage graft of different thickness and have done the honest efforts to find out the ideal graft that will form a perfect balance between the stability and the acoustic sensitivity of the tympanic membrane.
Materials and methods: 90 patients were included who underwent type one tympanoplasty between July 2003 to January 2006. 30 cases were included in Group A in which temporalis fascia was used. 30 cases were included in Group B in which full thickness tragal cartilage (1mm) was used and 30 cases were included in Group C in which partial thickness (0.5 mm) tragal cartilage was used. Results: Graft take was accomplished in 86 patients (95.5%). The average Air-Bone gap closure achieved in Group A was 27.4 dB; in Group B was 17.5dB while in Group C it was26.8 dB.
Conclusion- Cartilage of 0.5 mm thickness maintains a perfect balance between sufficient stability and adequate acoustic sensitivity. If the stability of the reconstructed membrane is a higher priority, like in chronic eustachian tube blockage, full thickness tragal cartilage can be used, although it entails some sacrifice of acoustic quality.