Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study

Abstract

Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.

Keywords: cartilage; fascia; graft; myringoplasty; perforation; tympanoplasty.

Figure 1

CONSORT 2010 Flow Diagram. Abbreviation: TF, temporalis fascia; C, Cartilage; COM, chronic otitis media; CRS, chronic rhinosinusitis; IOC, Impaired ossicular chain.

Figure 2

(A) Preoperative otoendoscopic image showing anterior perforation of the left tympanic membrane. Anterior wall of the procident duct. (B) CT scan in coronal section. (C) Intraoperative image of temporalis muscle fascia placed with Underlay technique. (D) Otoendoscopic follow-up at 6 months.

Figure 3

(A) Preoperative otoendoscopic image showing anterior perforation of the left tympanic membrane and signs of tympanosclerosis. (B) CT scan in coronal section. (C) Intraoperative image of molded tragal cartilage placed with Underlay technique. (D) Otoendoscopic follow-up at 6 months.