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Randomized Controlled Trial
. 2025 Jan-Dec:54:19160216251333748.
doi: 10.1177/19160216251333748. Epub 2025 Apr 22.

Randomized Comparison of Endoscopic Cartilage-Perichondrium Sandwich Technique Verses Underlay Technique for Large Tympanic Membrane Perforations

Yajian Shen  1 , Zhengcai Lou  1
Affiliations
Randomized Controlled Trial

Randomized Comparison of Endoscopic Cartilage-Perichondrium Sandwich Technique Verses Underlay Technique for Large Tympanic Membrane Perforations

Yajian Shen et al. J Otolaryngol Head Neck Surg. 2025 Jan-Dec.

Abstract

ImportantTrimming perforation margins is the basic procedure for any myringoplasties; however, to date, little literature has been reported on the effect of no trimming perforation margins on sandwich graft tympanoplasty.ObjectiveThe objective of this study was to compare the graft success rate, hearing improvement, and complications of endoscopic cartilage-perichondrium Sandwich technique (CPST) and cartilage-perichondrium underlay technique (CPUT) for repairing chronic large perforations.Study DesignProspective randomized controlled trial.SettingTertiary referral center.Participants and InterventionOne hundred two patients with chronic large perforations with 50% to 75% of tympanic membrane (TM) were recruited and randomly allocated to CPST (n = 51) and CPUT (n = 51), raising tympanomeatal flap and trimming perforation margins were not performed in both techniques.Main Outcome MeasurersThe graft success rate, air-bone gap (ABG) gain, operation time, and postoperative complications were evaluated at 12 months.ResultsAll the patients complete 12 months follow-up. The mean operation time was 30.6 ± 3.7 minutes in the CPST group and 29.8 ± 6.1 minutes in the CPUT group (P = .751).The graft success rate was 92.2% in the CPST group and 96.1% in the CPUT group (P = .979). Endoscopic examination revealed the perichondrial flap gradually became scab in the CPST group, 70.6% patients had the absence of typical cone-shaped TM. However, no scab was seen on the surface of graft, and all the patients had cone-shaped TM in the CPUT group. The ABG gain wasn't significantly different (12.9 ± 3.3 dB vs 13.1 ± 1.7 dB, P = .689).The successful surgery was 94.1% in the CPST group and 96.1% in the CPUT group, the difference wasn't significant among the 2 groups (P = .932). In addition, no procedure-related complications and no graft cholesteatoma were found in both groups during the follow-up period.Conclusions and RelevanceThe operation time, 12 months graft success rate, hearing improvement were comparable between CPST and CPUT for repairing large perforation, although raising tympanomeatal flap and trimming the perforation margins were not performed in both techniques.

Keywords: Sandwich graft; cartilage graft; endoscope; myringoplasty; perichondrium tucking technique; underlay graft.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Schematic drawings. CPST group: (A) graft harvesting. (B) Graft shaping. (C) Graft placement, cartilage medial to but the perichondrium lateral to TM remnant. CPUT group: (A) graft harvesting. (B) Graft shaping. (D) Graft placement, cartilage graft and perichondrium graft medial to TM remnant. Yellow: cartilage. Orange-yellow: perichondrium. CPST, cartilage-perichondrium Sandwich technique; CPUT, cartilage-perichondrium underlay technique; TM, tympanic membrane.
Figure 2.
Figure 2.
Surgical procedures of 2 techniques. (A) Preoperative perforations; (B) middle ear packing; (C) graft placement; (D) graft localization.
Figure 3.
Figure 3.
Enrollment, randomization, and follow-up of study participants.
Figure 4.
Figure 4.
CPST group: (A) postoperative; (B) post 2 weeks; (C) post 4 weeks; (D) post 12 months. CPST, cartilage-perichondrium Sandwich technique.
See this image and copyright information in PMC

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