Split-Thickness Cartilage Graft Combined With Perichondrium for Endoscopic Repair of Total and Subtotal Drum Perforations

ObjectiveThis study aims to describe our new modification to cartilage tympanoplasty for endoscopic repair of total and subtotal tympanic membrane perforations and evaluate its outcomes.Study DesignRetrospective case series.SettingMultiple institutions.MethodsThe study was conducted using records of patients who underwent tympanoplasty for subtotal and total perforations from January 2018 to June 2022. Utilizing an endoscopic transcanal approach, we employed a double graft consisting of outer tragal perichondrium supported by inner split-thickness tragal cartilage as separate layers, both placed in an underlay fashion lateral to the malleus, without the need to elevate a tympanomeatal flap. Anatomical success was defined as complete primary closure of the perforation, while functional success was defined as achieving an air-bone gap of <= 20 dB at 12 months postoperative.ResultsThe series involved 64 patients, predominantly males (53%). The mean age was 30.8 years. 56.3% of patients had subtotal perforations. The anatomical success rate was 90.6% while the functional success rate was 87.5%. Postoperative speech discrimination scores significantly increased in all patients.ConclusionOur modification provides effective anatomical and audiological outcomes. This technique reliably resists graft displacement and shrinkage before adequate healing. It avoids problems of elevating tympanomeatal flaps with comparable results to traditional approaches.