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Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty

  • A A Kolethekkat (a1), R Al Abri (a1), K Al Zaabi (a2), N Al Marhoobi (a2), S Jose (a3), S Pillai (a1) and J Mathew (a1)...



To validate a newly introduced cartilage rim augmented temporalis fascia tympanoplasty technique by statistically comparing it with the morphological and audiological outcomes of traditional temporalis fascia tympanoplasty.


A retrospective comparative study was conducted on 115 patients who underwent tympanoplasty during 2013 and 2015. Fifty-eight patients underwent temporalis fascia tympanoplasty and 57 underwent cartilage rim augmented fascia tympanoplasty.


In the cartilage fascia group, graft healing was achieved in 94.7 per cent of cases; in the temporalis fascia group, the graft take-up rate was 70 per cent. In those with a normal ossicular chain, the post-operative air–bone gap was within 20 dB in 92.6 per cent of cartilage fascia group cases and in 69.7 per cent of the temporalis fascia group cases, which was a statistically significant difference. Among the defective ossicular chain cases, the post-operative air–bone gap was within 20 dB in 76.9 per cent in the cartilage fascia group, as against 57.1 per cent in the temporalis fascia group.


Cartilage rim augmented temporalis fascia tympanoplasty has a definite advantage over the temporalis fascia technique in terms of superior graft take up and statistically significant hearing gain in those with normal ossicular mobility.


Corresponding author

Address for correspondence: Dr Arif Ali Kolethekkat, ENT Division, Department of Surgery, Sultan Qaboos University Hospital, PC 123, PO Box 38, Al Khoud, Sultanate of Oman E-mail:


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Dr A A Kolethekkat takes responsibility for the integrity of the content of the paper



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1Kazikdas, KC, Onal, K, Boyraz, I, Karabulut, E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 2007;264:985–9
2Wullstein, HL. Functional operations in the middle ear with split thickness skin graft. Arch Otorhinolaryngol 1952;161:422–35
3Zoellner, F. The principles of plastic surgery of the sound conducting apparatus. J Laryngol Otol 1955;69:567–9
4Dermirpehlivan, IK, Onal, K, Arslanoglu, S, Songu, M, Ciger, E, Can, N. Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty. Eur Arch Otorhinolaryngol 2011;268:471–4
5Kulkarni, S, Kulkarni, V, Burse, K, Sancheti, V, Roy, G. Cartilage support for fascia graft in type I tympanoplasty. Indian J Otolaryngol Head Neck Surg 2014;66:291–6
6Mohamad, SH, Khan, I, Hussain, SS. Is cartilage tympanoplasty more effective than facia tympanoplasty? A systematic review. Otol Neurotol 2012;33:699705
7Onal, K, Uguz, MZ, Kazidas, KC. A multivariate analysis of ontological, surgical and patient-related factors in determining success in myringoplasty. Clin Otolaryngol 2005;30:115–20
8Uguz, MZ, Onal, K, Kazidas, KC, Onal, A. The influence of smoking on success of tympanoplasty measured by serum cotinine analysis. Eur Arch Otorhinolaryngol 2008;256:513–16
9Murbe, D, Zahnert, T, Bornitz, M, Huttenbrink, KB. Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope 2002;112:1769–76
10Tek, A, Karaman, M, Uslu, C, Habesoglu, T, Kilicarslan, Y, Durmus, R et al. Audiological and graft take results of cartilage reinforcement tympanoplasty (a new technique) versus fascia. Eur Arch Otorhinolaryngol 2012;269:1117–26
11Salen, B. Myringoplasty using septum cartilage. Acta Otolaryngol 1963;188:8293
12Amedee, RG, Mann, WJ, Eiechelmann, H. Cartilage palisade tympanoplasty. Am J Otol 1989;10:447–50
13Milewski, C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993;103:1352–6
14Dornhoffer, J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1000 patient series. Laryngoscope 2003;113:1844–56
15Goodhill, V. Tragal perichondrium and cartilage in tympanoplasty. Arch Otolaryngol 1967;85:480–91
16Aidonis, I, Robertson, TC, Sismanis, A. Cartilage shield tympanoplasty: a reliable technique. Otol Neurotol 2005;26:838–41
17Arriage, MA. Cartilage tympanoplasty: classifications of methods-techniques-results. Otol Neurotol 2010;31:8611012
18Poe, DS, Gadre, AK. Cartilage tympanoplasty for management of retraction pocket and cholesteatomas. Laryngoscope 1993;103:614–18
19Gerber, MJ, Mason, JC, Lampert, PR. Hearing results after primary cartilage tympanoplasty. Laryngoscope 2000;110:1994–9
20Dornhoffer, JL. Hearing results with cartilage tympanoplasty. Laryngoscope 1997;107:1094–9
21Mundra, RK, Sinha, R, Agarwal, R. Tympanoplasty in subtotal perforation with graft supported by a slice of cartilage: a study with near 100% results. Indian J Otolaryngol Head Neck Surg 2013;65:631–5
22American Academy of Otolaryngology–Head and Neck Surgery Foundation. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 1995;113:186–7
23Altuna, X, Navarro, JJ, Martinez, Z, Lobato, R, Algaba, J. Island cartilage myringoplasty. Anatomical and functional results in 122 cases [in Spanish]. Acta Otorhinolaryngol Esp 2010;61:100–5
24Gierek, T, Slaska, KA, Majzel, K, Klimczak, GL. Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts [in Polish]. Otolaryngol Pol 2004;58:529–33
25Nichlani, SS, Jagade, MV, Ganeshan, A. Reconstruction of the tympanic membrane with partial tragal cartilage graft versus temporalis fascia graft. Bombay Hosp J 2010;52:197201
26Tos, M. Cartilage tympanoplasty methods: proposal for a classification. Otolaryngol Head Neck Surg 2008;139:747–58
27Yung, M. Cartilage tympanoplasty: literature review. J Laryngol Otol 2008;122:663–72
28Duckert, LG, Muller, J, Makielski, KH, Helms, J. Composite autograft shield reconstruction of remnant tympanic membranes. Am J Otol 1995;16:21–6
29Spielmann, P, Mills, R. Surgical management of retraction pockets of the pars tensa with cartilage and perichondrial grafts. J Laryngol Otol 2006;120:725–9
30Shin, SH, Lee, WS, Kim, HN, Lee, HK. Wheel-shaped cartilage-perichondrium composite graft for the prevention of retraction pocket development. Acta Otolaryngol 2007;127:25–8
31Eavey, RD. Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 1998;108:657–61
32Yung, M, Vivekanandan, S, Smith, P. Randomized study comparing fascia and cartilage grafts in myringoplasty. Ann Otol Rhinol Laryngol 2011;120:535–41
33Mauri, M, Neto, JF, Fichs, SC. Evaluation of inlay butterfly cartilage tympanoplasty: a randomised clinical trial. Laryngoscope 2001;111:1479–85
34Cabra, J, Moñux, A. Efficacy of cartilage palisade tympanoplasty: randomized controlled trial. Otol Neurotol 2010;31:589–95
35Onal, K, Arslanoglu, S, Oncel, S, Songu, M, Kopar, A, Demiray, U. Perichondrium/cartilage island flap and temporalis muscle fascia in type I tympanoplasty. J Otolaryngol Head Neck Surg 2011;40:295–9
36Ozbek, C, Ciftçi, O, Tuna, EE, Yazkan, O, Ozdem, C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol 2008;29:679–83
37Couloigner, V, Baculard, F, El Bakkouri, W, Viala, P, François, M, Narcy, P et al. Inlay butterfly cartilage tympanoplasty in children. Otol Neurotol 2005;26:247–51
38Albirmawy, OA. Comparison between cartilage-perichondrium composite ring graft and temporalis fascia in type one tympanoplasty in children. J Laryngol Otol 2010;124:967–74
39Wen, YH, Hsu, LP, Chen, PR, Lee, CF. Design optimization of cartilage myringoplasty using finite element analysis. Tzu Chi Med J 2006;18:370–7
40Zahnert, T, Huttenbrink, KB, Murbe, D, Bornitz, M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322–8


Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty

  • A A Kolethekkat (a1), R Al Abri (a1), K Al Zaabi (a2), N Al Marhoobi (a2), S Jose (a3), S Pillai (a1) and J Mathew (a1)...


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