Clinical advantages of cartilage palisades over temporalis fascia in type I tympanoplasty

Objective

To compare the post-operative outcomes in using temporalis fascia and full thickness broad cartilage palisades as graft in type I tympanoplasty.

Methods

This study, conducted at a tertiary referral institute, included 90 consecutive patients with mucosal type chronic otitis media requiring type I tympanoplasty with a 60/30 distribution of cases with fascia and cartilage palisades, respectively. The fascia group consisted of primary cases in adults and excluded revision cases, near-total or total perforations and pediatric cases. The cartilage group included pediatric, revision cases and near-total or total perforations. The fascia group utilized the underlay technique for grafting, whereas the cartilage group used tragal full thickness broad cartilage palisades with perichondrium attached on one side placed in an underlay or over-underlay manner. Post-operative graft take-up and hearing outcomes were evaluated after 6 months and 1 year with subjective assessment and pure tone audiometry.

Results

The graft take-up rate was 83.3% in the fascia group and 90% in the cartilage palisade group. The mean pure tone air–bone gaps pre- and post-operatively in the fascia group were 30.43 ± 5.75 dB and 17.5 ± 6.94 dB, respectively, whereas for the cartilage group, these values were 29 ± 6.21 dB and 7.33 ± 3.88 dB, respectively.

Conclusion

Cartilage grafting with full thickness palisades is more effective than fascia as graft material, particularly in “difficult” tympanoplasties fraught with higher failure rates otherwise.