IJOHNS  Vol.4 No.2 , March 2015
Role of Cartilage as a Graft Material for Tympanic Membrane and in Middle Ear Reconstruction
Abstract: Objective: The work was planned to evaluate the results of cartilage graft in the surgical treatment of chronic suppurative otitis media. Study Design: A prospective study. Materials and Methods: The present study was a prospective study of tympanoplasties and tympanomastoid surgeries performed on 100 patients. The main outcome measures were both anatomical and functional in form of graft incorporation and postoperative hearing function. Results: Cartilage was used as tympanic membrane and/or ossicle graft in the cases. There were no immediate postoperative or long term complications of surgery except for 10 cases in which there was a failure of graft uptake. There was a 7.6-decibel (dB) improvement in mean air conduction threshold post-operatively. A mean closure of average air bone gap of 8.4 decibels (dB) was noted which was statistically significant. Conclusion: The cartilage graft is a very effective option for the repair of the conducting mechanism of the ear with good take-up rates, less chances of rejection or extrusion and very few significant complications. The thickness of cartilage creates stiffness that is more resistant than the fascia to the anatomic deformities caused by negative middle ear pressure thus improving the long term integrity of the graft.
Cite this paper: Chouhan, A. , Singh, B. and Verma, P. (2015) Role of Cartilage as a Graft Material for Tympanic Membrane and in Middle Ear Reconstruction. International Journal of Otolaryngology and Head & Neck Surgery, 4, 66-72. doi: 10.4236/ijohns.2015.42012.

[1]   Levinson, R.M. (1987) Cartilage-Perichondrial Composite Graft Tympanoplasty in the Treatment of Posterior Marginal and Attic Retraction Pockets. Laryngoscope, 97, 1069-1074.

[2]   Buckingham, R.A. (1992) Fascia and Perichondrium Atrophy in Tympanoplasty and Recurrent Middle Ear Atelectasis. Annals of Otology, Rhinology Laryngology, 101, 755-758.

[3]   Milewski, C. (1993) Composite Graft Tympanoplasty in the Treatment of Ears with Advanced Middle Ear Pathology. Laryngoscope, 103, 1352-1356.

[4]   Committee on Conservation of Hearing of the American Academy of Ophthalmology and Otolaryngology (1964) Standard Classification for Surgery of Chronic Ear Disease. Archives of Otolaryngology—Head and Neck Surgery, 81, 204-205.

[5]   Zollner, F. (1955) The Principles of Plastic Surgery of the Sound Conducting Apparatus. Journal of Laryngology and Otology, 69, 637-652.

[6]   Wullstein, H.L. (1952) Functional Operation in the Middle Ear with Split Thickness Skin Graft. Archives of Otorhinolaryngology, 161, 422-436.

[7]   Heermann, H. (1960) Tympanic Membrane Plastic Repair with Temporalis Fascia. Hals Nas Ohrenh, 9, 136-139.

[8]   Salen, B. (1968) Tympanic Membrane Grafts of Full Thickness Skin, Fascia and Cartilage with Its Perichondrium, an Experimental and Clinical Investigation. Acta Oto-Laryngologica, 244, 5-73.

[9]   Bocca, E., Cis, C. and Zernotti, E. (1959) L’impiego di lembi liberi di periostio nella tympanoplastica. Archivio Italiano di Otologia, Rinologia e Laringologia. Supplemento, 40, 205.

[10]   Tabb, H.G. (1960) Closure of Perforation of the Tympanic Membrane by Vein Grafts: A Preliminary Report of 20 Cases. Laryngoscope, 70, 271-274.

[11]   Albrite, J.P. and Leigh, B.G. (1966) Dural Homograft (Alloplastic) Myringoplasty. The Laryngoscope, 76, 1687-1693.

[12]   Jansen, C. (1963) Cartilage-Tympanoplasty. The Laryngoscope, 73, 1288-1302.

[13]   Salen, B. (1963) Myringoplasty Using Septum Cartilage. Acta Otolaryngologica, 57, 82-91.

[14]   Utech, H. (1959) Ueber diagnostische und therapeutische Moeglichkeiten der Tympanotomie bei Schalleitungsstoerungen. Zeitschrift für Laryngologie, Rhinologie, Otologie und ihre Grenzgebiete, 38, 212-221.

[15]   Heermann, J. (1978) Auricular Cartilage Palisade Tympano-, Epitympano-, Antrum- and Mastoid-Plastics. Clinical Otolaryngology & Allied Sciences, 3, 443-446.

[16]   Heermann, J. (1992) Autograft Tragal and Conchal Palisade Cartilage and Perichondrium in Tympanomastoid Reconstruction. Ear, Nose & Throat Journal, 71, 344-349.

[17]   Guidelines of the Committee on the Hearing and Equilibrium (1995) Committee in Hearing and Evaluation of Results of Treatment of Conductive Hearing Loss. Otolaryngology—Head and Neck Surgery, 106, 865-867.

[18]   Sapci, T., Almac, S., Usta, C., Karavas, A., Mercangoz, C. and Evimik, M.F. (2006) Comparison between Tympanoplasties with Cartilage Perichondrium Composite Graft and Temporal Fascia Graft in Terms of Hearing Levels and Healing. Kulak Burun Bo?az ?htisas Dergisi, 16, 255-260.

[19]   Dabholkar, J.P., Vora, K. and Sikdar, A. (2007) Comparative Study of Underlay Tympanoplasty with Temporalis Fascia and Tragal Perichondrium. Indian Journal of Otolaryngology and Head & Neck Surgery, 59, 116-119.

[20]   Ozbek, C., Cifta, O., Tuna, E.E., Yazkan, O. and Ozdem, C. (2008) A Comparison of Cartilage Palisades and Fascia in Type I Tympanoplasty in Children: Anatomic and Functional Results. Otology & Neurotology, 29, 679-683.

[21]   Sirena, E., Carvalho, B., Buschle, M. and Mocellin, M. (2010) Timpanoplastia Myringoplasty Type 1 and in Residency Surgical Results and Audiometric. International Archives of Otorhinolaryngology, 14, 60-65.

[22]   Yetiser, S. and Hidin, Y. (2009) Temporalis Fascia and Cartilage Perichondrium Composite Shield Graft for Reconstruction for Tympanic Membrane. The Annals of Otology, Rhinology, and Laryngology, 118, 570-574.

[23]   Wright, W.K. (1956) Repair of Chronic Central Perforation of Tympanic Membrane by Skin Grafting. The Laryngoscope, 66, 1464-1487.

[24]   Marquet, J.F.E. (1968) Myringoplasty by Eardrum Transplantation. The Laryngoscope, 78, 1329-1336.

[25]   Mahadeviah, A. and Parikh, B. (2008) Modified Intact Canal Wall Mastoidectomy: Long Term Hearing Results in Hearing and Healing. Indian Journal of Otolaryngology and Head & Neck Surgery, 60, 317-323.