European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 3, pp 471–474 | Cite as

Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty

  • Inci Alkan Demirpehlivan
  • Kazim Onal
  • Secil Arslanoglu
  • Murat Songu
  • Ejder Ciger
  • Nazan Can
Short Communication


The objective of the study was to assess the functional results after type I tympanoplasty with temporal muscle fascia, perichondrium/cartilage island and cartilage palisades. The records of 120 patients who underwent type I tympanoplasty operation between January 2003 and June 2007 were retrospectively reviewed. This study aimed to comprise a homogeneous group of patients to make the comparisons as accurate as possible. For this purpose, primary tympanoplasty cases with subtotal perforations, intact ossicular chain, dry ear for a period of at least 1 month, and normal middle ear mucosa were included in the study. Patients younger than 15 years of age and patients with cholesteatoma were excluded. Temporal muscle fascia was used in 67 (55.8%), perichondrium/cartilage island flap was used in 34 (28.3%), and cartilage palisades were used in 19 (15.8%) of the patients. Pre- and postoperative otoscopic examinations, pure-tone averages, and air-bone gaps were compared pre and postoperatively. Concerning all of the cases, the graft take rate was 85% (102/120). In the perichondrium/cartilage island flap group, the graft take rate was 97.7%, whereas the graft take rates for the fascia group and cartilage palisades group were 80.6 and 79.0%, respectively. In the perichondrium/cartilage island flap group, the pure-tone average was 36.36 dB, whereas the pure-tone averages for the fascia group and cartilage palisades group were 36.07 and 39.79 dB, preoperatively. The postoperative pure-tone averages were 24.54 dB fort he perichondrium/cartilage island flap group, 24.51 dB for the fascia group and 23.23 dB for the cartilage palisades group. Cartilage grafting is not only more enduring against infection and negative middle ear pressure but also it has low re-perforation rates on long-term follow-up. Thus, cartilage may be preferred more often for primary tympanoplasties with high graft rate and hearing improvement.


Tympanoplasty Graft Cartilage Fascia Palisade 



The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: No financial support was received for this paper.

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Nankivell PC, Pothier DD (2010) Surgery for tympanic membrane retraction pockets. Cochrane Database Syst Rev 7:CD007943PubMedGoogle Scholar
  2. 2.
    Cayé-Thomasen P, Andersen J, Uzun C, Hansen S, Tos M (2009) Ten-year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction cholesteatoma in children. Laryngoscope 119(5):944–952CrossRefPubMedGoogle Scholar
  3. 3.
    Onal K, Uguz MZ, Kazikdas KC et al (2005) A multivariate analysis of otological, surgical and patient related factors in determining success in myringoplasty. Clin Otolaryngol 30:115–120CrossRefPubMedGoogle Scholar
  4. 4.
    Uguz MZ, Onal K, Kazikdas KC, Onal A (2008) The influence of smoking on success of tympanoplasty measured by serum cotinine analysis. Eur Arch Otorhinolaryngol 265(5):513–516CrossRefPubMedGoogle Scholar
  5. 5.
    Mürbe D, Zahnert T, Bornitz M, Huttenbrink KB (2002) Acoustic properties of different cartilage reconstruction techniques of the tympanic membrane. Laryngoscope 112(10):1769–1776CrossRefPubMedGoogle Scholar
  6. 6.
    Boedts D (1995) Tympanic grafting materials. Acta Otorhinolaryngol Belg 49(2):193–199PubMedGoogle Scholar
  7. 7.
    Neumann A, Kevenhoerster K, Gostian AO (2010) Long-term results of palisade cartilage tympanoplasty. Otol Neurotol 31(6):936–939CrossRefPubMedGoogle Scholar
  8. 8.
    Aidonis I, Robertson TC, Sismanis A (2005) Cartilage shield tympanoplasty: a reliable technique. Otol Neurotol 26(5):838–841CrossRefPubMedGoogle Scholar
  9. 9.
    Kirazli T, Bilgen C, Midilli R, Ogut F (2005) Hearing results after primary cartilage tympanoplasty with island technique. Otolaryngol Head Neck Surg 132(6):933–937CrossRefPubMedGoogle Scholar
  10. 10.
    Indorewala S (2002) Dimensional stability of the free fascia grafts: an animal experiment. Laryngoscope 112(4):727–730CrossRefPubMedGoogle Scholar
  11. 11.
    Palva P (1987) Surgical treatment of chronic middle ear disease. Acta Otolaryngol 104:279–284CrossRefPubMedGoogle Scholar
  12. 12.
    Heermann HJ, Heermann H, Kopstein E (1970) Fascia and cartilage palisade tympanoplasty: nine years experience. Arch Otolaryngol 91:229–240Google Scholar
  13. 13.
    Kazikdas KC, Onal K, Boyraz I, Karabulut E (2007) Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol 264(9):985–989CrossRefPubMedGoogle Scholar
  14. 14.
    Pinar E, Sadullahoglu K, Calli C, Oncel S (2008) Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg 139:386–390CrossRefPubMedGoogle Scholar
  15. 15.
    Gerber MJ, Mason JC, Lambert PR (2000) Hearing results after primary cartilage tympanoplasty. Laryngoscope 110:1994–1999CrossRefPubMedGoogle Scholar
  16. 16.
    Roger G, Bokowy C, Coste A, Moine A, Monier S, Florant A, Roulleau P (1994) Tympanoplasty using chondro-perichondral graft. Indications, techniques and results. A propos of a series of 127 cases. Ann Otolaryngol Chir Cervicofac 111(1):29–34PubMedGoogle Scholar
  17. 17.
    Levinson RM (1987) Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope 97(9):1069–1074CrossRefPubMedGoogle Scholar
  18. 18.
    Harner SG (1995) Management of posterior tympanic membrane retraction. Laryngoscope 1005:326–328CrossRefGoogle Scholar
  19. 19.
    Bernal-Sprekelsen M, Romaguera Lliso MD, Sanz Gonzalo JJ (2003) Cartilage palisades in type III tympanoplasty: anatomic and functional long-term results. Otol Neurotol 24(1):38–42CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Inci Alkan Demirpehlivan
    • 1
  • Kazim Onal
    • 1
  • Secil Arslanoglu
    • 1
  • Murat Songu
    • 1
  • Ejder Ciger
    • 1
  • Nazan Can
    • 1
  1. 1.Department of Otorhinolaryngology Clinic IIzmir Ataturk Research and Training HospitalIzmirTurkey

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