Tympanoplasty in Subtotal Perforation with Graft Supported by a Slice of Cartilage: A Study with Near 100 % Results

  • R. K. MundraEmail author
  • Richi Sinha
  • Richa Agrawal
Original Article


The aim of this study is to evaluate the results of closure of subtotal perforation by tympanoplasty using underlay technique with the perichondrium/temporalis fascia graft supported by single cartilage slice anteriorly. Our hypothesis was that the cartilage support, single slice, offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction. Retrospective and prospective study of patient undergoing tympanoplasty in subtotal perforation with graft supported by a slice of cartilage between March 2000 and October 2005. Intact perichondrium/temporalis fascia was placed as graft in subtotal perforation, supported by a slice of cartilage. Slice was placed anteriorly from hypotympanum to anterior part of attic. It does not obstruct Eustachian tube opening, as it is curved with concavity facing towards medial wall and lined by perichondrium without any raw area, which prevents adhesion formation. Hearing results were reported using four frequency (500, 1,000, 2,000 and 3,000) pure tone average air-bone gap. During the study period, perichondrium/temporalis fascia graft with support of cartilage slice was used for tympanic membrane reconstruction in 94 patients. Overall graft take rate was 98.94 %. In 95.74 % of patients of different types of tympanoplasty achieved hearing level of 30 dB or less. Complications included residual perforation in (1.06 %), infection or gaping of wound in 2 (2.13 %). Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (subtotal perforation, retraction pocket, cholesteatoma, anterior perforation of tympanic membrane).


Tympanoplasty Subtotal perforation Cartilage slice High-risk perforation 


  1. 1.
    Schuknecht HF, Kerr AG (1967) Pathology of Eustachian tube. Arch Otolaryngol 86:497PubMedCrossRefGoogle Scholar
  2. 2.
    Heerman J (1992) Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction. Ear Nose Throat J 71(8):344–349Google Scholar
  3. 3.
    Indorewala S (2005) Dimensional stability of free fascia grafts: clinical application. Laryngoscope 115:278–282PubMedCrossRefGoogle Scholar
  4. 4.
    Borkowski G, Sudhoff H, Luckhaupt H (1999) Autologous perichondrium–cartilage graft in the treatment of total and subtotal perforations of the tympanic membrane. Laryngorhino-otologic 78(2):68–72CrossRefGoogle Scholar
  5. 5.
    Dornhoffer JL (1997) Hearing results with cartilage tympanoplasty. Laryngoscope 107:1094–1099PubMedCrossRefGoogle Scholar
  6. 6.
    Indorewala S (1997) The anterior tympanotomy. Indian J Otolaryngol Head Neck Surg 49:122–124PubMedCentralPubMedGoogle Scholar
  7. 7.
    Dornhoffer JL (2003) Cartilage tympanoplasty: indications, techniques, and outcomes in a 1000 patient series. Laryngoscope 113:1844–1856PubMedCrossRefGoogle Scholar
  8. 8.
    Singh M, Rai A, Bandyopadhyay S, Gupta SC (2003) Comparative study of underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane. J Laryngol Otol 117:444–448PubMedGoogle Scholar
  9. 9.
    Wullstein HL (1963) Past and future of tympanoplasty. Arch Otolaryngol 78:371PubMedCrossRefGoogle Scholar
  10. 10.
    Glasscock ME, Jackson CG, Schwaber MK et al (1982) Post auricular undersurface tympanic membrane grafting: a follow up report. Laryngoscope 92:718–727PubMedCrossRefGoogle Scholar
  11. 11.
    Neumann A, Schultz-Coulon HJ, Jahnke K (2003) Type III tympanoplasty applying the palisade cartilage technique: a study of 61 cases. Otol Neurotol 24(1):33–37PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2013

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology and Head & Neck SurgeryMGM Medical College & MY HospitalsIndoreIndia
  2. 2.IndoreIndia
  3. 3.BhopalIndia
  4. 4.TimarniIndia

Personalised recommendations