Three Autologous Substitutes for Myringoplasty

OBJECTIVE: Evaluation of 3 different kinds of autologous substitutes for simple myringoplasty. STUDY DESIGN: Retrospective review of myringoplasty cases. PATIENTS: A total of 117 patients (52 women with 52 ears and 65 men with 65 ears) with an average age of 25.6 years (range, 12-51 yr) were examined. Forty-two cases exhibited large perforations, and 75 exhibited small perforations. INTERVENTION: Myringoplasty with temporal fascia, tragus perichondrium, or tragus cartilage-perichondrium composite grafts were randomly used in this comparative study. All the 117 operations were performed by a single surgeon. MAIN OUTCOME MEASURES: Otoscopic findings as assessed by a hearing examination using a quad-frequency pure-tone average air-bone gap. RESULTS: Recurrent defects were not observed in the small perforation group repaired with autologous substitutes. The graft acceptance rate in this group was 100%. For the large perforation group, the graft acceptance rate was highest with the cartilage-perichondrium composite grafts group (p < 0.05) 1 year after the operation. Tympanic membranes repaired with temporalis fascia or perichondrium eventually perforated again or seemed invaginated and adherent. Early hearing improvements in the temporalis fascia and perichondrium groups were better than that of cartilage-perichondrium composite grafts, but there was no significant difference 1 year after surgery. CONCLUSION: Temporal fascia, tragus perichondrium, and tragus cartilage-perichondrium composite grafts are all suitable for myringoplasty after a minor tympanic membrane perforation. However, cartilage-perichondrium composite graft material for myringoplasty has superior long-term benefits in regard to both hearing improvements and tympanic membrane morphology, which are especially evident in cases with large perforations.