Is the tragal cartilage necessary for type 1 tympanoplasties?

The use of cartilage grafts in tympanoplasties is recommended in cases with a higher probability of failure. Many grafting techniques have been reported, including palisade, cartilage island, and cartilage shield grafts. Cartilage minimizes the inflammatory tissue reaction, ensures resistance against infection during the recovery process, and provides good support against the retraction by virtue of its rigidity.This study compared the anatomic and functional results of conchal cartilage, tragal cartilage, and temporal muscle fascia grafts in primary type 1 tympanoplasty. Between January 2007 and January 2011, 79 patients with subtotal dry tympanic membrane perforation and an intact ossicular chain underwent primary type 1 tympanoplasty in our clinic. The postoperative perforation closure ratios, air and bone pure tone averages, and mean air-bone gap (ABG) in the 3 groups were compared with the preoperative values. The improvement in the mean ABG was assessed.The perforation closure ratio was 80.6%, 100%, and 88.5% in the muscle fascia, conchal cartilage, and tragal cartilage groups, respectively, and the mean increase in the ABG was 5.7, 8.9, and 9.7 dB, respectively.The island graft with cartilage perichondrium, which has recently become popular, can be also used in type 1 tympanoplasty. Because it does not require a second incision, conchal cartilage can be used routinely in tympanoplasties performed via a postauricular approach.