Kumar Alok, Singh Deepali, Baruah Binayak, Nag Deb Sanjay, Jana Amrita
Department of Otorhinolaryngology, Tata Main Hospital, Jamshedpur, IND.
Department of Otolaryngology - Head and Neck Surgery, Manipal Tata Medical College, Jamshedpur, IND.
Cureus. 2025 May 6;17(5):e83597. doi: 10.7759/cureus.83597. eCollection 2025 May.
Tympanic membrane perforation repair continues to evolve, with a shift toward endoscopic approaches and diverse grafting materials. Subtotal perforations with minimal anterior margins pose a significant clinical challenge. This study evaluated the efficacy of a novel composite graft (partial-thickness tragal cartilage overlaid with temporalis fascia) compared to established techniques: full-thickness tragal cartilage (butterfly graft) and temporalis fascia.
This observational retrospective study was conducted at a tertiary care setting. The medical records of 70 consecutive patients who underwent endoscopic transcanal myringoplasty were reviewed. Patients were categorized into three groups based on the myringoplasty technique: butterfly cartilage graft, temporalis fascia graft, and composite cartilage graft. Graft uptake rates and changes in air-bone gap (ABG) were compared pre- and postoperatively (at three months).
All three techniques demonstrated high graft uptake rates and statistically significant improvements in ABG. The butterfly graft had a 100% uptake rate, the temporalis fascia graft had an 89.47% uptake rate, and the composite cartilage graft had an 84.62% uptake rate. Mean ABG improvement at three months postoperatively was 10.06 dB for the butterfly group, 9.53 dB for the temporalis fascia group, and 10.23 dB for the composite cartilage graft group. Significant differences were observed between all groups (p < 0.001). The composite graft demonstrated promising results, particularly for subtotal perforations.
Endoscopic transcanal myringoplasty with various graft materials is an effective method for tympanic membrane repair. The butterfly cartilage graft is suitable for small- to medium-sized perforations, and temporalis fascia remains suitable for large- and medium-sized perforations with adequate anterior margins. For subtotal perforations with minimal anterior margins, the novel composite cartilage graft offers a promising alternative with a high potential for successful outcomes. This warrants further investigation in larger prospective studies.
鼓膜穿孔修复技术不断发展，正朝着内镜手术方法和多种移植材料的方向转变。前边缘极小的次全穿孔带来了重大的临床挑战。本研究评估了一种新型复合移植物（颞肌筋膜覆盖的部分厚度耳屏软骨）与现有技术（全厚度耳屏软骨（蝶形移植物）和颞肌筋膜）相比的疗效。
本观察性回顾性研究在三级医疗机构进行。回顾了70例连续接受内镜经耳道鼓膜成形术患者的病历。根据鼓膜成形术技术将患者分为三组：蝶形软骨移植物组、颞肌筋膜移植物组和复合软骨移植物组。比较术前和术后（三个月时）的移植物吸收率和气骨导差（ABG）变化。
所有三种技术均显示出高移植物吸收率和气骨导差的统计学显著改善。蝶形移植物的吸收率为100%，颞肌筋膜移植物的吸收率为89.47%，复合软骨移植物的吸收率为84.62%。术后三个月时，蝶形移植物组的平均气骨导差改善为10.06 dB，颞肌筋膜组为9.53 dB，复合软骨移植物组为10.23 dB。所有组之间均观察到显著差异（p < 0.001）。复合移植物显示出有前景的结果，特别是对于次全穿孔。
采用各种移植材料的内镜经耳道鼓膜成形术是鼓膜修复的有效方法。蝶形软骨移植物适用于中小穿孔，颞肌筋膜仍适用于前边缘足够的大中穿孔。对于前边缘极小的次全穿孔，新型复合软骨移植物提供了一个有前景的替代方案，成功结果的潜力很高。这值得在更大规模的前瞻性研究中进一步调查。
