Scholarly Article
TEMPORALIS FASCIA VERSUS PARTIAL-THICKNESS TRAGAL CARTILAGE IN TWO-HANDED ENDOSCOPIC TYMPANOPLASTY FOR CHRONIC OTITIS MEDIA: A PROSPECTIVE MULTICENTRE OBSERVATIONAL STUDY
Janat, Reyazul, Samuel, Ruby, Ohal, Meena Maruthi
2026-09-24 · International Journal of Clinical and Biomedical Research · Sumathi Publications
Abstract
Background: Two-handed endoscopic tympanoplasty, performed with the endoscope secured in a mechanical holder, permits bimanual instrumentation while preserving endoscopic visualization. Temporalis fascia is widely used for tympanic membrane reconstruction, whereas cartilage offers greater structural rigidity and resistance to retraction. This study compared anatomical and audiological outcomes of temporalis fascia and partial-thickness tragal cartilage in chronic otitis media. Methods: This prospective, comparative, multicentre observational study included a primary graft- comparison cohort of 132 patients aged 10-70 years: 66 underwent endoscopic tympanoplasty with temporalis fascia and 66 with partial-thickness tragal cartilage. A separate descriptive cohort of 42 patients with limited atticoantral disease underwent intact canal wall (ICW) inside-out atticoantrostomy and was not included in the primary graft comparison. Pure-tone audiometry was performed preoperatively and at the standardized 6-month postoperative assessment and followed up to 16 months. The primary outcome was successful anatomical graft uptake; secondary outcomes included pure-tone average (PTA), air-bone gap (ABG), ABG closure, and exploratory patient-reported benefit. Results: Successful graft uptake occurred in 57/66 patients (86.4%) in the fascia group and 60/66 (90.9%) in the cartilage group (absolute difference 4.5 percentage points; Fisher exact p=0.585). Mean ABG decreased from 28.6 ± 6.4 to 12.1 ± 4.8 dB with fascia and from 29.4 ± 6.7 to 10.8 ± 4.3 dB with cartilage (within-group p<0.001 for both). Mean ABG closure was 16.5 ± 5.6 dB and 18.6 ± 5.8 dB, respectively; the between-group difference was 2.1 dB (95% CI 0.14-4.06; p=0.036). Good or excellent subjective improvement was reported by 83.3% and 86.4% of patients in the two graft groups, respectively. Conclusion: Temporalis fascia and partial-thickness tragal cartilage were both associated with satisfactory anatomical and functional outcomes. The study did not demonstrate a statistically significant difference in graft uptake. Cartilage was associated with a small statistically significant advantage in mean ABG closure, but the clinical importance of an approximately 2-dB difference is uncertain. Graft selection should therefore be individualised according to perforation characteristics, middle- ear status, and the need for structural stability.
Keywords
chronic otitis media, endoscopic tympanoplasty, temporalis fascia, tragal cartilage, graft uptake, air-bone gap
Citation Details
International Journal of Clinical and Biomedical Research, Vol. 11, No. 3, pp. 418-426