The modified asymmetric chondro-perichondrial island graft in type I tympanoplasty: A retrospective analysis of 784 patients

•Asymmetric graft design accommodates malleus angulation and membrane obliquity.•Asymmetric design avoids posterior canal contact, suits neutral configuration.•Larger anterior portion promotes optimal contact with tympanic membrane remnant.•Asymmetric graft design improves success rate, contributes to better hearing gain. This study aimed to assess the efficacy of a novel modified asymmetric chondro-perichondrial island graft in tympanoplasty. The design features a longer anterior segment compared to the posterior segment, addressing limitations of symmetrical grafts. We investigated the impact of this modified graft on hearing improvement and graft success rates in patients undergoing tympanoplasty surgery. This retrospective study evaluated 784 patients with chronic otitis media who underwent primary type I tympanoplasty with a modified asymmetric chondro-perichondrial island graft technique. Demographics and characteristics of all patients, preoperative location of the perforation, and Pure-Tone Audiometry (PTA) were assessed preoperatively, and graft success and postoperative hearing outcomes were evaluated at the 12-month follow-up. This study evaluated the efficacy of a modified asymmetric chondro-perichondrial island graft in tympanoplasty. In 784 patients, the mean 12-month postoperative Air-Bone Gap (ABG) improvement was 17.3 dB with a 99% graft success rate. Preoperative ABG significantly improved from 24 dB to 6.6 dB postoperatively (p