Hearing results after primary cartilage tympanoplasty with island technique

Because of its rigid quality, cartilage is the grafting material of choice in advanced pathologies, such as adhesive processes or recurrent perforations. However, the use of such a rigid material in tympanic membrane reconstruction causes controversies as to the audiologic aspect. The purpose of this study was to assess overall and frequency-specific hearing results after primary cartilage tympanoplasty with island technique in comparison to the hearing results after primary tympanoplasty with temporalis muscle fascia. This study was a retrospective review of selected cases between 1999 and 2002. Primary cases with intact ossicular chain, normal middle ear mucosa, and subtotal perforation of the tympanic membrane were included in the study. Fifteen patients were in the cartilage group, whereas 10 patients were in the fascia group. Preoperative and postoperative air-bone gaps at the frequencies of 0.5, 1, 2, and 4 kHz were compared. Both groups were statistically similar on the aspect of the severity of middle ear pathology and the preoperative hearing levels. Mean postoperative gains in air-bone gap were 11.9 dB for the cartilage group and 11.5 dB for the fascia group. There were no statistically significant differences in the postoperative frequency-specific gains in air-bone gap between the 2 groups. Although cartilage is the ideal grafting material in problem cases, its comparable acoustic properties, especially in the form of cartilage island, to those of fascia will allow a more liberal application in less severe cases, in which functional outcome is more essential.