Objective: To assess anatomical and hearing results after different reconstruction methods of tympanic membrane in cases of severe middle ear granulation.
Study design: Retrospective review.
Setting: Secondary care medical center.
Patients: Forty patients with severe middle ear granulation were included.
Interventions: Canal wall-up mastoidectomy with Type I tympanoplasty. Temporalis fascia was used in 22 patients, cartilage island flap was used in 10 patients, and cartilage palisade was used in 8 patients.
Main outcome measures: Graft take, air-bone gap, and air-bone gap closure ratio of 50% or more.
Results: In the fascia group, the graft take rate was 91%, whereas the graft take rate for the cartilage island group and the cartilage palisades group was 100% (p = 0.617). Mean ± SD preoperative air-bone gaps for the fascia, island flap, and cartilage palisades were 30 ± 9.4, 26 ± 11.7, and 25 ± 10.8 dB, respectively. Postoperative air-bone gaps were 17 ± 10.2, 14 ± 8.4, and 19 ± 7.5 dB, respectively, in the same order. The cartilage palisades group failed to show statistically significant difference between preoperative and postoperative air-bone gaps (p = 0.195). Air-bone gap closure ratio of 50% or more was found in 11 cases (50%) of the fascia group, in 5 cases (50%) of the island flap group, and in 1 case (13%) of the cartilage palisades group.
Conclusion: Cartilage palisades showed reliable graft take but slightly poor hearing results. Thus, fascia or cartilage island grafting might be better for tympanoplasty in cases of severe middle ear granulation tissue.