A Novel Combined Cartilage-Fascia Technique for Anterior Perforation in Type-1 Underlay Tympanoplasty

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P < 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties.