Temporalis Fascia Versus Conchal Cartilage in Revision Type 1 Tympanoplasty

Objective/ Hypothesis: The primary goal of successful tympanoplasty is to creat a well-aerated closed middle ear (ME) cavity following disease removal. Temporalis fascia and cartilage are the most frequently used autografts due to their accessibility and favorable biological properties. Recurrent tympanic membrane (TM) perforation is considered a high-risk perforation. This study compared temporalis fascia and conchal cartilage grafts in revision type-1 tympanoplasty regarding graft uptake, hearing outcomes, and complications.Study Design: Prospective comparative study.Patients and Methods: This study included 26 adult patients (≥18 years) with recurrent, safe-type TM perforations and a history of recurrent tympanic membrane perforation at least six months prior. Patients were randomly divided into two equal groups (n=13). Group A underwent revision tympanoplasty using temporalis fascia graft; group B received Conchal cartilage graft. All patients were followed for six months. Outcomes assessed included graft take, pre- and post-operative pure tone average (PTA), air-bone gap (ABG), and complications.Results: Both groups showed statistically significant improvement in post-operative PTA and ABG compared to pre-operative values (p < 0.001). There was no statistically significant difference between the two groups in hearing outcomes. Graft failure occurred in two cases in the fascia group and none in the cartilage group, though the difference was not statistically significant. No deterioration in bone conduction thresholds or notable donor-site morbidity was observed.Conclusion: Temporalis fascia and Conchal cartilage grafts offer comparable results in type-1 tympanoplasty for recurrent TM perforations in terms of healing and hearing restoration.