Comparative study between double-layered reinforcement and temporalis fascia graft technique in endoscopic myringoplasty for subtotal tympanic membrane perforation

Abstract Introduction Techniques for myringoplasty are continually evolving, shifting from the use of microscopes to endoscopes and from employing temporalis fascia to utilizing double-layered grafts. The primary aim is to provide a robust scaffold that allows the neo-tympanic membrane to grow effectively. The choice of surgical technique is influenced by the specific pathology of the middle ear, the function of the Eustachian tube, and the surgeon’s training and expertise. In light of this, the present study compares the effectiveness of endoscopic trans-canal myringoplasty using temporalis fascia to that of a double-layered graft, which consists of partial thickness tragal cartilage and temporalis fascia, for repairing subtotal tympanic membrane perforations. Methods Over the past 3 years, 60 patients underwent endoscopic trans-canal myringoplasty for subtotal tympanic membrane perforations. Two different grafting techniques were utilized during this time: Temporalis fascia (Group 1) and a double-layered graft, which combined partial-thickness tragal cartilage (without perichondrium) and temporalis fascia (Group 2). Thirty patients underwent the temporalis fascia technique, followed by another 30 patients undergoing the double-layered technique. The results of the two groups were analyzed by assessing the rates of graft uptake, indicating successful graft integration, in addition to evaluating hearing outcomes through pre- and postoperative measurements of the air-bone gap (ABG). Various statistical methods were used to determine the significance of the findings in the study. Results In Group 1 ( n = 30), 73.33% of cases achieved successful uptake, compared to 96.67% in Group 2 ( n = 30). This difference in success rates was statistically significant ( P = 0.034). For Group 1, the average preoperative air-bone gap (ABG) was 41.47 ± 7.89 dB, and the postoperative ABG was 36.08 ± 12.38 dB, indicating a significant reduction of 5.39 dB ( P < 0.049). In Group 2, the mean preoperative air-bone gap was 40.16 ± 9.09 dB, while the postoperative measurement was 31.16 ± 12.59 dB, resulting in a notable reduction of 9.0 dB, which was also statistically significant ( P < 0.0024). Conclusion The double-layered graft has been proven to be a better graft for subtotal perforation closure than the temporalis fascia, with a better success uptake rate and a statistically similar hearing outcome.