title: Butterfly cartilage graft inlay tympanoplasty for large perforations.
abstract: OBJECTIVE
  Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small perforations. However, the efficacy of the technique for medium and large tympanic membrane perforations remains unknown.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Postauricular tympanoplasty and tympanomastoidectomy using a large butterfly cartilage inlay graft (>4 mm diameter to total drum replacement) were analyzed in 90 pediatric patients (99 ears).
  
  
  RESULTS
  Patient ages ranged from 2 to 20 years; mean follow-up duration was 27.6 months. Successful closure occurred in 92% of the ears. No graft lateralized nor displaced into the middle ear. No retraction pocket occurred during the follow-up period. In 62 cases, intact canal wall or canal wall window tympanomastoidectomy was performed; Fifty-one (82.2%) of the patients having mastoidectomy procedures had chronic otitis media with cholesteatoma. The mean preoperative to postoperative four-tone air-bone gap improved from 23 to 21 dB; the number of patients with 0 to 10 dB hearing results increased from 16 ears preoperatively to 32 ears postoperatively. Postoperative suboptimal results included eight patients with postoperative perforations in the residual tympanic membrane adjacent to an intact cartilage graft; two of these patients were the only individuals who exhibited otorrhea.
  
  
  CONCLUSIONS
  Cartilage butterfly graft inlay tympanoplasty is effective in the vast majority of patients with moderate to large perforations. The closure rate exceeded 90% with no graft displacement, postoperative adverse events were respectably low, and hearing results improved or remained stable despite the need for concurrent mastoidectomy in the majority of patients.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Marcielle A
authors.initials: MA
authors.lastname: Ghanem
authors.forename: Angelo
authors.initials: A
authors.lastname: Monroy
authors.forename: Farmarz S
authors.initials: FS
authors.lastname: Alizade
authors.forename: Yamileth
authors.initials: Y
authors.lastname: Nicolau
authors.forename: Roland D
authors.initials: RD
authors.lastname: Eavey
mesh_terms: D000293:Adolescent; D000328:Adult; D001299:Audiometry; D001844:Bone Conduction / Q000502:physiology; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery; D004424:Ear Canal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing / Q000502:physiology; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D010033:Otitis Media / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000601:surgery; D014433:Tympanoplasty / Q000379:methods*