title: Perichondrium/cartilage composite graft for repairing large tympanic membrane perforations and hearing improvement.
abstract: BACKGROUND
  The main risk factors for postoperative failure in tympanoplasties are large perforations that are difficult to repair, annular perforations, and a tympanic membrane (TM) with extensive granular myringitis that require middle ear exploration and mastoidectomy. The aim of this study was to investigate a novel technique of perichondrium/cartilage composite graft for repairing the large TM perforation in the patient of otitis media.
  
  
  METHODS
  Retrospective chart reviews were conducted for 102 patients with large tympanic membrane perforations, who had undergone tympanoplasty from August 2005 to August 2008. Tympanoplasty or tympanomastoidectomy using a perichondrium/cartilage composite graft was analyzed. The tragal or conchal perichondrium/cartilage was used to replace the tympanic membrane in patients.
  
  
  RESULTS
  Patients aged from 13 to 67 years were followed up in average for 24 months (10 - 36 months). Seventy-four ears (72.61%) were used the tragal perichondrium/cartilage as graft material and 27 ears (27.39%) were used the conchal perichondrium/cartilage. Graft take was successful in all patients. Postoperative complications such as wound infection, hematoma, or sensorineural hearing loss were not identified. Nine patients (8.82%) had the partial ossicular replacement prosthesis, 14 patients (13.72%) using the autologous curved incus and 79 patients (77.45%) without prosthesis. Successful closure occurred in 92% of the ears. A total of 85.8% patients achieved a postoperative hearing improvement.
  
  
  CONCLUSIONS
  The graft underlay tympanoplasty using perichondrium/cartilage composite is effective for the majority of patients with large perforation. The hearing was improved even if the mastoidectomy was required in the patients with otitis media with extensive granulation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. chenxw_pumch@yahoo.com.cn
authors.forename: Xiao-wei
authors.initials: XW
authors.lastname: Chen
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.forename: Ru-zhen
authors.initials: RZ
authors.lastname: Gao
authors.forename: Rong
authors.initials: R
authors.lastname: Yu
authors.forename: Zhi-qiang
authors.initials: ZQ
authors.lastname: Gao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media; D012189:Retrospective Studies; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult