COMPOSITE AUTOGRAFT SHIELD RECONSTRUCTION OF REMNANT TYMPANIC MEMBRANES

The authors present their combined experience with large cartilage-per ichondrial composite grafts used to reconstruct total tympanic membran e perforations in 294 years. Patients chosen for this procedure had fa iled earlier tympanoplasty surgery or were identified as poor candidat es for conventional fascial tympanoplasty because of the perforation s ize. Successful perforation closure was achieved in 97% of ears with c hronic otitis media characterized by absence of the tympanic membrane, including portions of the anterior annular ligament. Hearing results in general were good, considering the advanced stage of the disease, w hich required the use of alloplastic ossicular prostheses (PORP and TO RP) in 76% of ears. Hearing improvement was maximal at 2000 Hz regardl ess of the method of ossicular reconstruction. Closure of the air-bone gap at this frequency to within 10 dB was achieved in 87% of type I t ympanoplasties, 73% of type III (PORP), and 70% of type III (TORP) tym panoplasties. Although cartilage autografts have also been promoted to reverse tympanic membrane atelectasis, the authors believe that the a bove preoperative conditions are strong indications for this grafting technique, which is described in detail.