Five-Year Graft Outcomes and Complications of Endoscopic Cartilage–Perichondrium Sandwich Myringoplasty for Large Central Perforations

Abstract

Objective:

We evaluated the 5-year graft success rate and incidence of iatrogenic cholesteatoma following endoscopic cartilage–perichondrium sandwich myringoplasty for the repair of large central tympanic membrane perforations.

Materials and Methods:

This retrospective study included patients with large central perforations who underwent endoscopic cartilage–perichondrium sandwich myringoplasty. Graft integrity and the presence of iatrogenic middle ear cholesteatoma were assessed at a 5-year postoperative follow-up.

Results:

In total, 86 patients were included in the final analysis. The mean follow-up duration was 6.4 ± 1.2 years (range, 5-7 years). The graft take rates were 96.5% at 3 months, 94.2% at 6 months, and 93.0% at 5 years postoperatively. At 6 months postoperatively, 2.44% of patients demonstrated no change in hearing, whereas 3.66% experienced a deterioration in conductive hearing. In the remaining 93.90% of patients, the improvement in hearing was statistically significant; the mean air–bone gap decreased from 25.1 ± 4.6 dB preoperatively to 14.9 ± 3.1 dB postoperatively (P < .05). At the 5-year follow-up, high-resolution computed tomography (HRCT) revealed well-pneumatized mastoid and middle ear cavities in 93.02% of patients, eliminating the need for magnetic resonance imaging (MRI). HRCT revealed soft tissue opacities in the mastoid region in 4 patients who had undergone canal wall up mastoidectomy (CWUM) and in 2 patients without CWUM; however, subsequent MRI excluded mastoid cholesteatoma in all 6 cases. Notably, a small graft cholesteatoma was detected in 1 patient (1.16%).

Conclusions:

Five-year imaging follow-up demonstrated that endoscopic cartilage–perichondrium sandwich myringoplasty, performed without removal of the epithelium from the tympanic membrane remnant, achieved a stable graft success rate in the repair of large central perforations. The procedure was associated with a minimal risk of graft cholesteatoma and no observed risk of middle ear cholesteatoma.