Randomized Comparison of Endoscopic Cartilage-Perichondrium Sandwich Technique Verses Underlay Technique for Large Tympanic Membrane Perforations.

Abstract

ImportantTrimming perforation margins is the basic procedure for any myringoplasties; however, to date, little literature has been reported on the effect of no trimming perforation margins on sandwich graft tympanoplasty.ObjectiveThe objective of this study was to compare the graft success rate, hearing improvement, and complications of endoscopic cartilage-perichondrium Sandwich technique (CPST) and cartilage-perichondrium underlay technique (CPUT) for repairing chronic large perforations.Study DesignProspective randomized controlled trial.SettingTertiary referral center.Participants and InterventionOne hundred two patients with chronic large perforations with 50% to 75% of tympanic membrane (TM) were recruited and randomly allocated to CPST (n = 51) and CPUT (n = 51), raising tympanomeatal flap and trimming perforation margins were not performed in both techniques.Main Outcome MeasurersThe graft success rate, air-bone gap (ABG) gain, operation time, and postoperative complications were evaluated at 12 months.ResultsAll the patients complete 12 months follow-up. The mean operation time was 30.6 ± 3.7 minutes in the CPST group and 29.8 ± 6.1 minutes in the CPUT group (P = .751).The graft success rate was 92.2% in the CPST group and 96.1% in the CPUT group (P = .979). Endoscopic examination revealed the perichondrial flap gradually became scab in the CPST group, 70.6% patients had the absence of typical cone-shaped TM. However, no scab was seen on the surface of graft, and all the patients had cone-shaped TM in the CPUT group. The ABG gain wasn't significantly different (12.9 ± 3.3 dB vs 13.1 ± 1.7 dB, P = .689).The successful surgery was 94.1% in the CPST group and 96.1% in the CPUT group, the difference wasn't significant among the 2 groups (P = .932). In addition, no procedure-related complications and no graft cholesteatoma were found in both groups during the follow-up period.Conclusions and RelevanceThe operation time, 12 months graft success rate, hearing improvement were comparable between CPST and CPUT for repairing large perforation, although raising tympanomeatal flap and trimming the perforation margins were not performed in both techniques.