Endoscopic Cartilage Myringoplasty with Anterior Margin Preservation for Repairing Large Anterior Perforations.

Objective: This study compared the graft outcomes and complications of endoscopic cartilage inlay myringoplasty with preservation of anterior margins (IPAM) and the cartilage underlay technique with raising the tympanomeatal flap (CUTF) for repairing large anterior perforations. Materials and Methods: In total, 55 patients with large anterior perforations were recruited and allocated to the IPAM (n = 28) or the CUTF (n = 27) group. The graft success rate, hearing gain, operation time, and postoperative complications were compared between the groups at 12 months. Results: The mean operation times were 29.3 ± 2.7 minutes and 46.4 ± 3.9 minutes in the IPAM and CUTF groups, respectively (P < .001). The residual perforation rate was 0.0% in the IPAM group and 11.1% in the CUTF group (P = .222). All patients completed the 12-month follow-up. The overall graft success rate was 96.4% in the IPAM group and 88.9% in the CUTF group (P = .577). No significant differences were observed between the groups in terms of postoperative pure-tone averages for air conduction and bone conduction, air-bone gaps (ABGs), or ABG changes. In the CUTF group, 22.2% of the patients reported altered taste perception, 3.7% experienced bony external auditory canal (EAC) stenosis, and 3.7% developed EAC cholesteatoma. By contrast, the IPAM group did not have any cases of altered taste perception, EAC stenosis, or cholesteatoma. Conclusions: Endoscopic cartilage myringoplasty with IPAM and anterior perichondrium folding is a simple, effective, and minimally invasive technique for repairing large anterior perforations. It offers a high graft success rate and better hearing improvement compared to CUTF.