Endoscopic Repair of Tympanic Membrane Perforation with Tragus Cartilage-Perichondrium Complex and Perichondrium without Tympanomeatal Flap Elevation

LIU Sha; QIU Jingjing; LIU Dawei; ZHAI Xiaoyu; ZHANG Qiang; CHEN Liang; SUN Yan

doi:10.3969/j.issn.1672-2922.2025.03.011

Abstract：Objective To report clinical outcomes of endoscopic tympanic membrane perforation repair with tragus cartilage-perichondrium complex and perichondrium without lifting the tympanomeatal flap.Methods Clinical data from 87 patients(87 ears)treated for tympanic membrane perforation at Yantai Yuhuangding Hospital,Qingdao University,from January 2021 to December 2023 were retrospectively analyzed.Techniques used included endoscopic medial(30 cases)and lateral(28 cases)faced grafting,and trans-perforation perichondrium grafting(29 cases),all without elevating the tympanomeatal flap.The cartilage-perichondrium clip with the perichondrium side facing either the tympanic cavity(medial)or the ear canal(lateral),whereas the tragus perichondrium was passed through the perforation in trans-perforation approach.Operation time,blood loss,grafting success rate,hearing outcomes and postoperative complications were compared among the techniques.Results The rate of success grafting was 96.67%(28/29)with medial facing chondroperichondrial clips,100%(28/28)with lateral facing chondroperichondrial clips,and 79.31%(17/23)with trans-perforation perichondrium grafts(P<0.05).Operation time with chondroperichondrial clips was significantly shorter than with trans-perforation perichondrium grafts(P<0.05),with no significant differences in blood loss,pre-and post-operative air-conduction threshold(AC)and air-bone gap(ABG)changes,and postoperative complications(P>0.05).Conclusion Compared with trans-perforation repair with tragus perichondrium,endoscopic composite chondroperichondrial clip tympanoplasty for repairing central perforation of 3～5 mm shows higher rates of grafting success with shorter operation time,and is worthy of adoption in clinical practice.