Assessment of Hearing Improvement after Type I Myringoplasty Using Cartilage vs Temporalis Fascia Grafts in Chronic Suppurative Otitis Media Adult Patients

Abstract

Background: Type I myringoplasty is a hearing loss procedure that is frequently used to treat chronic otitis media and repair the conduction of hearing and the structure of the tympanic membrane. The use of temporalis fascia graft has been widely applied, although it does not hold up in large, anterior, or high-risk perforations; cartilage graft has better mechanical stability with equivalent hearing loss. The purpose of the study was to compare graft uptake, hearing recovery, time in the operating room, as well as postoperative complications between temporalis fascia and cartilage grafts in adults undergoing Type I myringoplasty. 
Methodology: The quasi-experimental study was carried out in the ENT Department, Sir Ganga Ram Hospital, Lahore, be-tween January and March 2025 upon the ethical approval of Fatima Jinnah Medical University. The sample size was determined at 95% confidence and 90 power. A total of one hundred adult patients (16 - 65 years old) with chronic Type I myringoplasty of the ear were enrolled, and patients with active discharge, prior ear surgery, ossicular pathology, sensorineural hearing loss, or systemic illness were excluded. Temporalis fascia graft (n=50) and composite cartilage island graft (n=50) were used on patients. 
Results: There were 100 patients (50 each) with an average age of 40.07 + 14.50 years; half of them were males. The grafts of temporalis fascia graft (TFG) and composite cartilage island graft (CIG) had a similar operative time (82.4 ± 22.2 vs 80.1 ± 23.6 min; p = 0.611). There was no statistically significant difference between postoperative air-bone gap (16.9 + 8.6 vs 17.5 + 7.4 dB; p = 0.717), but each of the groups had improved significantly compared to baseline (p < 0.001). There were also comparable graft uptakes (82.0% vs 80.0%; p = 0.799). The complications were infection (14.0% vs 6.0%), persistent perforation (6.0% vs 2.0%), and graft rejection (4.0% vs 2.0%); there was no significant intergroup difference (p = 0.318).
Conclusion: Both temporalis fascia and composite cartilage island grafts provide similar short-term anatomical and functional outcomes in myringoplasty. Either technique may be effectively selected based on surgeon preference or individual patient needs.