Beyond the Tradition in Tympanoplasty: A Retrospective Cohort Study of a New Modified Palisade Tympanoplasty Technique.

BACKGROUND &

aimTympanic membrane perforation is a common cause of conductive hearing loss and otologic morbidities. The most common cause is trauma, which tends to heal spontaneously. Conversely, perforations caused by infections or middle ear pathology require surgical intervention, such as tympanoplasty. While cartilage tympanoplasty provides benefits of durability and resistance to retraction, concerns persist regarding graft rigidity and its adverse effects on hearing outcomes. This study was implemented to assess the anatomical and functional success of an innovative and novel form of modified palisade cartilage tympanoplasty, which is designed to improve graft flexibility, stability, and audiological results. MATERIALS &

methodsA retrospective cohort study was conducted at a tertiary referral center between 2019 and 2023. Nineteen patients (age range = 9-64 years) who underwent the modified palisade tympanoplasty using a tragal composite cartilage-perichondrium graft were included, and alternative grafting techniques were excluded. Variables including demographic data, clinical history, surgical information, and postoperative follow-up regarding graft uptake and both functional and anatomical success were assessed for each patient. Functional success was defined as a postoperative air-bone gap (ABG) ≤ 20 dB, while anatomical success was defined as an intact, dry tympanic membrane. Pre- and postoperative audiometric outcomes were compared using paired statistical analysis.

resultsComplete graft uptake was accomplished in 89.5% (N = 17) of cases. Anatomical success was achieved in 78.9% (N = 15) of patients, and functional success in 84.2% (N = 16). Audiometric evaluation showed a statistically significant improvement in postoperative ABG compared to preoperative values (p = 0.004). Disrupted ossicular chain and the presence of cholesteatoma or tympanosclerosis were significantly associated with poorer outcomes (p < 0.001). No significant associations were found between outcomes and patient demographics, perforation characteristics, smoking status, or surgical approach. Favorable results were achieved across surgeons with varying levels of experience.

conclusionsThe modified palisade tympanoplasty technique is shown to have effective graft uptake and considerable improvement in hearing by overcoming the stiffness of the cartilage graft. The effectiveness of this technique has been exhibited across a wide age range, co-existing health conditions, and different levels of surgeon expertise, proving that all patients can be subjected to the procedure. Further studies need to be conducted to validate our findings.