Tympanoplasty in High-Risk Perforation and Atelectatic Ear Using Perichondrium-Cartilage Island Graft and Temporalis Fascia: A Comparative Analysis

Background: The prevalence of chronic otitis media in the Armed Forces is high. Moreover, management of high-risk perforation and atelectatic ear is an even greater challenge. It is necessary to assess the most viable management approach to achieve an optimal outcome. Aims and Objectives: We aimed to compare anatomical and audiological results in tympanoplasty for high-risk perforation and atelectasis using perichondrium-cartilage island (PCI) graft with temporalis fascia (TF) graft. Materials and Methods: A retrospective study was carried on 110 patients. Fifty-four patients and 56 patients underwent PCI graft and TF tympanoplasty, respectively. Postoperative graft integration rates and hearing outcomes were compared. Chi-square test was carried out to compare postoperative graft uptake. Postoperative audiological outcomes were compared using t-tests. Results: At 2-year follow-up, the graft take-up rate for PCI graft and TF graft was 96.29% and 82.14%, respectively (statistically significant). In the TF group, 17.86% had reperforation and recurrence of retraction pockets. In the PCI group, 3.71% had recurrent perforation. Furthermore, there was a statistically significant in the postoperative long-term improvement in pure-tone average air-bone gap in the cartilage island graft group (15.01 +/- 3.53 db vs. 21.96 +/- 4.09 db, P < 0.05). Conclusion: PCI graft achieves better morphological and audiological results in comparison to TF graft in high-risk perforation and atelectatic ears. It has a higher graft integration rate and better long-term audiological outcomes.