Cartilage “Shield” Tympanoplasty: An Effective and Reliable Procedure

Objective: To report our experience and the hearing results following cartilage “shield” tympanoplasty in selective cases that necessitated total tympanic membrane replacement due to chronic tympanic perforations, cholesteatomas, and atelectatic/tympanosclerotic tympanic membranes.

Study Design: Retrospective chart review at a tertiary referral center.

Methods: Conchal cartilage, shaped as a shield, was used to replace the entire tympanic membrane. Graft take was evaluated in follow-up examination and hearing results were determined by comparing pre- and postoperative pure tone air bone gap (PTA-ABG) and speech audiometry.

Results: Between December 1999 and December 2005, 132 patients (38 children and 94 adults) were treated. The mean age of these patients was 34 years (range, 7 to 72 years). The mean follow-up was 33 months (range, 6 to 60 months). In 77 patients (58.3%) the procedure was primary and in 55 (41.6%) it was a revision. Sixty-four (48.4%) were for chronic tympanic membrane perforation, 45 (34%) for cholesteatoma, 20 (15%) for atelectatic tympanic membranes, and 2 (1.5%) for atresia. Graft take was successful in all but 1 patient (99%).

Audiometric results were available for comparison in 100 patients. The average preop PTA-ABG was 32.18 ± 13.9 dB and the postop was 20.7 dB ± 10.6 dB, for an average improvement of 11.42 dB (p < 0.0001). A postoperative ABG of 25 dB or less was achieved in 72 (72%) of the patients. Speech discrimination scores remained unchanged postoperatively. No complications were identified.

Conclusion: Cartilage “shield” tympanoplasty is an effective and reliable technique in selected patients with chronic otitis media. Hearing results are satisfactory.