INTRODUCTION
Perforation closure plays an important role in Chronic suppurative
otitis media (CSOM) treatment to restore the anatomy and function of the
tympanic membrane and prevent repeated infection. Endoscopic
myringoplasty with cartilage perichondrium complex has been considered
an effective and well-developed surgery method, especially for patients
with eustachian tube dysfunction, large perforations, sub-total or
marginal perforations (1, 2).
The effectiveness of myringoplasty is evaluated by the healing rate of
tympanic membrane. Multiple factors affect the healing rate of tympanic
membrane, including surgical approaches, location and size of
perforations, graft choice and preparation, use of antibiotics, repair
technology and status of tympanum and mastoid, etc. (3). Among all of
these factors, Carr (4) found that the location of perforation is the
most important, with subtotal perforations and anterior marginal
perforations subject to the lowest healing rates. Similarly, a
multicenter retrospective study of 523 patients undergoing cartilage
myringoplasty (5) also showed the lowest healing rates in subtotal
perforations (89%) and anterior perforations (92.4%) three months
after surgery, while the healing rates of inferior and posterior
perforations were higher at 94.9% and 95.6%, respectively. New surgery
techniques have been explored by otologists to improve the healing rate
of large perforations and marginal perforations, such as skin flap
method((6) ,anterior wall skin flap(7) , butterfly cartilage
myringoplasty(8) and inside out elevation of a tympanomeatal flap
(9).The healing rate of anterior marginal perforations and large
perforations remains significantly lower than that of small, inferior
and posterior perforations, and should be further improved. In this
study we modified the classic endoscopic cartilage myringoplasty by
adding an extra perichondrium patch to strengthen the anterior-inferior
tympanic membrane. The new method was applied to three types of patients
with: (1) large perforations where the grafts could not tightly fit
tympanic membrane remnant during operation; (2) marginal perforations
without residual tympanic membrane to support the graft; or (3)
preoperative eustachian tube dysfunction. Using this newly developed
method, we performed endoscopic myringoplasty on 80 patients and
statistically analyzed the healing rate and hearing improvement.