Endoscopic Transcanal Myringoplasty: A Comparative Analysis of Graft Uptake and Hearing Outcomes Using Butterfly Cartilage, Temporalis Fascia, and a Novel Composite Cartilage Graft.

Background: Tympanic membrane perforation repair continues to evolve, with a shift toward endoscopic approaches and diverse grafting materials. Subtotal perforations with minimal anterior margins pose a significant clinical challenge. This study evaluated the efficacy of a novel composite graft (partial-thickness tragal cartilage overlaid with temporalis fascia) compared to established techniques: full-thickness tragal cartilage (butterfly graft) and temporalis fascia.

Methods: This observational retrospective study was conducted at a tertiary care setting. The medical records of 70 consecutive patients who underwent endoscopic transcanal myringoplasty were reviewed. Patients were categorized into three groups based on the myringoplasty technique: butterfly cartilage graft, temporalis fascia graft, and composite cartilage graft. Graft uptake rates and changes in air-bone gap (ABG) were compared pre- and postoperatively (at three months).

Results: All three techniques demonstrated high graft uptake rates and statistically significant improvements in ABG. The butterfly graft had a 100% uptake rate, the temporalis fascia graft had an 89.47% uptake rate, and the composite cartilage graft had an 84.62% uptake rate. Mean ABG improvement at three months postoperatively was 10.06 dB for the butterfly group, 9.53 dB for the temporalis fascia group, and 10.23 dB for the composite cartilage graft group. Significant differences were observed between all groups (p < 0.001). The composite graft demonstrated promising results, particularly for subtotal perforations.

Conclusions: Endoscopic transcanal myringoplasty with various graft materials is an effective method for tympanic membrane repair. The butterfly cartilage graft is suitable for small- to medium-sized perforations, and temporalis fascia remains suitable for large- and medium-sized perforations with adequate anterior margins. For subtotal perforations with minimal anterior margins, the novel composite cartilage graft offers a promising alternative with a high potential for successful outcomes. This warrants further investigation in larger prospective studies.