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Objective <p>The objective of this study was to evaluate the graft success rate, hearing outcomes, and complications associated with three-layer graft myringoplasty for repairing subtotal and total perforations.</p> Materials and methods <p>Forty-two patients with subtotal and total perforations underwent endoscopic perichondrium-cartilage three-layer graft myringoplasty. Graft success, hearing improvement, and complications were assessed 6 months postoperatively.</p> Results <p>Among the 42 patients, 59.52% presented with subtotal perforation and 40.48% with total perforation. Preoperative air-bone gap (ABG) ≤ 40 dB was observed in 92.86% of patients, whereas ABG &gt; 40 dB was found in 7.14% of patients with ossicular chain fixation or interruption. The mean operative time was 36.6 ± 2.8&#xa0;min (range, 32–41&#xa0;min). The graft success rate at postoperative 6 months was 97.62%. Audiological testing was completed in 39 (92.9%) patients with a normal ossicular chain at 6 months. Postoperative air-conduction pure-tone average (PTA) improved from 36.60 ± 12.14 dB to 26.53 ± 11.70 dB, with a mean change of − 10.07 dB (95% confidence interval [CI]: −15.39 to − 4.75; <i>P</i> = 0.000464). Bone-conduction PTA demonstrated no significant change (15.08 ± 7.49 dB vs. 13.82 ± 8.52 dB; mean change − 1.26 dB, 95% CI: −5.05 to 2.53; <i>P</i> = 0.506). The ABG significantly improved from 21.52 ± 6.38 dB to 12.71 ± 4.58 dB, corresponding to a mean reduction of − 8.81 dB (95% CI: −11.17 to − 6.45; <i>P</i> = 4.35 × 10⁻⁹). No graft-related complications (e.g., graft lateralization, significant blunting, or graft medialization) were identified during the follow-up period.</p> Conclusions <p>The endoscopic three-layer graft technique without raising the tympanomeatal flap appears feasible and associated with favorable short-term outcomes. However, future prospective controlled studies with larger sample sizes and longer-term endoscopic or radiologic follow-up are needed to validate these findings and provide more comprehensive insights.</p>

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Endoscopic three-layer graft myringoplasty without tympanomeatal flap elevation for repairing subtotal and total perforations

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Zhengcai Lou,
  • Hailing Yang

摘要

Objective

The objective of this study was to evaluate the graft success rate, hearing outcomes, and complications associated with three-layer graft myringoplasty for repairing subtotal and total perforations.

Materials and methods

Forty-two patients with subtotal and total perforations underwent endoscopic perichondrium-cartilage three-layer graft myringoplasty. Graft success, hearing improvement, and complications were assessed 6 months postoperatively.

Results

Among the 42 patients, 59.52% presented with subtotal perforation and 40.48% with total perforation. Preoperative air-bone gap (ABG) ≤ 40 dB was observed in 92.86% of patients, whereas ABG > 40 dB was found in 7.14% of patients with ossicular chain fixation or interruption. The mean operative time was 36.6 ± 2.8 min (range, 32–41 min). The graft success rate at postoperative 6 months was 97.62%. Audiological testing was completed in 39 (92.9%) patients with a normal ossicular chain at 6 months. Postoperative air-conduction pure-tone average (PTA) improved from 36.60 ± 12.14 dB to 26.53 ± 11.70 dB, with a mean change of − 10.07 dB (95% confidence interval [CI]: −15.39 to − 4.75; P = 0.000464). Bone-conduction PTA demonstrated no significant change (15.08 ± 7.49 dB vs. 13.82 ± 8.52 dB; mean change − 1.26 dB, 95% CI: −5.05 to 2.53; P = 0.506). The ABG significantly improved from 21.52 ± 6.38 dB to 12.71 ± 4.58 dB, corresponding to a mean reduction of − 8.81 dB (95% CI: −11.17 to − 6.45; P = 4.35 × 10⁻⁹). No graft-related complications (e.g., graft lateralization, significant blunting, or graft medialization) were identified during the follow-up period.

Conclusions

The endoscopic three-layer graft technique without raising the tympanomeatal flap appears feasible and associated with favorable short-term outcomes. However, future prospective controlled studies with larger sample sizes and longer-term endoscopic or radiologic follow-up are needed to validate these findings and provide more comprehensive insights.