Objectives: To evaluate a new composite cartilage–perichondrium
graft (button graft) for repair of small-sized
tympanic membrane perforations and to compare its success
rate with that of the underlay and overlay techniques with
temporal fascia or tragal perichondrium.
Design: Prospective, sequential allocation of surgical
technique study.
Setting: Tertiary care university hospital.
Patients: One hundred 95 patients aged 14–42 years with
central, uncomplicated tympanic membrane perforations
with completely visualised margins affecting less than 25% of
the tympanic membrane, distributed in three groups: 1
(underlay), 2 (overlay) and 3 (button graft).
Interventions: Patients were allocated in sequence to: 1
underlay graft, 2 overlay graft and 3 cartilage tympanoplasty
with button graft technique. Patients were operated on
under local anaesthesia.
Main outcome measures: Postoperative status of the
tympanic membrane, hearing improvement, duration of
surgery and incidence of complications at 12 months
postoperative.
Results: Group 1 (underlay) had 66 patients; group 2
(overlay), 65; and group 3 (cartilage), 66. Success was defined
as the complete closure of the tympanic membrane one year
after the operation. The success rates were 98.5% (65 of 66),
97% (63 of 65) and 98.5%(65 of 66) cases, and the mean air–
bone gap gains were 10.18 (
5.4) dB, 8.5 (+6.5) dB and 9.1
(+5.1) dB for groups 1, 2 and 3, respectively. No bone
conduction threshold or speech discrimination score worsening
was noted. The mean durations of the operative
procedure were 35
8.4 (range 22,63), 42
6.8 (range
33,75) and 23
6.3 (range 15,41) min for groups 1, 2 and 3,
respectively (P = 0.02). Tympanic membrane retraction
occurred in three cases in underlay group 1, and tympanic
membrane cholesteatoma pearls occurred in two cases in
overlay group 2.
Conclusions: The button graft technique is an effective and
fast alternative for the repair of small tympanic membrane
perforations if complete visualisation of the margin is
possible. The shorter time taken with the button grafts is
mainly due to the non-requirement for a skin incision. The
results are comparable to those of the underlay and overlay
techniques.
Healing of