Tympanoplasty with tragal cartilage graft, postauricular approach
Blake Hollowoa, Michael Kubala, Gresham Richter.
Tympanic membrane (TM) perforations arise from multiple conditions including acute otitis media, barotrauma, chronic eustachian tube dysfunction, or as a complication of pressure equalization (PE) tube insertion. Most perforations heal spontaneously or with conservative measures such as ototopical drops and dry ear precautions. Perforations that do not heal can lead to conductive hearing loss, chronic infection, or cholesteatoma. A 6-year-old patient with a persistent TM perforation presented with otalgia and otorrhea. A tympanoplasty with a tragal cartilage graft was performed to repair the patient’s TM perforation.
The patient was intubated and the operation carried out under general anesthesia. Facial electrodes were inserted for facial nerve monitoring. The patient was prepped and draped in sterile fashion. The external canal was suctioned and irrigated. A tragal incision was then made to harvest a 1 cm piece of cartilage for the TM graft. The tragal incision was closed with monocryl suture. A postauricular incision was made in the natural skin crease to expose the posterior canal. Canal incisions were made to enter the external canal. A tympanomeatal flap was elevated until the middle ear was entered. The previously harvested tragal cartilage graft was inserted medial to the native TM perforation. Gel-Foam was inserted medial to the graft for support. Tragal perichondrium was inserted lateral to the tragal cartilage graft. Gel-Foam was then inserted lateral to the graft for support. The periosteum and postauricular incision were closed with vicryl suture. The external canal was inspected, then antibiotic ointment and an ear wick was inserted. The patient was dressed using a Glasscock dressing.
The patient was discharged the same day and seen in clinic two weeks from his surgery. The incisions were healing well with no indications of infection or wound dehiscence. His pain was resolved and an appointment for formal audiology was scheduled for a 3-month follow-up visit.
Tympanoplasty with a tragal cartilage graft using a postauricular approach is a successful method to surgically correct persistent tympanic membrane perforations.