Type 1 tympanoplasty is a procedure performed to repair tympanic membrane perforations, primarily to reduce otorrhoea. This may subsequently lead to improvement of hearing. The common graft materials used are temporalis fascia and cartilage from tragus or concha. The authors undertook a retrospective study to compare tympanic membrane closure rate and hearing outcomes of temporalis fascia and tragal cartilage grafts in the elderly population. They included patients aged 65 years old and above, without previous middle ear surgery or cholesteatoma. All procedures were performed under general anaesthesia with a post-auricular approach under the senior author’s supervision. The authors defined anatomical success as complete closure of the tympanic membrane perforation and functional success as postoperative air-bone gap (ABG) ≤10dB. They retrospectively identified 73 elderly patients who had at least 12 months’ follow-up: 42 patients in the fascia group and 31 patients in the cartilage group. There was no statistical difference in patient and perforation characteristics of the two groups.
The graft success rate was 83.5% for the entire group and higher in the cartilage group compared to the fascia group (93.5% and 76.2% respectively). Functional success rate (ABG≤10dB) was 65.7% for the entire group. Although mean hearing gain was significantly higher in the fascia group than in the cartilage group (12.5±7.6 and 8.9±6.1dB respectively), functional success rates (ABG≤10dB) were similar in both groups.
This study demonstrates that type 1 tympanoplasty is an effective procedure in elderly patients. When considering tympanoplasty in elderly patients, who often have mixed hearing loss, they have to be appropriately counselled about poorer hearing gain, if any, and that they may still require hearing aids postoperatively. In such cases, cartilage graft might be the better choice due to its higher success rate and functional outcomes similar to temporalis fascia.