INTRODUCTION
Perforation closure plays an important role in Chronic suppurative otitis media (CSOM) treatment to restore the anatomy and function of the tympanic membrane and prevent repeated infection. Endoscopic myringoplasty with cartilage perichondrium complex has been considered an effective and well-developed surgery method, especially for patients with eustachian tube dysfunction, large perforations, sub-total or marginal perforations (1, 2).
The effectiveness of myringoplasty is evaluated by the healing rate of tympanic membrane. Multiple factors affect the healing rate of tympanic membrane, including surgical approaches, location and size of perforations, graft choice and preparation, use of antibiotics, repair technology and status of tympanum and mastoid, etc. (3). Among all of these factors, Carr (4) found that the location of perforation is the most important, with subtotal perforations and anterior marginal perforations subject to the lowest healing rates. Similarly, a multicenter retrospective study of 523 patients undergoing cartilage myringoplasty (5) also showed the lowest healing rates in subtotal perforations (89%) and anterior perforations (92.4%) three months after surgery, while the healing rates of inferior and posterior perforations were higher at 94.9% and 95.6%, respectively. New surgery techniques have been explored by otologists to improve the healing rate of large perforations and marginal perforations, such as skin flap method((6) ,anterior wall skin flap(7) , butterfly cartilage myringoplasty(8) and inside out elevation of a tympanomeatal flap (9).The healing rate of anterior marginal perforations and large perforations remains significantly lower than that of small, inferior and posterior perforations, and should be further improved. In this study we modified the classic endoscopic cartilage myringoplasty by adding an extra perichondrium patch to strengthen the anterior-inferior tympanic membrane. The new method was applied to three types of patients with: (1) large perforations where the grafts could not tightly fit tympanic membrane remnant during operation; (2) marginal perforations without residual tympanic membrane to support the graft; or (3) preoperative eustachian tube dysfunction. Using this newly developed method, we performed endoscopic myringoplasty on 80 patients and statistically analyzed the healing rate and hearing improvement.
METHOD