Double-Layer Tympanic Membrane Graft in Type I Tympanoplasty.

Background: Some discussion remains among otologists regarding the best grafts for tympanic membrane closure. It is unclear whether double-layer grafts are superior to single-layer and whether single-layer cartilage is superior to fascia or perichondrium alone. The objective of the current study was to examine the relative efficacy of single-layer versus double-layer tympanic membrane grafting techniques.

Materials And Methods: A retrospective review of the medical records was used to address the objective of the study. Patients operated on in an over/under technique by the same surgeon underwent single-layer perichondrium or single-layer perichondrium with a cartilage island, or a double-layer of perichondrium combined with periochondrium with a cartilage island. The outcomes assessed were tympanic membrane reperforation and hearing improvement.

Results: A total of 135/177 (76%) perichondrium grafts had no reperforation, and 43/55 (78%) perichondrium with cartilage island grafts had no reperforation; 352/390 (90%) of the double-layer closures had no reperforation. There was no statistically significant difference in reperforation rates between the 2 single-layer techniques ( = .926). The difference in reperforation rates after the double-layer closure versus the perichondrium single-layer closure was statistically significant ( = .001), as was the difference in reperforation rates after the double-layer closure versus the cartilage island single-layer closure ( = .02). All 3 groups showed statistically significant hearing improvement postoperatively ( < .0001). Preoperative hearing levels ( = .179), postoperative hearing ( = .857), and decibels of hearing improvement ( = .356) were the same for all 3 groups.

Conclusion: Double-layer closure gives lower tympanic membrane reperforation rates than does single-layer closure, as well as similar hearing outcomes.