A 25-year-old man had Type I tympanoplasty with temporalis fascia two years ago for a central perforation. He now has a deep posterior retraction pocket over the incus with early erosion, attributed to persistent Eustachian tube dysfunction. Which graft material is preferred for revision repair?

• A Temporalis fascia again
• B Vein graft
• C Tragal cartilage with perichondrium ✓
• D Synthetic alloplastic sheet

Explanation

Cartilage is stiff and resists negative middle ear pressure, so cartilage tympanoplasty with perichondrium is the revision choice in adhesive otitis, retraction pockets and other ears at high risk of re-retraction. Fascia is pliable, survives well in a well aerated ear, but thins and retracts again under sustained negative pressure, which is exactly what happened in this patient. Vein grafts are historical stapes surgery materials and alloplasts carry extrusion risk in chronically diseased ears.

Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.