Comparison of postoperative outcomes between accordion cartilage graft and island cartilage graft techniques in tympanoplasty

Objective: The purpose of this study is to compare the postoperative success of the accordion cartilage graft technique in tympanoplasty operations in terms of audiologic outcomes and quality of life contributions against to the island cartilage graft technique. It also aims to determine if this success varies with the severity of the disease, history of previous operations, location and size of the perforation, and ossicular chain reconstruction. Materials and Methods: This study examines tympanoplasty operations conducted on a total of 94 patients, aged between 18 and 80, during the years 2019-2023. Forty-five patients were operated using the accordion cartilage graft technique, while forty-nine patients underwent surgery with the island cartilage graft technique. The research comprehensively compares both groups in terms of patients' complaints, previous surgeries, form of anesthesia, surgical notes, preoperative and postoperative examination findings, and pure tone audiometry results. Additionally, the Chronic Otitis Quality of Life survey (CES) was administered to patients before and after the operations. Groups were also subdivided based on whether ossicular chain reconstruction was performed. Functional and anatomical success rates, postoperative audiologic gain, and increase in survey scores were compared in both groups; furthermore, the effects of the graft technique, perforation location and size, Middle Ear Risk Index (MERI), and CES scores on success were analyzed. Results: No significant difference was identified between groups in terms of patients' demographic characteristics, characteristics of the perforation, operation time, and MERI scores (p>0.05). Significant improvements were observed in both groups in terms of average air conduction hearing threshold (AC PTA), air-bone gap (ABG) values, and CES scores post-operation compared to pre-operation (p<0.05). The accordion group showed significantly better results in terms of postoperative ABG gain compared to the island cartilage group (p<0.05). The superiority of the accordion group in terms of functional success rates was statistically marginally significant (p=0.070). When subgroups within the accordion and island cartilage groups were formed based on whether ossicular chain reconstruction was performed, no significant differences were observed in postoperative AC PTA and ABG gain, improvement in CES score, and rates of anatomical and functional success (p>0.05). Additionally, a significant correlation was found between MERI scores, CES scores, and the diameter of the perforation with the success of the operation (p<0.05). Conclusion: It has been seen that the accordion cartilage graft offers superior postoperative hearing benefits compared to the island cartilage graft. In tympanoplasty, the accordion cartilage graft technique stands out as an effective and reliable method; it is adaptable to various perforation sizes and types in both primary and revision surgeries, regardless of the need for ossicular chain repair. Keywords: tympanoplasty, accordion, island cartilage, perforation, graft, ossicular chain, operational success