Double-Layered (Cartilage Island + Extra Perichondrium) Graft for Type 1 Tympanoplasty.

Objective: To compare the graft success rates and hearing results of single-layered (composite island) grafting (SLG) vs double-layered (composite plus second layer of perichondrium) grafting (DLG) for over-under type 1 tympanoplasty techniques.
Study Design: Retrospective chart review.
Settings: Tertiary center otorhinolaryngology clinic.
Subjects and Methods: Medical charts of the patients who underwent type 1 tympanoplasty via the microscopic technique by a single surgeon between 2015 and 2019 were analyzed.
Results: A total of 48 patients were included. The DLG (n = 26) group had higher graft take rates as compared to the SLG group (n = 22) for all patients ( P = .038) and for moderate- to high-risk patients according to Middle Ear Risk Index (MERI) scores ( P = .029) but not for patients with mild disease ( P = .429) or myringosclerotic patients ( P = .242). The DLG group exhibited higher air-bone gap closure (C-ABG) values as compared to the SLG group for all patients ( P = .018). However, there was no noticeable difference in C-ABG values within the patients with successful grafting ( P = .217). Only graft success status had a significant effect on C-ABG values when the multivariate linear regression was performed. ( P = .016). Higher MERI scores and presence of myringosclerosis were related to the unsuccessful grafting ( P < .01).
Conclusion: DLG tympanoplasty is encouraged, especially for patients with higher MERI scores, to increase the graft success rates. Better hearing outcomes of DLG tympanoplasty were related to the higher graft success status of this technique; DLG had no additional hearing effect for patients with successful grafting. Higher MERI scores and presence of myringosclerosis were related to graft failure.