Prospective Comparison of Hearing Outcomes Using Three Grafts in Type 1 Tympanoplasty: Temporalis Fascia, Fascia Lata, and Tragal Perichondrium

Abstract

Background: Type 1 tympanoplasty is the standard treatment for chronic suppurative otitis media (CSOM) with conductive hearing loss. Graft material choice plays a critical role in surgical outcomes, yet comparative data are limited.
Objective: To compare hearing improvement and graft uptake rates using temporalis fascia, fascia lata, and tragal perichondrium in Type 1 tympanoplasty.
Methods: A prospective study was conducted on 105 CSOM (tubotympanic type) patients undergoing Type 1 tympanoplasty at R.D. Gardi Medical College, Ujjain, from August 2023 to February 2025. Patients were randomly assigned to three graft groups (n=35 each). Outcomes assessed at 3 months included graft uptake and hearing improvement via pure-tone audiometry and air-bone gap closure.
Results: Graft uptake was successful in 91.4% of patients. Temporalis fascia showed the highest uptake (94.3%), followed by fascia lata (91.4%) and tragal perichondrium (88.6%). Fascia lata demonstrated the greatest hearing gain (mean PTA improvement: 18.72 ± 10.01 dB), followed by tragal perichondrium (19.58 ± 4.17 dB) and temporalis fascia (15.80 ± 5.49 dB). All groups showed statistically significant hearing improvement (p <0.001) with minimal complications.
Conclusion: All grafts are safe and effective for Type 1 tympanoplasty. Temporalis fascia ensures better graft uptake, while fascia lata offers superior hearing outcomes, especially when mastoidectomy is performed. Graft choice should be tailored to individual cases.