Effect of Graft Size on Air-bone Gap Closure in Cartilage Button Tympanoplasty.

OBJECTIVE: To study the effect of graft size on postoperative air-bone gap in children undergoing butterfly inlay cartilage tympanoplasty using circular punch grafts. STUDY DESIGN: Retrospective case review. SETTING: Tertiary, academic children's hospital. PATIENTS: Children less than 16 years old undergoing circular butterfly inlay tympanoplasty using 4, 5, or 6 mm round grafts. INTERVENTION: Butterfly inlay tympanoplasty using circular punch graft harvest technique. MAIN OUTCOME MEASURES: Postoperative pure-tone average and air-bone gap. RESULTS: Fifty-two children were included in the analysis: 18 in the 4 mm group, 28 in the 5 mm group, and 6 in the 6 mm group. There was no significant difference in either postoperative pure-tone average or air-bone gap among the three groups. Closure rates for the 4, 5, and 6 mm graft groups were 94, 96, and 67%, respectively, for an overall rate of 92%. CONCLUSIONS: Cartilage button butterfly inlay tympanoplasty with punch graft is an effective method for tympanic membrane repair with similar hearing results among various graft diameters but may have diminished success with perforations requiring grafts larger than 5 mm. Larger case series are necessary to determine if larger defects are best managed with other repair techniques.