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Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair

  • H Demirhan (a1), Ö Yiğit (a1), B Hamit (a2) and M Çakır (a1)

Anteriorly located tympanic membrane perforations can negatively affect surgical success rates. This study aimed to present, using our case series results, endoscopic triple-C (composite chondroperichondrial clip) tympanoplasty as an alternative method in the repair of tympanic membrane anterior quadrant perforations.


This study included patients with a perforation sized greater than 3 mm, who had an anterior quadrant dominant perforation where the anterior portion could not be seen during microscopic examination; all underwent endoscopic triple-C tympanoplasty.


Operating time was 30–79 minutes (mean, 46.6 minutes). The post-operative graft success rate at six months was 92 per cent (23 out of 25). Mean post-operative follow-up duration was 21.5 ± 7.3 months (range, 11–40 months), and no intratympanic cholesteatoma was observed.


Endoscopic triple-C tympanoplasty is a comfortable, minimally invasive alternative method to repair anterior tympanic membrane perforations. The graft success rate and the degree of recovery from hearing loss were in accordance with the literature. However, more reliable results may be obtained in a larger series with longer follow-up times.

Corresponding author
Author for correspondence: Dr Hasan Demirhan, Sağlık Bilimleri Üniversitesi, İstanbul Egitim ve Arastirma Hastanesi, KBB Klinigi, Kasap İlyas Mah. Org. Abdurrahman Nafiz Gurman Cad, PK: 34098, Fatih – Istanbul, Turkey E-mail:
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Dr H Demirhan takes responsibility for the integrity of the content of the paper

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1Iacovou, E, Vlastarakos, PV, Papacharalampous, G, Kyrodimos, E, Nikolopoulos, TP. Is cartilage better than temporalis muscle fascia in type I tympanoplasty? Implications for current surgical practice. Eur Arch Otorhinolaryngol 2013;270:2803–13
2Nardone, M, Sommerville, R, Bowman, J, Danesi, G. Myringoplasty in simple chronic otitis media: critical analysis of long-term results in a 1,000-adult patient series. Otol Neurotol 2012;33:4853
3Potsic, WP, Winawer, MR, Marsh, RR. Tympanoplasty for the anterior-superior perforation in children. Am J Otol 1996;17:115–18
4Lade, H, Choudhary, SR, Vashishth, A. Endoscopic vs microscopic myringoplasty: a different perspective. Eur Arch Otorhinolaryngol 2014;271:1897–902
5Furukawa, T, Watanabe, T, Ito, T, Kubota, T, Kakehata, S. Feasibility and advantages of transcanal endoscopic myringoplasty. Otol Neurotol 2014;35:e1405
6Khan, I, Jan, AM, Shahzad, F. Middle-ear reconstruction: a review of 150 cases. J Laryngol Otol 2002;116:435–9
7Tos, M. Cartilage tympanoplasty methods: proposal of a classification. Otolaryngol Head Neck Surg 2008;139:747–58
8Fernandes, SV. Composite chondroperichondrial clip tympanoplasty: the triple “C” technique. Otolaryngol Head Neck Surg 2003;128:267–72
9Ahmed, S, Raza, N, Ullah, S, Shabbir, A. Chondroperichondrial clip myringoplasty: a new technique for closure of tympanic membrane perforations. J Laryngol Otol 2013;127:562–7
10Parelkar, K, Nagle, S, Jagade, M, Thorawade, V, Khairnar, P, Attakil, A et al. Triple-c cartilage tympanoplasty: case series. Int J Otolaryngol Head Neck Surg 2015;4:2631
11Rizer, FM. Overlay versus underlay tympanoplasty. Part I: historical review of the literature. Laryngoscope 1997;107:125
12Ayache, S. Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol 2013;270:853–60
13Harugop, A, Mudhol, R, Godhi, R. A comparative study of endoscope assisted myringoplasty and microscope assisted myringoplasty. Indian J Otolaryngol Head Neck Surg 2008;60:298302
14Eren, SB, Tugrul, S, Ozucer, B, Veyseller, B, Aksoy, F, Ozturan, O. Endoscopic transcanal inlay myringoplasty: alternative approach for anterior perforations. Otolaryngol Head Neck Surg 2015;153:891–3
15Kaya, I, Benzer, M, Gode, S, Bilgen, C, Kirazli, T. Butterfly cartilage tympanoplasty: an alternative new technique instead of conventional surgery method. Eur Arch Otorhinolaryngol 2017;274:3311–14
16Tseng, C-C, Lai, M-T, Wu, C-C, Yuan, S-P, Ding, Y-F. Endoscopic transcanal myringoplasty for anterior perforations of the tympanic membrane. JAMA Otolaryngol Head Neck Surg 2016;142:1088–93
17Eavey, RD. Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 1998;108:657–61
18Shrestha, B. How I do it? Endoscopic modified inlay butterfly cartilage perichondrium myringoplasty. Kathmandu Univ Med J (KUMJ) 2013;11:185–7
19Zahnert, T, Hüttenbrink, K-B, Mürbe, D, Bornitz, M. Experimental investigations of the use of cartilage in tympanic membrane reconstruction. Am J Otol 2000;21:322–8
20Levinson, RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope 1987;97:1069–74
21Dornhoffer, JL. Hearing results with cartilage tympanoplasty. Laryngoscope 1997;107:1094–9
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
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