We have been using a piece of tragal cartilage for reconstructing the ossicular chain in tympanoplasty because of its stability and ease of trimming. Before 1990, the cartilage columella was relatively large and square (4mm×4mm). It was superposed in two or three layers to adapt the height between the head of the stapes and eardrum. Fibrin glue has been used to stabilize a slim cartilage columella (1mm×1mm, length 4 to 6mm) with certainty.
From 1990 to 1993 a slim cartilage columella has been used in 56 ears (group I) of tympanoplasty and the postoperative hearing results were compared with that of the 39 ears (group II) with a large columella before 1990. In 41 of 56 ears of the recent series and 25 of 39 ears of the former series, tympanoplasty type III was performed, and the remainder of each series, tympanoplasty type IV was performed. In tympanoplasty type III, the postoperative air-bone gap within 20dB was obtained in 78% and 56% of the cases in group I and group II, respectively. In tympanoplasty type IV, the postoperative air-bone gap within 20dB was obtained in 60% and 36% of the cases in group I and group II, respectively. All subjects were then divided into the following three categories according to the severity of mucosal pathology around stapes: group A: nearly intact mucosa, group B: mucosa with edema, group C: much granulation or adhesion without aeration. In ears in which the slim cartilage columella was used, the postoperative air bone gap within 20dB was achieved in 93%(15/16 ears), 85%(17/20 ears) and 45%(9/20 ears) in group A, B and C, respectively. In contrast, the rate was 50%(5/10 ears), 55%(6/11 ears), and 50%(9/18 ears) in group A, B, C, respectively, when the large columella was used. In group A and B, postoperative hearing of the ears with the slim columella was significantly better than that with the large columella. These results showed that when the aeration around the stapes was present, high success rate in hearing could be obtained by using a slim cartilage columella.
