Surgical technique
perforation
MIDDLE EAR
All patients underwent endoscopic perichondrium-cartilage underlay myringoplasty without tympanomeatal flap elevation.The perforation edges were freshened to de-epithelialize and encourage migration of the mucosal layer and epithelium.A single-layer, perichondrial, composite cartilage graft was harvested from the ipsilateral tragus. The lateral perichondrium was peeled circumferentially, with the pedicle attachment the cartilage graft. The cartilage graft was shaped to be 1 mm larger than the perforation margins, with the perichondrium more than 1–2 mm the cartilage graft.The middle ear was packed with Biodegradable NasoPore (Biodegradable NasoPore, Stryker Canada, Hamilton, ON, Canada. Biodegradable NasoPore is a biodegradable synthetic polyurethane foam, the expected time for the material to dissolve is four weeks according to the manufacturer). The perichondrium-cartilage composite graft was placed trans-perforation, the cartilage graft was placed medial to the remnant TM and the annulus. Also, the perichondrium was placed medial to the remnant TM and the annulus.The cartilaginous was then packed with antibiotic-soaked gauze, up to the tragus incision.