LAUSR

ossicular reconstruction. In patients with subtotal and anterosuperior perforations, the anterior edge of the perforation may not be completely exposed and/or marginal support may be inadequate [2–6]. Therefore, temporalis fascia grafts may degenerate and shrink over time [7]. Conventional temporalis fascia myringoplasty (underlay and overlay) techniques are inappropriate; re-perforations are common. Cartilage myringoplasty has replaced temporalis fascia myringoplasty when anterior and subtotal perforations are to be repaired; the long-term success rates are higher when the former technique is employed. Mokbel et al. [8] performed ultrathin cartilage shield myringoplasty and reported that the take rate was 100% in those with partial-thickness cartilage shields, 100% in those with full-thickness shields, and 60% in a fascia group. Shishegar et al. [9] reported the graft take rate was 100% when palisade cartilage was placed in patients with subtotal perforations, compared to 92.5% in a fascia group. Kazikdas et al. [10] used the temporalis fascia technique to repair subtotal perforations and reported that the graft take rate was 95.7% in a palisade cartilage group and 75% in a fascia group. Recently, Alain et al. [11] reported a 94% success rate when butterfly myringoplasty was used to repair total, subtotal, and annular perforations. Cartilage grafts have some obvious advantages compared to fascia grafts when myringoplasty of anterior and subtotal perforations is required: cartilage does not shrink or deteriorate and the tissue is stiff [12, 13]. Cartilage does not commonly become necrotic and has a low nutrient requirement, thereby tolerating a reduced blood supply. Cartilage survives for at least 17 years after implantation into the middle ear [14]. Thus, an appropriately sized cartilage graft may reliably seal a perforation and form a firm scaffold, limiting epithelial proliferation and migration to the edge of the perforation and the Dear Editor,