الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Large tympanic membrane perforations present a surgical challenge.
Large perforations tend to be more symptomatic (otorrhea and hearing loss). It has been reported that the size of the perforation is a prognostic factor, and poorer results are obtained with large versus small perforations. In cases of large perforations, the incorporation of the graft is compromised by several factors including limitations in surgical exposure, vascularity, and support for the donor material (Simon et al.,2006)
Use of tragal cartilage has resulted in a significant improvement in the tympanic membrane reconstruction procedure. Graft take of cartilage myringoplasty has been excellent, hearing results are satisfactory and complications are minimal.
Thanks to its resistance, cartilage is the grafting material of choice in more advanced pathological conditions, such as recurrent perforation after myringoplasty ,total or subtotal tympanic membrane perforation.
Graft take was achieved in 23 cases (74.2%). In cases operated upon by trans canal approach the success rate was 64.7 % and was 85.7% when post auricular approach was used.
The overall graft take rate of 74.2% suggests that cartilage myringoplasty is a reliable graft, which is in agreement with the results of most studies in the field.
In our study,Hearing improved in most patients (25 cases, 72%) with average hearing gain of about 8 db and this agree with the literature
The relative low success rate- as regard graft take and hearing improvement- in our study in comparison to other studies may be attributed to their studies were on different sizes of perforations, but our study was on subtotal perforations which of course more techniqually difficult with less
success rate and may be due to non compliance of the patient to treatment and strict follow up and may be due to post operative infection or short follow up period