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Chronic suppurative otitis media (CSOM) remains one of the most common otological disorders encountered in clinical practice, particularly in developing countries where recurrent upper respiratory tract infections, poor hygiene, overcrowding, and limited access to healthcare contribute significantly to its prevalence. Tympanic membrane perforation resulting from chronic otitis media often leads to conductive hearing loss, recurrent ear discharge, reduced quality of life, and increased susceptibility to middle ear infections. Myringoplasty, a surgical procedure aimed at repairing tympanic membrane perforation, plays a vital role in restoring the integrity of the tympanic membrane, improving hearing, and preventing recurrent infections.

Over the years, several graft materials have been used for myringoplasty, among which temporalis fascia and tragal cartilage are the most commonly preferred due to their easy availability, biocompatibility, and favorable surgical outcomes. The selection of an ideal graft material remains an important challenge in otologic surgery. Temporalis fascia has traditionally been considered the gold standard graft material because of its thinness, translucency, ease of harvesting, and acoustic properties closely resembling the native tympanic membrane. However, fascia grafts may undergo atrophy, shrinkage, or reperforation, particularly in patients with eustachian tube dysfunction, large perforations, retraction pockets, or recurrent infections.

On the other hand, tragal cartilage has gained popularity due to its rigidity, resistance to resorption, and ability to withstand negative middle ear pressure. Cartilage grafts provide greater structural support and have shown improved graft uptake rates in difficult cases, although concerns remain regarding their potential effect on sound conduction because of increased stiffness and thickness.

The growing debate regarding the superiority of temporalis fascia versus tragal cartilage has generated considerable clinical interest. Despite numerous studies comparing the anatomical and functional outcomes of these graft materials, the results remain inconsistent. Some studies report better hearing outcomes with temporalis fascia due to its pliability and acoustic compatibility, whereas others demonstrate higher graft success rates with cartilage, especially in high-risk perforations. Therefore, determining the most effective graft material for successful myringoplasty continues to be a relevant clinical problem. This uncertainty forms the basis of the present study.

The rationale of this study lies in the need to evaluate and compare the effectiveness of tragal cartilage and temporalis fascia grafts in terms of graft uptake, hearing improvement, postoperative complications, and long-term surgical success. As both materials are widely used in otologic practice, understanding their relative advantages and limitations can help surgeons make evidence-based decisions tailored to individual patient characteristics. Furthermore, in regions where chronic ear disease is highly prevalent, optimizing surgical outcomes is essential to reduce morbidity and improve hearing-related quality of life.

The novelty of this study is based on its comparative clinical evaluation of two commonly used graft materials in myringoplasty within the same institutional setting and patient population. By assessing both anatomical success and functional hearing outcomes simultaneously, the study aims to provide a balanced evaluation of the efficacy of tragal cartilage and temporalis fascia. In addition, the study may contribute to identifying specific clinical situations where one graft material may be more advantageous than the other, thereby improving patient selection and surgical planning.

The expected outcome of this study is that both graft materials will demonstrate satisfactory graft uptake and hearing improvement, but differences may exist in graft stability, resistance to reperforation, and postoperative hearing gain. Tragal cartilage is expected to provide better anatomical success, particularly in large or high-risk perforations, whereas temporalis fascia may show slightly superior acoustic performance. The findings of this study may help establish clearer guidelines regarding graft selection in myringoplasty.

The implications of this study are significant for both clinicians and patients. A better understanding of graft performance can improve surgical success rates, reduce recurrence of tympanic membrane perforation, and enhance postoperative hearing outcomes. The study may also assist otologic surgeons in selecting the most appropriate graft material based on patient-specific factors and disease severity. Ultimately, this research aims to contribute to improved standards of care in middle ear surgery and better quality of life for patients suffering from chronic tympanic membrane perforations.