Introduction
Tympanic membrane perforation is a common otologic condition caused by trauma, infections, or sudden pressure changes.Reference Castelhano, Correia, Colaço, Reis and Escada1 Tympanic membrane perforation leads to hearing loss, tinnitus, and recurrent infections, significantly reducing patients’ quality of life (QoL).Reference Kanai, Kanemaru, Yamaguchi, Kita, Miwa and Kumazawa2 While smaller perforations may heal spontaneously, persistent or larger perforations typically require surgical intervention to restore hearing, reduce complications, and improve overall QoL.Reference Huang, Teh, Eikelboom, Han, Xu and Yao3, Reference Rahman, Olivius, Dirckx, Von Unge and Hultcrantz4
Tympanic membrane repair is a well-established surgical treatment for middle-ear conditions. The choice of repair materials and techniques based on the size and location of the perforation is critical. Conventional methods often use gelatine sponges to support grafts and facilitate healing. However, these materials may cause complications such as foreign-body reactions, tissue fibrosis, and delayed hearing recovery.Reference Anari, Yazdi, Kazemi, Moghtadaie, Farbod and Emami5 As a result, biocompatible grafts and non-packing techniques are gaining attention for improving outcomes and comfort.
Tragal cartilage–perichondrium, valued for its excellent biocompatibility, resistance to shrinkage, and structural stability, has become a preferred material for tympanic membrane repair.Reference Zhao, Zhang, Tian and Cui6, Reference Varma, Bansal and Singh7 With advancements in endoscopic techniques, non-packing air-filled chamber repair methods have gained prominence.Reference Lou, Lou and Chen8 These techniques stabilise the graft over the perforation by leveraging its shape and adhesion properties rather than relying on packing materials, thereby reducing foreign body reactions and post-operative discomfort associated with traditional packing methods. We introduced the dumbbell-shaped tragal cartilage–perichondrium air-filled chamber technique, utilising suction to form a stable ‘dumbbell’ shape, enhancing graft stability and post-operative outcomes.
To evaluate the clinical efficacy of the dumbbell-shaped tragal cartilage–perichondrium air-filled chamber repair technique compared to the conventional gelatine sponge packing method in the treatment of small-to-medium tympanic membrane perforations, we systematically assessed differences in tympanic membrane healing rates, hearing recovery, and patient comfort. The primary objective was to determine whether the dumbbell-shaped, air-filled chamber technique could achieve comparable or superior results to the traditional packing method under non-packing conditions, providing a safer and more effective alternative for otologic surgery. This retrospective analysis includes 68 patients treated at our department between January 2020 and September 2024, comparing surgical outcomes of the dumbbell-shaped, air-filled chamber repair and the gelatine sponge packing method under endoscopic guidance.
Materials and methods
General clinical data
This retrospective study included 68 patients with tympanic membrane perforations treated at our hospital from January 2020 to September 2024, all of whom met the inclusion and exclusion criteria. The patients were recruited consecutively from the otolaryngology outpatient clinic and inpatient department, ensuring a representative sample. The allocation of patients to the air-filled chamber group or the gelatine sponge group was not based on traditional randomisation but on a predefined surgical schedule. Specifically, certain surgical dates were designated for performing the air-filled chamber technique, while other dates were reserved for the gelatine sponge technique. As a result, there was a slight imbalance in the number of patients between the two groups (39 vs 29). However, statistical analysis was conducted to confirm that baseline characteristics, including age, gender, perforation size, and pre-operative hearing levels, were comparable between the two groups (p > 0.05).
Air-filled chamber group
This group consisted of 39 cases (39 ears) treated using the dumbbell-shaped tragal cartilage–perichondrium air-filled chamber tympanic membrane repair technique under endoscopic guidance. The group included 22 left ears and 17 right ears, with 19 male and 20 female patients, and an average age of 43.38 ± 10.67 years. The tympanic membrane perforation sizes averaged 3.13 ± 0.60 mm, comprising 14 small perforations (< 3 mm) and 25 medium perforations (≥ 3 mm). Pre-operative air-conduction pure-tone average (PTA) was 35.74 ± 3.6 dB HL, and the air–bone gap (ABG) was 21.67 ± 4.36 dB HL.
Gelatine sponge group
This group included 29 cases (29 ears) treated with the gelatine sponge packing technique under endoscopic guidance. The group included 16 left ears and 13 right ears, with 17 male and 12 female patients, and an average age of 40.93 ± 11.93 years. The tympanic membrane perforation sizes averaged 3.18 ± 0.54 mm, comprising 11 small perforations (< 3 mm) and 18 medium perforations (≥ 3 mm). Pre-operative air-conduction PTA was 36.12 ± 3.65 dB HL, and ABG was 22.46 ± 3.38 dB HL.
Criteria for inclusion and exclusion
Strict inclusion and exclusion criteria were established to ensure the reliability of results.
Inclusion criteria
Patients meeting the following criteria were included. (1) Central perforation of the pars tensa with a diameter of 2–4 mm and a residual edge of at least 2–3 mm, confirmed by endoscopic examination; the perforation was dry, with smooth edges, and deemed suitable for air-filled chamber repair. (2) Pure-tone audiometry (PTA) indicating conductive hearing loss, with air-conduction thresholds consistent with the degree of tympanic membrane perforation. (3) Absence of middle-ear mucosal pathology, as confirmed by high-resolution temporal bone computed tomography, which showed normal middle-ear structures without ossification or bony destruction. (4) Normal Eustachian tube function, with no history of upper respiratory tract infection or acute otitis media within one month prior to surgery. (5) No history of tympanic membrane or middle-ear surgery, with intact ear structures. (6) Voluntary participation, with patients providing fully informed consent after understanding the surgical procedure and associated risks.
Exclusion criteria
Patients were excluded if any of the following conditions were met. (1) Sensorineural or mixed hearing loss, as confirmed by PTA and clinical assessment. (2) Presence of significant calcification plaque or extensive calcification at the perforation edge, preventing stable attachment of the cartilage–perichondrium graft. (3) Contraindications to surgery, such as poorly controlled diabetes, severe cardiovascular diseases, or coagulation disorders. (4) Evidence of ossicular chain abnormalities, such as ossicular fixation or bony defects, detected pre-operatively or intra-operatively. (5) Active or recent (within one month) middle-ear infections, upper respiratory tract infections, or evidence of middle-ear mucosal abnormalities, such as metaplasia or granulation tissue proliferation, as detected by endoscopy or imaging.
Surgical methods
All patients in this study underwent surgery under general anaesthesia, performed by the same surgeon to maintain consistency in surgical techniques. Patients were positioned supine with the affected ear facing upward.
Tragal cartilage–perichondrium graft preparation
At the start of the procedure, the tragal cartilage–perichondrium graft was prepared. To prevent post-operative tragal deformation, a skin incision approximately 3 mm medial to the free edge of the tragus was made, extending through the subcutaneous tissue. The cartilage–perichondrium was carefully dissected between the subcutaneous tissue and perichondrium and harvested to match the perforation size. The cartilage was thinned to reduce its weight and minimise the gravitational influence on the graft’s positioning. During preparation, the perichondrium was trimmed to be slightly larger than the cartilage, ensuring its edges could adequately cover the surrounding tympanic membrane tissue and enhance graft stability. The final graft size was approximately 2–3 mm larger than the perforation, ensuring complete and secure coverage. The harvested cartilage–perichondrium graft was dried flat and set aside, while the tragal incision was sutured to avoid deformation.
Under endoscopic visualisation, the surgeon used a fine hook to clean the perforation edges by removing residual epithelial tissue and the fibrous annulus. Approximately 1 mm of the edge was excised to expose fresh tissue (Figure 1A). A ring knife was employed to access the middle-ear cavity through the perforation, meticulously debriding the residual mucosal epithelium around the perforation until slight bleeding was observed. This ensured the graft bed was free of tissue remnants, enhancing adhesion. Additionally, this step stimulated local blood circulation, providing a favourable attachment surface for the cartilage–perichondrium graft and promoting stronger integration with the perforation edges (Figure 1B).
Key steps of the endoscopic dumbbell-shaped tragal cartilage-perichondrium air-filled chamber tympanic membrane repair technique. Legend: A: Residual epithelial tissue and the fibrous annulus at the perforation edges are meticulously removed using a fine hook to expose fresh tissue. B: A ring knife is introduced through the perforation into the middle ear cavity to meticulously debride residual mucosal epithelium around the perforation until slight bleeding is observed, confirming and preparing the graft bed. C–E: The tragal cartilage-perichondrium graft is securely adhered to the inner edge of the tympanic membrane perforation using the inner placement method, ensuring stable attachment. F: A suction device is used to gently press the tragal cartilage-perichondrium graft onto the graft bed, ensuring a precise and stable fit. G: The graft is gently pulled back through the perforation using the suction device, creating a subtle ‘dumbbell-shaped’ structure. A final check confirms the absence of residual perforation, ensuring complete closure. H: Coronary diagram of surgery.
Air-filled chamber group
After examining the middle-ear cavity, no packing material was placed inside the tympanic cavity. Using the inner placement method, the tragal cartilage–perichondrium graft was adhered to the inner edge of the perforated tympanic membrane (Figure 1C–E). The suction device was adjusted to a reduced pressure of approximately 15 kPa, using it to gently adhere the graft to the prepared graft bed (Figure 1F). The graft was then slightly lifted through the perforation using the suction device, creating a slight bulge that formed a stable ‘dumbbell-shaped’ structure. This ensured the graft was securely embedded within the perforation, leaving no residual perforation (Figure 1G). After graft placement, no gelatine sponge was applied in the external auditory canal. Instead, a cotton ball was exclusively placed at the tragal site to provide gentle compression and stabilisation. Figure 1H is a coronal view of the ear, highlighting the final position of the graft within the tympanic membrane perforation. As previously described, the graft assumes a stable ‘dumbbell-shaped’ configuration, which effectively confirms the success of the repair procedure.
Gelatine sponge group
After examining the middle-ear cavity, gelatine sponge particles were placed into the tympanic cavity as support to help stabilise the cartilage–perichondrium graft. Using the inner placement method, the tragal cartilage–perichondrium graft was positioned along the inner edge of the perforated tympanic membrane. After the graft was securely positioned, additional gelatine sponge particles were placed in the external auditory canal to secure the graft. Finally, the canal was packed with iodoform gauze to further stabilise the graft and ensure it remained securely in place.
Post-operative management
To prevent infection, routine antibiotics were administered within the first 24 hours after surgery to prevent infection. In the air-filled chamber group, the tragal dressing was removed on post-operative day 1, and stitches were removed on day 7. For patients in the gelatine sponge group, tragal stitches were also removed on day 7, while the packing materials in the external auditory canal were removed on day 10. Patients were given detailed post-operative instructions, including avoiding forceful nose-blowing and taking precautions against upper respiratory infections. Additionally, patients in the air-filled chamber group were advised to minimise head movements and avoid strenuous activities to ensure graft stability and promote healing. Regular follow-up examinations using fibreoptic otoscopy were conducted to monitor the growth and healing of the tympanic membrane. Pure-tone audiometry was performed at one month and six months post-operatively to assess hearing recovery, focusing on changes in PTA and ABG at frequencies of 0.5, 1, 2, and 4 kHz.
Observational indicators
The following parameters were recorded: operative time, intra-operative blood loss, tympanic membrane healing status, incidence of complications (including post-operative ear fullness), and post-operative pain levels measured using the visual analogue scale (VAS). Pre- and post-operative changes in pure-tone audiometry (PTA) and air–bone gap (ABG) at frequencies of 0.5, 1, 2, and 4 kHz were analysed. Successful tympanic membrane healing was defined as achieving an intact tympanic membrane with normal morphology and complete epithelialisation.
Statistical methods
Data were analysed using SPSS 23.0 statistical software (IBM, Armonk, New York). Continuous variables were presented as mean ± standard deviation (SD). Between-group comparisons were conducted using an independent samples t-test, while within-group pre- and post-treatment comparisons were analysed using a paired samples t-test. Categorical variables were expressed as percentages. Tympanic membrane healing rates were compared using Yates’ correction for continuity, and the incidence of ear fullness was analysed with the chi-square test (χ2 test). Visual analogue scale scores were analysed using the Mann–Whitney U test for non-parametric data. Repeated measures data were evaluated with two-factor repeated measures analysis of variance (ANOVA). The air-conduction PTA and ABG were calculated as the mean of frequencies at 0.5, 1, 2, and 4 kHz. All statistical tests were two-sided, and a p-value of < 0.05 was considered statistically significant.
Results
Tympanic membrane healing and complications
All surgical incisions at the tragal cartilage–perichondrium donor sites healed well post-operatively, with no signs of infection or noticeable changes in appearance. By post-operative day 14, complete tympanic membrane healing was observed in 35 ears in the air-filled chamber group, while 4 ears exhibited slight graft displacement at the perforation site. In the gelatine sponge group, after removal of the external auditory canal packing on post-operative day 10, complete healing was observed in 27 ears by day 14, with 2 ears showing small residual gaps at the perforation site.
At the three-month follow up, the tympanic membrane healing rate was 89.7 per cent (35/39) in the air-filled chamber group. Two cases presented small residual perforations with initial perforation diameters of 3.7 mm and 3.9 mm. Another two cases exhibited minimal changes in perforation size compared to pre-operative measurements, likely due to graft displacement caused by post-operative upper respiratory tract infections or coughing, resulting in insufficient adhesion to the perforation edges. In the gelatine sponge group, the healing rate was 93.1 per cent (27/29), with two ears still displaying residual slit-like perforations.
Consistent with existing literature, the ideal healing rate for tympanic membrane repair typically ranges from 80 per cent to 95 per cent. The healing rates observed in both the air-filled chamber group (89.7 per cent) and the gelatine sponge group (93.1 per cent) fall within this range, demonstrating high success rates for both techniques. Although the healing rate in the air-filled chamber group was slightly lower than that in the gelatine sponge group, the difference was not statistically significant (Yates’ correction for continuity test, p = 0.959, p > 0.05). This indicates comparable healing outcomes for both techniques.
Incomplete healing was primarily attributed to post-operative complications such as upper respiratory tract infections or coughing contributing to slight graft displacement, which is an issue commonly encountered in tympanic membrane repair surgeries. Improved post-operative management could further enhance healing outcomes. During follow up, no cases of tympanic membrane retraction, adhesion, or reperforation were observed in either group, confirming the safety and durability of both techniques.
Post-operative ear fullness
On post-operative day 14, the incidence of ear fullness was significantly lower in the air-filled chamber group (10.3 per cent, 4/39) compared to the gelatine sponge group (48.3 per cent, 14/29). This difference was statistically significant (χ2 = 12.352, p < 0.05).
VAS scores
Descriptive statistics (Table 1) revealed that the air-filled chamber group had significantly lower VAS scores compared to the gelatine sponge group (p = 0.022). Specifically, the mean VAS score in the air-filled chamber group was 1.13 ± 0.864, markedly lower than the 1.59 ± 0.628 observed in the gelatine sponge group. These results indicate reduced pain levels in the air-filled chamber group.
Descriptive statistics of visual analogue scale (VAS) scores for the air-filled chamber group and gelatine sponge group; SD = standard deviation; CI = confidence interval
Operative time and blood loss
The operative time for the air-filled chamber group (23.05 ± 5.21 minutes) was slightly shorter than for the gelatine sponge group (24.21 ± 4.55 minutes), with no statistically significant difference (t = −0.954, p = 0.344). Regarding intra-operative blood loss, the air-filled chamber group had an average blood loss of 6.36 ± 1.50 mL, which was marginally lower than the 6.62 ± 1.12 mL recorded in the gelatine sponge group. Similarly, this difference was not statistically significant (t = −0.792, p = 0.431, p > 0.05).
Pure tone audiometry results
Table 2 presents the therapeutic effects of the two surgical techniques on PTA and ABG. Before treatment, there were no statistically significant differences between the air-filled chamber group and the gelatine sponge group in terms of PTA and ABG (p > 0.05). However, at six months post-treatment, both groups exhibited significant improvements in PTA and ABG (p < 0.001), demonstrating that both surgical techniques achieved excellent therapeutic outcomes.
Therapeutic outcomes of the two surgical techniques; PTA = pure tone audiometry; AGB = air–bone gap
A two-factor repeated measures ANOVA was performed to evaluate the interaction effects of surgical technique and time on patients’ hearing outcomes. The Shapiro–Wilk test confirmed that the data from all groups followed a normal distribution (p > 0.05), and standardised residuals fell within ± 3 standard deviations, indicating no outliers.
The analysis revealed significant interaction effects of surgical technique and time on both PTA (F(1.646, 46.082) = 33.193, p < 0.001) and ABG (F(2, 56) = 27.129, p < 0.001). Further individual-effect tests showed no significant differences in PTA and ABG between the air-filled chamber group and the gelatine sponge group pre-operatively (p > 0.05).
However, at one month post-operatively, the air-filled chamber group demonstrated significantly lower PTA and ABG values compared to the gelatine sponge group (p < 0.05), with a mean difference in PTA of 4.569 dB HL (95 per cent confidence interval (CI): 3.303–5.835 dB HL) and a mean difference in ABG of 4.914 dB HL (95 per cent CI: 3.528–6.300 dB HL). By six months post-operatively, the differences in PTA and ABG between the two groups were no longer statistically significant (p > 0.05), as detailed in Table 3. In this analysis, the degrees of freedom for the treatment factor were 1, and the degrees of freedom for the error were 28. These trends are also visualised in Figure 2, which highlights the superior early hearing recovery in the air-filled chamber group and the convergence of values between the two groups at six months post-operatively.
Comparison of Hearing Outcomes Between the Air-Filled Chamber and Gelatin Sponge Groups Over Time Legend:Changes in pure-tone audiometry (PTA) and air-bone gap (ABG) values for the air-filled chamber group and gelatin sponge group at preoperative, 1 month postoperative, and 6 months postoperative time points (A: PTA; B: ABG). At 1 month postoperatively, the air-filled chamber group demonstrated significantly lower PTA and ABG values compared to the gelatin sponge group (P < 0.05), indicating better early hearing recovery. By 6 months postoperatively, both PTA and ABG values converged, showing no statistically significant differences (P > 0.05). Error bars represent standard deviations.The three stars (***) indicate statistically significant differences (p < 0.001).
Independent effects of surgical techniques at different time points
Discussion
Tympanic membrane repair is a cornerstone procedure in otolaryngology, aiming to restore hearing, prevent recurrent infections, and improve patients’ QoL. This study demonstrates the clinical superiority of the dumbbell-shaped tragal cartilage–perichondrium air-filled chamber technique in early post-operative outcomes compared to the gelatine sponge packing method. By integrating findings with current literature, this discussion highlights the advantages, applicability, and prospects of the air-filled chamber technique, providing novel insights into otologic surgical strategies. This study provides a unique approach by combining biocompatible materials with a non-packing technique, addressing common limitations in traditional tympanic membrane repair methods.
The prevalence of tympanic membrane perforation is approximately 2.1 per cent, with a comparable incidence between genders.Reference Kim, Betz, Reed, Ward and Nieman9 Common causes include trauma and infection. While acute or small perforations may heal spontaneously, chronic perforations or those persisting for more than six weeks typically require surgical intervention to restore hearing and prevent middle-ear infections. Endoscopic tympanic membrane repair has gained prominence for its minimally invasive nature, shorter operative times, reduced post-operative bleeding, and lower complication rates, alongside significant improvements in auditory outcomes.Reference Hsu, Kuo and Huang10 Tragal cartilage–perichondrium is widely regarded as an optimal graft material for tympanic membrane repair due to its exceptional biocompatibility, tensile strength, and resistance to shrinkage. Given these challenges, tragal cartilage–perichondrium stands out as an ideal graft material due to its superior mechanical support, especially for large perforations or those with thin residual edges.Reference Ferlito, Fadda, Lechien, Cammaroto, Bartel and Borello11 Its robustness and resistance to infection enhance surgical stability and success rates.Reference Sood, Pal and Singla12
In this study, the tragal cartilage was intra-operatively thinned to reduce weight and minimise gravitational stress on the graft. Using a modified inner-placement technique, the graft was slightly retracted with suction to form a ‘dumbbell-shaped’ structure. This configuration securely anchors the graft within the perforation, eliminating the need for packing materials and leveraging the mechanical stability and biocompatibility of the tragal cartilage–perichondrium for effective and safe tympanic membrane repair.
Our results showed no statistically significant differences between the air-filled chamber and gelatine sponge techniques in tympanic membrane healing rates (89.7 per cent vs 93.1 per cent, p = 0.959) or long-term auditory outcomes (p > 0.05). However, the air-filled chamber group demonstrated marked advantages in early auditory recovery and post-operative comfort. By avoiding mechanical irritation and inflammation caused by packing materials, the air-filled chamber technique mitigates risks of fibrosis and temporary conductive hearing loss.Reference Xu, Bei, Li, Ye, Chu and Zhao13 Furthermore, gelatine sponges may take up to nine weeks to fully absorb, potentially disrupting acoustic conduction during early recovery.Reference Anari, Yazdi, Kazemi, Moghtadaie, Farbod and Emami5 Temporary conductive hearing loss of up to 40 dB has also been associated with gelatine sponges.Reference Hussain and Pei14 In contrast, the air-filled chamber group exhibited significantly better PTA and ABG values at one month post-operatively (p < 0.05), supporting the technique’s ability to preserve the middle ear’s acoustic environment. These findings highlight the clinical potential of the air-filled chamber technique as a safer and more effective alternative for early auditory recovery.
Additionally, the reduced incidence of ear fullness and lower post-operative pain scores underscore the advantages of non-packing methods in improving patient comfort. These outcomes align with the growing trend toward minimally invasive, patient-centred otologic surgery. Unlike traditional packing techniques or advanced flap approaches, the air-filled chamber method uniquely integrates biocompatible grafts and non-packing stabilisation, offering both acoustic and structural advantages. By eliminating the need for packing materials, the air-filled chamber technique mitigates inflammation and foreign-body reactions, reducing discomfort and accelerating recovery. In contrast, traditional gelatine sponge methods may exacerbate these issues due to prolonged absorption times and the potential for residual irritation.Reference Anari, Yazdi, Kazemi, Moghtadaie, Farbod and Emami5 Despite these advantages, certain challenges must be addressed to maximise the efficacy of the air-filled chamber technique.
While advantageous, the air-filled chamber technique has limitations. Four cases of graft displacement highlighted the importance of surgical precision in achieving successful outcomes. Precise positioning of the graft and forming a stable ‘dumbbell-shaped’ structure require advanced skills and experience. Additionally, gravitational forces may increase the risk of graft displacement, particularly in large perforations or those in the anterior–inferior quadrant. Meticulous debridement of epithelial and mucosal remnants at the perforation edges is crucial to promote graft adhesion. However, in some complex cases, adhesion relying solely on blood coagulation may be insufficient, necessitating auxiliary materials such as biological adhesives. Surgical glues, including porcine fibrin glue and other bio-adhesive formulations such as gelatine-based and synthetic polymer adhesives, have been reported to effectively stabilise grafts, seal wounds, and reduce post-operative infection risks. These adhesives leverage strong bonding capabilities, biocompatibility, and haemostatic properties to enhance surgical outcomes and support tissue repair in various clinical applications.Reference Jain and Wairkar15 Similarly, hyaluronic acid has shown promise in tympanic membrane repair by regulating fibrous layer healing and promoting epithelial proliferation.Reference Sainsbury, Amaral, Blayney, Walsh, O’Brien and O’Leary16 The integration of bio-adhesives could potentially expand the indications of the air-filled chamber technique to include large or complex perforations, where graft stability is critical. Incorporating biomaterials with the air-filled chamber technique may enhance efficacy in complex cases.
Tragal cartilage–perichondrium provides an excellent foundation for the air-filled chamber repair technique due to its remarkable tensile strength and stability. However, for large perforations or complex cases involving marginal perforations, relying solely on a single technique may not fully meet repair needs. In recent years, external auditory canal flap techniques have demonstrated significant value in repairing large perforations and addressing complex cases, such as exploring the sinus tympani entrance, achieving satisfactory clinical outcomes.
Given this, exploring the integration of external auditory canal flap techniques with the air-filled chamber approach is a promising direction. This combined approach could leverage the adaptability of flap techniques in anatomically complex cases while preserving the air-filled chamber technique’s advantages in acoustic protection and reduced post-operative complications. Hybrid techniques could address large or marginal perforations effectively. Future studies should refine the technique, integrate biomaterials, and explore novel strategies to optimise outcomes and broaden applications.
• Tympanic membrane perforations are commonly caused by trauma, infections, or pressure changes and often require surgical intervention to restore hearing and prevent complications
• Conventional gelatine sponge packing methods are widely used but can result in post-operative discomfort, inflammation, and delayed hearing recovery
• Tragal cartilage–perichondrium is recognized as an optimal graft material due to its biocompatibility, tensile strength, and resistance to shrinkage
• This study introduces the dumbbell-shaped, air-filled chamber technique, demonstrating its clinical superiority in early auditory recovery compared to the gelatine sponge method
• The air-filled chamber technique reduces post-operative discomfort, eliminates the need for packing materials, and provides comparable long-term outcomes
• The non-packing approach minimises inflammation and foreign body reactions while maintaining graft stability, offering a safer and more patient-centered surgical option
Conclusion
The dumbbell-shaped, air-filled chamber technique ensures effective tympanic membrane healing, superior early hearing recovery, and reduced post-operative discomfort. As a safe and effective modification, the air-filled chamber technique offers substantial clinical value and potential for widespread application in small-to-medium tympanic membrane perforations. Future studies should focus on refining the technique, integrating biomaterials such as hyaluronic acid or surgical glues, and exploring its effectiveness in diverse clinical scenarios. Combining this approach with external auditory canal flap techniques may also address anatomical challenges in large or marginal perforations, potentially improving outcomes in more complex cases.
Funding statement
This study was supported by the Nantong Municipal Health Commission's Scientific Research Project (QN2024016).
Competing interests
The authors declare that they have no competing interests.
