{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:57:08Z","timestamp":1793494628561,"version":"4.5.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Otol Rhinol Laryngol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We evaluated the 5-year graft success rate and incidence of iatrogenic cholesteatoma following endoscopic cartilage\u2013perichondrium sandwich myringoplasty for the repair of large central tympanic membrane perforations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This retrospective study included patients with large central perforations who underwent endoscopic cartilage\u2013perichondrium sandwich myringoplasty. Graft integrity and the presence of iatrogenic middle ear cholesteatoma were assessed at a 5-year postoperative follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 86 patients were included in the final analysis. The mean follow-up duration was 6.4\u2009\u00b1\u20091.2\u2009years (range, 5-7\u2009years). The graft take rates were 96.5% at 3\u2009months, 94.2% at 6\u2009months, and 93.0% at 5\u2009years postoperatively. At 6\u2009months postoperatively, 2.44% of patients demonstrated no change in hearing, whereas 3.66% experienced a deterioration in conductive hearing. In the remaining 93.90% of patients, the improvement in hearing was statistically significant; the mean air\u2013bone gap decreased from 25.1\u2009\u00b1\u20094.6\u2009dB preoperatively to 14.9\u2009\u00b1\u20093.1\u2009dB postoperatively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.05). At the 5-year follow-up, high-resolution computed tomography (HRCT) revealed well-pneumatized mastoid and middle ear cavities in 93.02% of patients, eliminating the need for magnetic resonance imaging (MRI). HRCT revealed soft tissue opacities in the mastoid region in 4 patients who had undergone canal wall up mastoidectomy (CWUM) and in 2 patients without CWUM; however, subsequent MRI excluded mastoid cholesteatoma in all 6 cases. Notably, a small graft cholesteatoma was detected in 1 patient (1.16%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Five-year imaging follow-up demonstrated that endoscopic cartilage\u2013perichondrium sandwich myringoplasty, performed without removal of the epithelium from the tympanic membrane remnant, achieved a stable graft success rate in the repair of large central perforations. The procedure was associated with a minimal risk of graft cholesteatoma and no observed risk of middle ear cholesteatoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00034894251356306","type":"journal-article","created":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T04:43:02Z","timestamp":1752381782000},"page":"929-936","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Five-Year Graft Outcomes and Complications of Endoscopic Cartilage\u2013Perichondrium Sandwich Myringoplasty for Large Central Perforations"],"prefix":"10.1177","volume":"134","author":[{"given":"Zhonghan","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Jiangshan People\u2019s Hospital, Jiangshan City, Zhejiang Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0835-994X","authenticated-orcid":false,"given":"Rongxin","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Jiangshan People\u2019s Hospital, Jiangshan City, Zhejiang Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.191"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198902000-00015"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-023-03487-w"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000003141"},{"issue":"118","key":"e_1_3_3_6_2","first-page":"291","article-title":"Long term versus short term hearing results in endoscopic sandwich myringoplasty","volume":"33","author":"Shrestha BL","year":"2021","unstructured":"Shrestha BL, Dhakal A, Pradhan A, et al. Long term versus short term hearing results in endoscopic sandwich myringoplasty. Iran J Otorhinolaryngol. 2021;33(118):291-299.","journal-title":"Iran J Otorhinolaryngol"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0145561319875663"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2024.104394"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-023-04338-4"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-020-06039-y"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812458401"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2023.104121"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjorl.2017.03.009"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1258\/0022215001905274"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/19160216241291822"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/01455613231182661"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-023-02286-y"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2024.104232"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016489.2022.2042596"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-020-06222-1"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002649"},{"issue":"4","key":"e_1_3_3_22_2","article-title":"Comparative study between single layer and double layer graft technique in tympanoplasty for subtotal tympanic membrane perforation","volume":"27","author":"Aziz AARA","year":"2023","unstructured":"Aziz AARA, Hafez MAS, Mahmoud AG, Hamad AH. Comparative study between single layer and double layer graft technique in tympanoplasty for subtotal tympanic membrane perforation. Int Arch Otorhinolaryngol. 2023;27(4):e667-e671.","journal-title":"Int Arch Otorhinolaryngol"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-012-2329-4"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joto.2020.01.001"},{"issue":"116","key":"e_1_3_3_25_2","first-page":"137","article-title":"Tragal perichondrium and composite cartilage graft complimenting endoscopic tympanoplasty in true sense: a comparison","volume":"33","author":"Varma A","year":"2021","unstructured":"Varma A, Bansal C, Singh VP. Tragal perichondrium and composite cartilage graft complimenting endoscopic tympanoplasty in true sense: a comparison. 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