EC: Cartilage Tympanoplasty - CCPA Technique


Cartilage tympanoplasty is a very versatile technique for closing perforations of the tympanic membrane. Usually, autogenous cartilage is readily available in the operative field (tragus, concha, etc.), is well tolerated by the tympanic membrane, and may be combined with autogenous perichondrium (soft tissue covering cartilage). A graft composed of a combination of cartilage and its attached perichondrium is called a "composite cartilage perichondrial autograft" or CCPA graft.

CCPA grafts may be used as underlays, overlays, underlay-inlays or in combination. CCPA grafts are versatile, strong, and well tolerated. They are often used when other graft materials, such as temporalis fascia, have failed to close difficult (revision procedures) or large perforations. They are particularly useful when the existing tympanic membrane is known or suspected to have a poor blood supply such as occurs with burn or other thermal injuries of the tympanic membrane.

Operative steps in cartilage tympanoplasty are:

  • Cleaning the existing perforation.
  • Removing the epithelial margin of the perforation call "rimming" (Kraus TM Micro-cut forceps are useful).
  • Checking for "turned in" margin tissue (45 and 120 degree McCabe perforation rasps are very useful).
  • Elevating an atticotomy or tympanotomy flap.
  • Harvesting the CCPA graft (ipsilateral tragus, choncha, etc.)
  • Designing and creating an island of cartilage with a perichondrial cuff.
  • "Inking" the circumference of the cartilage island with a marking pen to identify the margin.
  • Placing the cartilage in the perforation (underlay, overlay, underlay-inlay, etc.).
  • Supporting the CCPA graft with medial and lateral Gelfoam packing.


CCPA Graft Technique for Closure of a Central Tympanic Membrane Perforation (Right Ear)


central_perforation perforation_rimmed CCPA_graft
1. Original R Central Tm Perforation
2. Perforation margin removed (rimmed)
3. CCPA graft harvested from R tragus



cartilage_marked cartilage_island underlay_graft
4. Cartilage island designed.
5. Cartilage island created.
6. Underlay CCPA graft closing the perforation



1. Tos, Mirko. Cartilage Tympanoplasty: Classification of Methods, Techniques, Results. Thieme, Stuttgart/NewYork, 2009.

To learn more about cartilage tympanoplasty at The Ear Center of Greensboro, please contact our Nursing staff at 336-273-9932.