A prospective observational study of comparison of tympanoplasty using endomeatal approach using tragal cartilage and perichondrium with post auricular approach using temporalis fascia graft: an institutional study

Abstract

A prospective observational study of comparison of tympanoplasty using endomeatal approach using tragal cartilage and perichondrium with post auricular approach using temporalis fascia graft: an institutional study V. Krishna Chaitanya*, N. Janardhan, Teja, Vinay Singh Bhat, Rajaram INTRODUCTIONAlthough tympanoplasty is being preferred as the procedure of choice for the eradication of disease in middle ear with closure of tympanic membrane perforation and is also helpful in reconstruction of the hearing mechanism with or without ossiculoplasty, there exists a lot of interest in various techniques of tympanoplasty and their clinical outcomes. 1 Though a lot of work has been published in this area and research is progressing to a lot more advanced aspects, understanding the proper technique of approach of the ABSTRACT Background: Evaluation of success of tympanoplasty depends on various host and surgical factors has been subject of interest for many years and still continues to be challenge. Methods: Present study was undertaken to observe results of type I tympanoplasty using tragal cartilage and perichondrium with temporalis fascia grafts using endomeatal and postauricular approach. Results: Study group comprises of 30 patients in Group A and B operated by tympanoplasty type I by endomeatal and postauricular techniques. Success was 96.3% in Group A and 94.7% in Group B for closure of membrane perforation. During postoperative period average time taken for wound healing was 23 days in Group A and 35 days in Group B. Preoperative and postoperative assessment of hearing performed with pure tone audiometry revealed an average hearing loss of 36.50 dB in Group A before surgery and postoperative assessment at end of 1 year revealed hearing improvement of 14.23 dB. In Group B preoperative assessment revealed hearing loss of 38.23 dB lowered to 15.12 dB after surgery. When hearing improvement in both groups were compared preoperatively and postoperatively, in Group A there was improvement of 22.27 dB while in Group B was 23.11 dB. The hearing improvements in both the groups appear to be similar when the results were compared. In present study overall success rate was 89.7% which is comparable to outcome of surgery performed with post auricular approach with temporalis fascia graft which is 91.3%. When postoperative complications were studied it was observed that Group A had fewer numbers of complications as over Group B which was documented in Table 2. Conclusions: Success of tympanoplasty depends on several host and surgical factors. Tragal perichondrium appears as proven alternate for closure of perforation of tympanic membrane. Cosmetically endomeatal approach appears promising over post auricular approach.