Effect of Packing Versus No Packing in Transperforation Myringoplasty for Chronic Tympanic Membrane Perforations

Abstract

ObjectiveTo compare the operation times, graft survival and success rates, audiometric outcomes, and complications of patients who underwent transperforation myringoplasty with and without packing but without perforation rimming.Study DesignA prospective, randomized controlled trial.SettingA university‐affiliated teaching hospital.MethodsWe conducted a randomized controlled trial that enrolled patients who underwent underlay myringoplasty. No patient underwent perforation rimming. Patients underwent myringoplasty with or without graft lateral packing. The operation times, graft survival and success rates, audiometric outcomes, and complications were compared between the 2 groups.ResultsSixty patients with unilateral perforations were included. The mean neovascularization score at postoperative week 2 was significantly higher in the no‐packing group than in the packing group (p < .01) but did not differ significantly at postoperative weeks 3 and 4, or postoperative month 3. Neither the graft healing rate (p = .313) nor the perforation closure rate (p = .640) significantly differed between the 2 groups. The mean air‐bone gap improved by 8.91 ± 5.45 dB in the packing group and 8.17 ± 1.19 dB in the no‐packing group (p = .758).ConclusionThe long‐term graft success and hearing improvements in transperforation myringoplasty with no rimming of the perforation and no‐graft lateral packing were comparable to those in the graft lateral packing group with no rimming of the perforation, with a low incidence of complications. These results may change the traditional practice of packing the external auditory canal and rimming the perforation in underlay myringoplasty, even for all myringoplasty surgery.

Role of Topical Antibiotic Ointment in the Lateral Graft following Underlay Myringoplasty: A Prospective Randomised Study

“…In fact, there is a paucity of work published on ear packing, except for comparisons of various types of ointment used with the packs. Nevertheless, recent some evidences suggested that the type of EAC packing did not affect the graft outcomes and increase the complications [ 3 , 10 ].This avoids the discomfort of ear pack removal and an unnecessary out-patient visit, thereby potentially reducing the cost of care. Unfortunately, it is relatively common for surgeons to use antibiotic ointment only in EAC packing, this is believed to prevent the infection of graft [ 2 , 3 , 5 ].…”

“…Nevertheless, recent some evidences suggested that the type of EAC packing did not affect the graft outcomes and increase the complications [ 3 , 10 ].This avoids the discomfort of ear pack removal and an unnecessary out-patient visit, thereby potentially reducing the cost of care. Unfortunately, it is relatively common for surgeons to use antibiotic ointment only in EAC packing, this is believed to prevent the infection of graft [ 2 , 3 , 5 ]. However, the fundamental need for preveting graft infection via use of antibiotic ointment has not been established.…”

“…Pre- and postoperative air bone gap (ABG) was calculated by subtracting the AC PTA from the BC PTA. ABG closure was calculated as preoperative ABG minus postoperative ABG [ 3 ].…”

“…The type of packing varies between departments, with a wide range of individual preference based more on tradition than evidence [ 1 , 2 ]. Some recent studies demonstrated that the type of EAC packing did not affect the graft outcome [ 3 ], which avoids the discomfort of ear pack removal and an unnecessary out-patient visit, thereby potentially reducing the cost of care. However, although biological materials packing is gradually reduced in the EAC packing, even it was abandoned entirely in some studies [ 2 , 4 ], it is relatively common for surgeons to use antibiotic ointment only in EAC packing in tympanoplasty/tympanomastoidectomy [ 2 , 3 , 5 ],this is believed to prevent the infection of graft.…”

“…Some recent studies demonstrated that the type of EAC packing did not affect the graft outcome [ 3 ], which avoids the discomfort of ear pack removal and an unnecessary out-patient visit, thereby potentially reducing the cost of care. However, although biological materials packing is gradually reduced in the EAC packing, even it was abandoned entirely in some studies [ 2 , 4 ], it is relatively common for surgeons to use antibiotic ointment only in EAC packing in tympanoplasty/tympanomastoidectomy [ 2 , 3 , 5 ],this is believed to prevent the infection of graft. Nevertheless, the antibiotic ointment may also adhere to the graft, ear canal or, in particular, the tympanomeatal flap, traumatizing these and disturbing the graft on removal [ 1 , 2 ].…”