Endoscopic Tympanomeatal Flap versus Push Through Tympanoplasty: A Prospective Study

Abstract

Introduction: Tympanoplasty is a procedure aimed at eradicating middle ear disease, repairing a perforated tympanic membrane, and restoring hearing. Endoscopic tympanoplasty offers advantages such as a magnified view and avoidance of larger incisions, but is limited by being a single-handed technique with no depth perception. The two techniques compared were: Conventional Method: Involves an extended Rosen’s incision and raising a Tympanomeatal flap to reach the middle ear. Push Through Technique: Involves no Tympanomeatal flap elevation; a cartilage graft is pushed through   the tympanic membrane perforation after filling middle ear with antibiotic soaked gelfoams.

The study's aim was to study the difference between the two techniques in terms of operative time, post-operative pain, post-operative complications (granulation formation and canal stenosis) graft take rate, and hearing improvements.

Materials and Methods: This was a  prospective comparative study of 50 patients undergoing Type I Endoscopic Tympanoplasty.

• Inclusion Criteria included patients with moderate and small perforations, Type I Tympanoplasty, and tuning fork test/Pure Tone Audiometry results coherent with the tympanic membrane defect.


• Exclusion Criteria included patients with a discharging ear, tympanoplasty other than Type I, and patients less than 18 years of age.

Results and Conclusion: The two techniques yielded similar results in terms of graft uptake rate and post-operative audiometry changes. The push through technique demonstrated clear advantages with less post-operative pain, no incidence of granulation tissue formation, and less operative and recovery time.