Results of tympanoplasty type I using multiple pieces of graft for chronic otitis media with perforation

Abstract

Endaural type-I tympanoplasty, using an ear speculum, is the most commonly performed minimally invasive surgery for the treatment of chronic otitis media at our center. In this approach, a minimum incision of the meatal skin is made in the bony portion of the ear canal. As the surgical field is narrow in this procedure compared to the retroauricular approach, larger grafts can often limit the view of anterior part of the eardrum, specifically in cases with curved ear canal or total perforation of the eardrum. In such cases, to enable better surgical vision, small, multiple pieces of graft are useful to repair the perforation. Single and multiple graft piece tymphanoplasties for perforations of various sizes were compared for postoperative hearing restoration and closure rates. For larger perforations, multiple piece grafting showed significantly higher closure rate than single piece grafting. However, in cases of medium to small sized perforations there was no significant difference between single and multiple piece grafting in terms of perforation closure rate or postoperative hearing restoration. Therefore, we conclude that multiple-piece grafting, through an ear speculum, enhances the efficacy of type-I tympanoplasty in repairing large perforations.