Comparison between Outcome of Myringoplasty with and without Ensuring the Patency of Aditus ad Antrum

Abstract

Background: Myringoplasty is a technique for the closure of the simple perforation of the tympanic membrane. For the better outcome, myringoplasty combined with cortical mastoidectomy has been tried in many studies. Objectives: To compare the outcome of repair of tympanic membrane perforations with myringoplasty alone versus myringoplasty with opening of blocked aditus if any by doing antrostomy. Methodology: This was a prospective study. Patients included in the study were randomly allocated into 2 groups, the group I and the group II. The group I included 17 patients undergoing myringoplasty with antrostomy and the group II included 17 patients undergoing only myringoplasty. The blocked aditus was made patent if it was found blocked during antrostomy procedure. Graft uptake rate and improvement in conductive hearing loss were measured as success rate. Results: Mean age of the patients in the group I was 23.12 ± 7.55 years. The mean age of patients in the group II was 25.53 ± 8.79 years. In the group I unilateral disease was present in 6 (35%) cases. In the group II unilateral disease was present in 12 (70.5%) cases. In the group I subtotal perforation was present in 9 (52.9%) cases and moderate to large perforation was present in 8 (47%) cases. In the group II subtotal perforation and moderate to large perforation were present in 9 (52.9%) and 8 (47%) cases respectively. Aditus was found to be blocked in eleven (64.7%) patients in the group I. Successful graft uptake was seen in twelve cases (70.58%) in the group I and eleven cases (64.7%) in the group II with all of them showing improvement in hearing. The success rate of the group I was 70.58% while success rate of the group II was 64.7%. The mean of pre-operative and post-operative air-bone gap was 31.94 ± 11.7 dB and 24.8 ± 10.55 dB respectively in the group I with the mean hearing gain of 7.06 ± 3.9 dB. Similarly, the mean of pre-operative and post-operative air-bone gap was 28.24 ± 10.5 dB and 17.9 ± 0.08 dB respectively in the second group with the mean hearing gain of 10.29 ± 4.83 dB. Conclusion: There was no difference between success rate of myringoplasty with antrostomy group and myringoplasty alone group in the treatment of mucosal tympanic membrane perforation; however in majority of cases where aditus patency was checked (group I) it was found to be blocked (64.7%).