Comparison Between Transtympanic and Elevation of Tympanomeatal Flap Approaches in Tympanoplasty

Abstract

Transtympanic tympanoplasty is an easy way of introducing a graft through the tympanic membrane to repair a perforation. The aim of our study is to compare the transtympanic technique with the usual method of elevating a tympanomeatal flap. Prospective randomized trial. Tertiary referral teaching hospital. Patients undergoing surgery for tympanic membrane perforations by the ENT team of King Abdullah University hospital between April 2004 and June 2009. Surgery. Perforations were stratified according to their sizes. Hearing was assessed preoperatively and postoperatively. The success rates defined as perforation closure and hearing improvement were compared between the 2 groups. A total number of 61 patients were enrolled in this study; 29 patients underwent the transtympanic approach, and 32 patients had a tympanomeatal flap elevated under general anesthesia. There was no statistical difference in the success rate between the 2 groups for all perforation sizes, although the tympanomeatal flap elevation technique was more effective in large perforations. There was a statistically significant average of 9 minutes saved in the transtympanic approach. There was a significant advantage in hearing improvement at 1 kHz favoring the transtympanic method. Transtympanic tympanoplasty is a simple technique with comparable success rate to the tympanomeatal flap technique in tympanic membrane closure and hearing results. We recommend it for small- and medium-sized perforations.