Comparison of Temporalis Fascia Graft Medial and Lateral to Handle of Malleus in Dry Central Tympanic Membrane Perforation

Abstract

Background: Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. The two most common techniques for positioning the graft relative to the remnant of both the tympanic membrane and the tympanic annulus are the ‘overlay’ and the ‘underlay’ techniques. Objectives: To compare two methods of tympanic membrane (TM) grafting when graft materials medial (group A) or lateral (group B) to malleus. Materials and Methods: This prospective study was carried out on thirty patients (30) from May 2017 to August 2018. All operations were done at Hearing and Speech Institute. They were divided into two groups; the first one (group A): included 15 patients treated by grafting with temporalis fascia medial to handle of malleus. The second one (group B): included 15 patients treated by grafting with temporalis fascia lateral to it. Patients with obvious ossicular dysfunction or external ear pathology were excluded from the study. Patients with ear discharge were initially treated conservatively and were included in the study when their ear became dry for at least 3monthes. Any patient requiring ossiculoplasty was subsequently excluded from the study. Diagnosis of the disease was established by clinical, otoscopic, endoscopic and microscopic examination. All patients examined and tested by audiometry 3 month after surgery. Success of surgery is defined as complete repair of TM, without lateralization, atelectasis or retraction pocket. Results: 83.33 % was total graft success. 86.7% with (group A) underlay technique comparing this with 80.0% with (group B) over-underlay technique. Differences of air-bone gap in each group before and after surgery was 33.42 ±3.71 dB in Group A, and 22.30 ± 5.56 dB in Group B. Improvement of hearing level was not significant between the two surgical methods. Conclusions: Both techniques (medial and lateral to malleus handle) of TM grafting are effective with success rates 86.7% and 80.0% respectively.