Comparative study between post-aural and per-meatal approach type-1 tympanoplasty.

Abstract

Objective: To compare the results after tympanoplasty between post-aural and per-meatal approach. Study Design: Comparative study. Setting: Social Security Landhi Hospital, Karachi. Al-Tibri Medical College & Hospital (Isra University Karachi Campus), old thana Malir, Karachi. Period: July 2017 till June 2018. Material & Methods: In this study, 76 Patients of both genders with dry tympanic membrane perforations were included. They were aged between 18 to 40 years. Period of research was one year, study was started since July 2017 till June 2018. Patients were distributed into two groups, group-1 and group-2. 38 patients were included in every group. In group-1, post-aural approach tympanoplasty was done. In group-2, per-meatal approach tympanoplasty was performed. Observed results of both procedures after 1^st post-operated day, after 1^st post-operated week, after 1^st month and after 2^nd month post operatively. Variables were intensity of pain, bleeding, PTA (Ac, BC and AB-gap measured by tympanometer) and duration (time period) of surgical procedure. Result: In group-1(post-aural approach tympanoplasty), out of 38 patients, 36 patients had intact grafted tympanic membrane while in group-2 (per-meatal approach tympanoplasty), 37 patients had intact grafted tympanic membrane and 1 patient had residual perforation. Smaller amount of bleeding was noted during surgery and post-operative in group-2, in comparison with group-1. All the dressing gauze were dry in per-meatal approach tympanoplasty group (group-2). Mean time period of surgery was less in per-meatal tympanoplasty (group-2) 65.1 + 3.7 mins and mean time period of post-aural tympanoplasty (group-1) was 82.0 + 5.6 mins. P value was found to be significant i.e. < 0.001. Consumed time period of surgery was also decreased in per-meatal tympanoplasty (group-2). After tympanoplasty, hearing status was also enhanced on PTA in both groups. Post- operatively, it was observed that AB gap was reduced in both groups. On 1^st post -operative day, Weber test was done, vibrating sound was heard (lateralized) in post-operated ears which ensured the safety of inner ear apparatus. Conclusion: Results of post-aural and per-meatal tympanoplasty were approximately same but per-meatal approach tympanoplasty is superior as it took shorter amount of time period, minimum post- operative pain and post- operative bleeding.