Endoscopic Transcanal Type I Cartilage Tympanoplasty for Anterior Perforation of Tympanic Membrane: A Cross-sectional Study

Abstract

Introduction: Repair of anterior perforation of the tympanic membrane is difficult mainly due to inadequate exposure, minimal tympanic membrane remnant, impaired vascular supply, and delayed healing. Methods: This analytical cross-sectional study was done in a tertiary center over a period of 12 months from 25 April 2021 to 24 April 2022. There were 47 patients who underwent endoscopic transcanal type I cartilage tympanoplasty for anterior perforation. All operations were performed using an underlay technique and by transcanal approach. In all the cases, perichondrium with tragal cartilage was used as a graft for the reconstruction of the tympanic membrane.  The evaluation was done after three months post-operatively in terms of graft uptake and post-operative hearing status. Results: The overall graft uptake success rate after three months post-operatively was 89.4%. The pre-operative mean pure-tone average was 34.72 ± 6.45 dB, (range 17 dB to 43 dB). The mean postoperative pure-tone average was 22.09 dB ± 9.30 (range 10 to 41 dB). The mean difference between the preoperative pure tone average and the postoperative pure tone average was 12.63 dB ± 8.96 (p < 0.05). The mean preoperative air-bone gap average was 23.38 dB ±7.98 (range 6 to 40 dB) and the mean postoperative air-bone gap of 13.45 ± 6.89 (range 5 to 32 dB). This resulted in improvement in the air-bone gap by 9.93 dB (p < 0.05). Conclusion: Endoscopic transcanal tympanoplasty is a minimally invasive procedure, which provides complete exposure of anterior tympanic membrane perforation thus avoiding external incisions and canaloplasty