Per-meatal myringoplasty; determinants of outcome of tympanic membrane reconstruction

Objectives: To evaluate the outcome and pit falls of per-meatal myringoplasty Methodology: This randomized control trial was conducted fromAugust 2010 to August 2012 at the Department of ENT, Combined Military Hospital, Gujranwala Cantonment. It included 97 ears from 97 patients of chronic inactive mucosal otitis media, irrespective of size and location of pars tensa perforation. They underwent myringoplasty under general anesthesia through three different approaches, i.e. per-meatal, post-aural and endaural. Results: Out of 97 myringoplasties, a successful graft take up was noticed in 74(76.3%) and 24(24.7%) procedures were carried out through a post-aural approach. Twelve (12.4%) operations were performed through end-aural and 61(62.9%) through per-meatal approach. Out of 61 per meatal myringoplasties, a successful graft take up was found in 51(83.6%) patients. Successful graft take up was observed in 15(62.5%) post-aural and eight (66.7%) end-aural myringoplasties. Take up of graft was influenced by pre-operative patient selection and the size and location of perforation, surgical technique and presence or absence of post-operative infection. Conclusion: Per-meatal myringoplasty, if skillfully performed, is a more favored approach of tympanic membrane repair having favorable outcome. It is less time consuming, involves little blood loss, is cosmetically appealing and has relatively better outcome. Careful patient selection and pre-operative preparation influence the results. (author)