Preliminary results of a new endoscopic underlay cartilage tympanoplasty with lateral malleolar flap.

BACKGROUND

A new endoscopic tympanoplasty technique for large and medium-sized central perforations via a transcanal approach, without tympanomeatal flap elevation compared the preliminary postoperative graft success and hearing outcomes with other techniques in the literature.

METHODS

The study involved 75 patients aged 12 to 44 who underwent tympanoplasty with the lateral malleolar flap technique from 2014 to 2017. Pre-operative otoscopy recorded perforation sizes, and pure tone averages were calculated at 500, 1000, 2000, and 4000 Hz. The procedure was performed under general anesthesia via a transcanal approach using tragal cartilage, without tympanomeatal flap elevation. A control otoscopy was conducted six months post-operation to assess reperforation and graft position. Pure tone averages were measured, and pre-operative and post-operative audiological values were compared.

RESULTS

Post-operative six-month graft success rate was 94.6%. Reperforation was observed in one patient (1.3%), while another patient (1.3%) exhibited lateralization, and two patients (2.6%) demonstrated medialization. The pre-operative mean hearing level was recorded at 33.3 ± 7.0 dB, accompanied by an Air-Bone Gap (ABG) of 24.0 ± 6.6 dB. Post-operative measurements indicated an improvement in these values, with the mean hearing level decreasing to 18.0 ± 4.8 dB and the ABG reducing to 16.3 ± 5.3 dB (p < 0.05).

CONCLUSION

The endoscopic underlay cartilage tympanoplasty with lateral malleolar flap is a safe technique that avoids elevating the tympanomeatal flap. It offers shorter operation time, easier postoperative dressing, and high graft success rates similar to other tympanoplasty techniques.