Influence of tympanosclerosis on the graft uptake and hearing results in patients undergoing underlay myringoplasty

Abstract

Objective: - To observe the frequency of tympanosclerosis and assess its influence on the graft uptake and hearing results in patients undergoing underlay myringoplasty. Material and methods: - Patients 2>12 years of age with a diagnosis of chronic Suppurative otitis media tubo-tympanic type were included in the study. All the patients were recruited from the outpatient clinic (OPD) of the Department of Otorhinolaryngology and Head & Neck Surgery, Bheri Hospital from 18 October 2022 to 14 April 2024. Pre- operative and post-operative pure tone audiogram was performed to evaluate the bearing threshold. The sites of tympanosclerotic plaques were noted intraoperatively after otomicroscopic examination. The patients with tubo-tympanic diseases with tympanosclerosis were enrolled as study group and those without tympanosclerosis were kept in control group. Tympanosclerotic plaques from tympanic membrane were removed completely wherever possible and were either removed partially or left as such wherever they were located far away from the margins of the perforation. After 10th post-operative weeks graft uptake was noted and pure tone audiogram was performed. Results: - Frequency of tympanosclerosis was seen in 30% of cases of tubo-tympanic disease who were undergoing underlay myringoplasty. Graft uptake was seen in 96.1% cases of study group and in 94.9% cases of control group. In the same way, the graft uptake was noted in 96.36% of cases in whom tympanosclerotic plaques were completely removed compared to 95.23% cases in whom tympanosclerotic plaques were either partially removed or left as such. These differences in graft uptake rates were however statistically not significant. Post-operative average hearing gain in study and control group were 12.1dB & 15.9dB respectively which was also statistically not significant. Difference in post-operative average hearing improvement of 12.1dB & 15.9dB respectively seen in groups in which tympanosclerotic plaques were completely removed or partially, was also statistically not significant. However. Group with tympanosclerosis had more cases with longer duration of inactivity and less number of episodes of discharges as compared to group without tympanosclerosis and the difference was found to be statistically significant. Conclusion: - Tympanosclerosis if removed as far as practicable has no effect on either graft uptake or post-operative hearing result in patient undergoing underlay myringoplasty.

Keywords: tympanosclerosis, myringoplasty, tubo-tympanic