Comparison Between Transtympanic and Elevation of Tympanomeatal Flap Approaches in Tympanoplasty

Objective: Transtympanic tympanoplasty is an easy way of introducing a graft through the tympanic membrane to repair a perforation. The aim of our study is to compare the transtympanic technique with the usual method of elevating a tympanomeatal flap.

Study Design: Prospective randomized trial.

Setting: Tertiary referral teaching hospital.

Patients: Patients undergoing surgery for tympanic membrane perforations by the ENT team of King Abdullah University hospital between April 2004 and June 2009.

Interventions: Surgery.

Main Outcome Measures: Perforations were stratified according to their sizes. Hearing was assessed preoperatively and postoperatively. The success rates defined as perforation closure and hearing improvement were compared between the 2 groups.

Results: A total number of 61 patients were enrolled in this study; 29 patients underwent the transtympanic approach, and 32 patients had a tympanomeatal flap elevated under general anesthesia. There was no statistical difference in the success rate between the 2 groups for all perforation sizes, although the tympanomeatal flap elevation technique was more effective in large perforations. There was a statistically significant average of 9 minutes saved in the transtympanic approach. There was a significant advantage in hearing improvement at 1 kHz favoring the transtympanic method.

Conclusion: Transtympanic tympanoplasty is a simple technique with comparable success rate to the tympanomeatal flap technique in tympanic membrane closure and hearing results. We recommend it for small- and medium-sized perforations.