An Observational Study on Underlay Type I Endoscopic Tympanoplasty in Patients with Inactive Mucosal Chronic Otitis Media with Large Central Perforation

Abstract

Background and Objectives: Chronic otitis media (COM) remains a significant cause of preventable hearing loss, especially in developing countries. Large central perforations of the tympanic membrane pose a surgical challenge due to poor vascular supply and limited graft support. This study aimed to evaluate the outcomes of underlay Type I endoscopic tympanoplasty in patients with inactive mucosal COM presenting with large central perforations.

Materials and Methods: This prospective observational study was conducted on 60 patients with inactive mucosal COM and large central perforations at ANIIMS, Shrivijayapuram, tertiary care center. All patients underwent endoscopic underlay Type I tympanoplasty using temporalis fascia graft. Preoperative and postoperative hearing was assessed using pure tone audiometry, and patients were followed at 2 weeks and 3 months. Outcomes assessed included graft uptake, pure tone average gain, air-bone gap (ABG) closure, and complications.

Results: Successful graft uptake was achieved in 56 patients (93.3%). The mean preoperative PTA was 34.65 ± 5.46 dB, which improved to 17.64 ± 6.45 dB postoperatively, yielding a mean hearing gain of 16.85 ± 6.01 dB (p < 0.0001). The mean ABG improved significantly from 29.82 ± 3.33 dB to 12.86 ± 5.34 dB (p < 0.0001). Subjective hearing improvement was reported by 93.3% of patients. Complications were minimal, with residual perforation occurring in 4 cases (6.7%), mostly associated with postoperative upper respiratory tract infection. No cases of graft medialization, lateralization, myringitis, or epithelial pearls were observed.

Conclusion: Underlay Type I endoscopic tympanoplasty is a safe and effective technique for large central perforations in inactive mucosal COM, offering excellent graft uptake and significant functional hearing restoration with minimal complications.