Tympanomeatal Degloving Technique Versus Ring Graft Underlay Technique in Tympanoplasty Type I for Subtotal Perforations

Abstract
Background: Tympanoplasty is an operative procedure used in the reconstruction of a perforation of the tympanic membrane (TM). Two classic methods for reconstruction of a TM perforation have been used: The underlay or overlay graft techniques. Each of these approaches and techniques has its advantages and disadvantages [1,2,3].
Objectives: The aim of this study was to evaluate the outcomes of tympanoplasty type I performed with overlay temporalis fascia using tympanomeatal degloving technique and to compare them with results of tympanoplasty type I performed with underlay ring graft [modified cartilage peri-chondrium composite graft, CPCG].
Patients and Methods: This study is a comperative pro-spective study carried out in ORL-HNS Department in Tanta University Hospital, operative procedures was done in the period from October 2015 to February 2016 Study followed by 3 month follow-up for each case, population was forty-eight consecutive cases of subtotal TM perforation undergoing type one tympanoplasty.
The patients were divided into 2 surgical groups [I&II], 24 ears each. Group (I) is treated by using tympanomeatal degloving technique & overlay temporalis fascia. While Group (II) is treated by using ring graft underlay technique.
Results: Fascia group showed better hearing results [the change in ABG was (mean: 12.6±5.2) dB] than the Ring group [the change of ABG was (mean: 11.6±3.9) dB] but the differ-ence between both groups is statistically insignificant.
The graft success rate in (group 1) was 83.3%. Only 4 cases (16.7%) developed post operative perforations. In (group II) the success rate was 95.8%. Only one case (4.2%) developed post operative perforation. The difference in the graft success rates between the 2 groups is statistically insignificant (p>0.05)
Conclusion: Both techniques we used in this study were very effective in closing subtotal large perforations of TM. Ring group showed better healing results but the difference between both groups is statistically insignificant (p>0.05).
Fascia group showed better hearing results but the differ-ence between both groups is statistically insignificant.