Outcome of single-sitting bilateral type 1 tympanoplasty in Indian patients

Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations. Traditionally each ear drum is taken up for grafting sequentially in two different sittings, which leads to huge increase in operation cost, time and discomfort to the patient. Since, simultaneous bilateral tympanic membrane grafting could be quite safe and helpful to the patients, we performed the same in 32 patients with bilateral (64) ear drum perforations due to chronic suppurative otitis media. All patients had a conductive hearing loss corresponding to the size and site of the perforation, without evidence of ossicular chain defect or any other middle or inner ear pathology. The post-aural route was approached for the grafting in 27 ears, endaural in 22 perforations and the remaining 15 small perforations were done via endomeatal approach. All the ears were operated using the Underlay technique. The majority of the grafts were harvested from temporalis fascia (59 grafts), remaining five were obtained from tragal perichondrium. All the patients were subjected to regular follow-up evaluation and audiometry for up to 1 year after the surgery. Six ears showed incomplete recovery with residual perforation, although in two of them the tissue regeneration over next few weeks led to entire shutting down of the defect. Thus, the graft take rate was 93.75 % without any retraction pockets or displaced grafts. We did not encounter any iatrogenic sensorineural hearing loss. Thus the results from our study reinforce the safety of the single-step procedure and question the traditional apprehension regarding theoretical risk of iatrogenic sensorineural hearing loss making the ENT surgeon reluctant to perform this readily acceptable minor surgery in one sitting.