Size-based individualized tympanic membrane repair in elderly patients under otoendoscopy

To explore the effectiveness and safety of different surgical methods based on perforation size selection for repairing tympanic membrane perforation (TMP) in elderly patients.

This retrospective analysis included clinical data of 156 elderly patients who underwent TMP repair surgery at Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022. Patients were grouped based on the size of TMP: the Group-S (TMP size ≤ 2mm, n=48) underwent TMP repair using the butterfly technique; the Group-M (2mm < TMP size ≤ 4mm, n=62) underwent TMP repair by tragus cartilage tympanoplasty; the Group-L (TMP > 4mm, n=46) underwent repair using the tragus cartilage-perichondrium membrane composite. The surgical time, intraoperative blood loss, healing rate, air bone gap (ABG), and complications among the three groups of patients were compared.

The surgical time and intraoperative blood loss in Group-S were significantly lower than those in Group-M and Group-L (P<0.05). After a six months follow-up, the tympanic membrane healing rates ranged from 87.0% to 95.8% among the three groups, with no statistically significant difference observed (P>0.05). All groups demonstrated significant postoperative improvement in air-bone gap (ABG), while the magnitude of ABG reduction was greater in Group-S and Group-M than in Group-L (P<0.05). No significant difference in the incidence of postoperative complications was observed among the three groups (P>0.05).

For elderly patients with TMP, different surgical procedures can be selected according to the size of the perforation, and can achieve a high tympanic membrane healing rate and satisfactory hearing improvement effect.