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Comparison of Myringoplasty Outcomes Among External Auditory Canal Packing, Blood on the Graft Surface, or No
1Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu, Zhejiang, China.
Objective:
The objective of this study was to compare graft outcomes and complications of myringoplasty among external auditory canal packing (EAC) with Nasopore, blood on the graft surface, and no EAC packing.
Materials And Methods:
Patients with chronic perforation were randomly allocated to the EAC packing with Nasopore group (n = 40), blood on the graft surface group (n = 40), or no EAC packing group (n = 40). All patients underwent endoscopic cartilage myringoplasty with middle ear packing. Self-reported subjective symptoms, graft success, audiometric outcomes, and complications were evaluated at up to 24 months postoperatively.
Results:
In total, 120 patients were randomized into the study groups. The rates of aural fullness were 79.49% in the EAC packing group, 28.95% in the blood on the graft surface group, and 21.05% in the no EAC packing group ( P < 0.001). At 24 months postoperatively, the graft success rates were 79.49% in the EAC packing group, 94.74% in the blood group, and 81.58% in the no EAC packing group, with a statistically significant difference among the groups ( P < 0.001). Pairwise comparisons demonstrated a significant difference between the EAC packing and blood on the graft surface groups ( P < 0.05), but no significant difference between the EAC packing and no EAC packing groups ( P > 0.05) or between the blood on the graft surface and no EAC packing groups ( P > 0.05). When outcomes were stratified by perforation size, the blood on the graft surface consistently demonstrated higher graft success rates compared with the EAC packing and no EAC packing groups for medium perforation. No significant differences were observed among the groups in terms of preoperative or postoperative mean air or bone conduction pure-tone averages, air-bone gaps, or air-bone gap closure. The incidences of myringitis were 5.13% in the EAC with Nasopore packing group, 7.89% in the blood on the graft surface group, and 28.95% in the no EAC packing group ( P < 0.001).
Conclusions:
Autologous blood on the graft surface yielded higher graft success rates than EAC packing following cartilage underlay myringoplasty with middle ear packing, while there was no statistically significant difference between blood and no packing groups. Nevertheless, audiometric outcomes were comparable among these 3 arms.
Insights
Autologous blood on the graft surface improved myringoplasty success rates compared to external auditory canal (EAC) packing. No significant difference was found between blood and no packing, with comparable audiometric outcomes across all groups.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Regenerative Medicine
Background:
- Myringoplasty is a common surgical procedure to repair tympanic membrane perforations.
- External auditory canal (EAC) packing is often used post-myringoplasty to support the graft.
- Optimal EAC packing methods for graft success and complication reduction require further investigation.
Purpose of the Study:
- To compare graft outcomes and complications of myringoplasty using three different external auditory canal (EAC) packing methods: Nasopore, autologous blood on the graft surface, and no EAC packing.
- To evaluate the impact of these packing methods on subjective symptoms, graft success, audiometric results, and complications.
Main Methods:
- A randomized controlled trial involving 120 patients with chronic tympanic membrane perforations undergoing endoscopic cartilage myringoplasty.
- Patients were allocated to one of three groups: EAC packing with Nasopore (n=40), blood on the graft surface (n=40), or no EAC packing (n=40).
- Outcomes including graft success, audiometry, subjective symptoms, and complications were assessed up to 24 months postoperatively.
Main Results:
- Graft success rates at 24 months were 79.49% (EAC packing), 94.74% (blood surface), and 81.58% (no packing), with a significant difference among groups (P < 0.001).
- The blood on the graft surface group showed significantly higher graft success than EAC packing (P < 0.05).
- Aural fullness was significantly higher in the EAC packing group (79.49%) compared to the blood (28.95%) and no packing (21.05%) groups (P < 0.001).
- Incidences of myringitis were significantly lower in the EAC packing (5.13%) and blood (7.89%) groups compared to the no packing group (28.95%) (P < 0.001).
- No significant differences were observed in audiometric outcomes (pure-tone averages, air-bone gaps) among the three groups.
Conclusions:
- Autologous blood on the graft surface is a superior method for enhancing graft success in cartilage underlay myringoplasty compared to EAC packing with Nasopore.
- There was no statistically significant difference in graft success between the blood on the graft surface and no EAC packing groups.
- Audiometric outcomes remained comparable across all three packing methods, suggesting that graft success can be improved without compromising hearing results.
