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Adjuvant Use of Intranasal Fluticasone Furoate to Improve Graft Uptake in Type 1 Tympanoplasty Cases: A Comparative
Apurva Anil Jarandikar1, Chekuri Charmila, Gundappa Dhondiappa Mahajan
1Department of Otorhinolaryngology, Dr. D. Y. Patil Hospital and Research Centre, D. Y. Patil Vidhyapeeth, Pune, Maharashtra, India.
Background:
Chronic otitis media (COM) with tympanic membrane perforation remains a significant cause of hearing impairment worldwide. While tympanoplasty is the standard surgical treatment, graft failure rates of 10%-30% persist despite technical refinements. Topical corticosteroids may improve outcomes by modulating postsurgical inflammation.
Objective:
The objective of the study was to compare graft uptake rates in type 1 tympanoplasty between patients receiving adjuvant topical intranasal fluticasone furoate (FF) versus standard postoperative care alone.
Methodology:
This prospective cross-sectional study included 60 patients with COM and central tympanic membrane perforation who underwent type 1 tympanoplasty at a tertiary care center between January 2024 and June 2025. Patients were randomly allocated to Group A (n = 31) receiving standard care plus FF nasal spray for 1 month starting postoperative day 7, or Group B (n = 29) receiving standard care alone. The primary outcome was graft uptake status assessed at 1 month postsurgery. Secondary outcomes included gender- and age-based subgroup analyses.
Results:
Group A demonstrated 87.1% graft success rate compared to 69% in Group B, representing an 18.1% absolute risk reduction. Graft failure occurred in 12.9% of fluticasone-treated patients versus 31% in controls. Chi-square analysis yielded P = 0.088. Benefits were consistent across both genders, with males showing 87.5% success and females 86.7% in the fluticasone group. Younger patients (12-29 years) achieved 100% success with fluticasone compared to 33.3%-50% without it. No adverse effects related to fluticasone were observed.
Conclusion:
Adjuvant topical intranasal FF demonstrated clinically meaningful improvement in tympanoplasty graft success rates with an excellent safety profile. Despite narrowly missing statistical significance, the substantial reduction in graft failure rates suggests fluticasone represents a promising, cost-effective intervention worthy of incorporation into standard posttympanoplasty protocols.