Aoicon Conference Knowledge

1. Comparison of tympanoplasty done
with removal of posterior canal wall
skin versus tympanoplasty done with
preservation of canal wall skin
Sohil Vadiya

2. Practical Problems during tympano
plasty
• Raising Tympanomeatal flap
• Tears
• Oozing
• Poor view of surgical field
• Exposure is compromized if flap in the field

3. TM perforations – Curable disease

4. Several factors to determine succes
s
• Exposure and identification of structures durin
g surgery
• Experience and skills of a surgeon
• Support of the graft

5. Improve exposure

6. Pre-op
• History, Examination
• Microscopic Examination
• Oto endoscopy, PTA
• Informed consent
• Antibiotics – Peri operatively

7. • Post auricular Wilde’s incision used in all cases
• Temporalis fascia used as graft material in all c
ases

8. Two groups
Group A
• Skin of Posterior canal wall r
emoved
• All cases Type I tympanopla
sty
• Dry ears
Group B
• Skin of Posterior canal wall
preserved
• All cases Type I tympanopla
sty
• Dry ears

9. Meatotomy and Release incisions i
n canal at 6 and 12 o’clock

10. Refreshing the margins

12. Tympanoplasty by underlay metho
d

13. Post op
• Stitches removed on 8th post op day
• All patients were given Neosporin ointment fo
r LA in the canal for 3 weeks
• Ciprofloxacin + Dexamethasone ear drops for
next 2 weeks
• Oto endoscopy at 6 weeks
• PTA done at 6 weeks post op

14. Post op

15. Result after 6 weeks

16. Results
Group A
• Total 45 ears
• 41 had successful graft take
up
• Granulations in 1 ear,
healed with conservative
management
Group B
• Total 49 ears
• 42 had successful graft
uptake
• Granulations in 2 ears,
healed with conservative
management

17. Hearing gain
p > 0.1
Group A
• Air bone gap less than 15 db
– 26 ears. (65%)
• Gain in Air bone gap – 18.17
db
• P>0.1
Group B
• Air bone gap less than 15 db
in 29 ears. (69%)
• Gain in Air bone gap – 19.10
db
• P> 0.1

18. Conclusion
• Removal of posterior canal wall skin offers bet
ter view during Tympanoplasty
• Removal or preservation of posterior canal wal
l skin during tympanoplasty does not alter fina
l results of surgery if proper technique is appli
ed in underlay method of tympanoplasty.

19. Thank you