Aoicon

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
tympanoplasty
• 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
success
• Exposure and identification of structures
during 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
cases

8. Two groups
Group A
• Skin of Posterior canal wall
removed
• All cases Type I
tympanoplasty
• Dry ears
Group B
• Skin of Posterior canal wall
preserved
• All cases Type I
tympanoplasty
• Dry ears

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

10. Refreshing the margins

12. Tympanoplasty by underlay
method

13. Post op
• Stitches removed on 8th post op day
• All patients were given Neosporin ointment
for 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
better view during Tympanoplasty
• Removal or preservation of posterior canal
wall skin during tympanoplasty does not alter
final results of surgery if proper technique is
applied in underlay method of tympanoplasty.

19. Thank you