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Comparison of tympanoplasty done
with removal of posterior canal wall
skin versus tympanoplasty done with
preservation of canal wall skin
Sohil Vadiya
Practical Problems during tympano
plasty
• Raising Tympanomeatal flap
• Tears
• Oozing
• Poor view of surgical field
• Exposure is compromized if flap in the field
TM perforations – Curable disease
Several factors to determine succes
s
• Exposure and identification of structures durin
g surgery
• Experience and skills of a surgeon
• Support of the graft
Improve exposure
Pre-op
• History, Examination
• Microscopic Examination
• Oto endoscopy, PTA
• Informed consent
• Antibiotics – Peri operatively
• Post auricular Wilde’s incision used in all cases
• Temporalis fascia used as graft material in all c
ases
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
Meatotomy and Release incisions i
n canal at 6 and 12 o’clock
Refreshing the margins
Tympanoplasty by underlay metho
d
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
Post op
Result after 6 weeks
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
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
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.
Thank you

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AOICON 2020.pptx

  • 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
  • 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
  • 11.
  • 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
  • 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.