SUBJECTS AND METHODS
Subjects
Fifty-seven patients who underwent swing-door overlay tympanoplasty by
one surgeon (S.N.P) in the department of otorhinolaryngology-head and
neck surgery of tertiary referral centre between June 2015 and May 2016
were enrolled in this study. Patients who had cholesteatoma and previous
middle ear surgery history were excluded. They were randomly divided
into the gelfoam-packing group(GPG) and the non-gelfoam-packing
group(NGPG). The data of 30 patients of GPG and 27 patients of NGPG were
prospectively collected and compared. All patients visited the
outpatient department every month for up to postoperative 3 months.
Physical and Audiologic
Evaluations
Postoperative healing status of the neodrum with perforation,retraction,
lateralization, or anterior wall blunting was considered as surgical
failure, whereas complete healing of the neodrum without perforation,
free mobile drum without atelectasis, and keeping the anteroinferior
tympanomeatal recess angle almost acute without blunting as shown under
a microscope were designated as the success of healing. Post-operative
edema of the fascia and degree of neodrum epithelization were observed
by a 0-degree otoendoscope (Karl Storz, Tuttlingen, Germany). With the
group blinded, two otology specialists quantified the degree of edema
and epithelization of the neodrum. Out of the total neodrum width, the
epithelized area was scored as percent and the edema rate was measured
in scores from 0 to 3 points; 0 as none, 1 as mild, 2 as moderate, and 3
as severe edema. Also, changes in the air-bone gap (ABG) were conducted
with pure-tone audiometry (PTA) of 0.5, 1, 2, and 4 kHz for evaluating
audiologic outcome.
Surgical procedure
All patients underwent swing-door overlay
tympanoplasty3. Under general anaesthesia, the
temporalis muscle facia harvested as usual. After reaching the meatus
via a post-auricular skin incision, the posterior canal skin was incised
circumferentially from 12 to 6 o’clock. A superior longitudinal incision
was made to join the circumferential cut. The remnant of the tympanic
membrane (TM) was excised and pathologic tissue in the middle ear cavity
was removed. After irrigation, middle ear gelfoam packing was performed
only in GPG.
The fascia graft was placed following the modified overlay technique,
involving placing the fascia under the handle of the malleus (umbo)and
elevated tympanomeatal flap but over the annulus. Lastly, firm furacin
gauze packing over thebony tympanic sulcus and the external auditory
canal was performed. At postoperative 1 month, the packing was
completely removed.
Statistical Analysis
SPSS24.0 program for Windows (SPSS Inc., Chicago, IL) was used for
statistical analysis. Data were expressed as mean, standard deviation,
and percentage.Student’s t-test and chi-square testwere used to compare
the clinical characteristics of the patients and student’s t-test was
used to analyse the surgical outcomes. Differences were considered
significant when the p-value was 0.05.