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.