Influence of the Size and Location of the Perforation on the Anatomical Results of Myringoplasty

Introduction: Type 1 tympanoplasty (myringoplasty) is the surgical closure of a perforated eardrum. Its purpose is to restore the integrity of the tympanic membrane and to improve hearing in the affected ear. Nowadays, we note the increasing use of cartilage as material for the reconstruction of the tympanic membrane. The main objective of our study is to evaluate the influence of size and perforation site on the results of type 1 tympanoplasties performed in our department. Materials and methods: We carried out a retrospective study of a series of myringoplasties spread over a period of four years and five months from January 1, 2017, to May 31, 2021. For every patient, we collected data regarding age, sex, perforation size, location, and closure of the tympanic membrane after myringoplasty. The audiological results for air conduction (AC) and bone conduction (BC), as well as air-bone gap reduction following surgery, were noted. Follow-up audiograms were performed at the following intervals: two months, four months, and eight months postoperatively. The frequencies tested included 250, 500, 1000, 2000, and 4000 Hz. Similarly, the air-bone gap was estimated on the mean of all frequencies. A chi-squared test and Mann-Whitney test were used to compare qualitative and quantitative variables, respectively. Results: A total of 123 myringoplasties were included in this study. Closure of the tympanic membrane was achieved successfully in 85.7% for one-quadrant-size perforations (24 cases), and in 76.2% for two-quadrant-size perforations (16 cases). When 50-75% of the tympanic membrane was absent at the time of diagnosis, full repairment was achieved in 89.6% of the patients (n = 24), and in 85.0% (n = 34) when the perforation was subtotal. Recurrences have not happened more significantly for one location of the tympanic defect compared to another. Indeed, failures for anterior quadrant perforations were 14 whereas other sites represented 19 cases of non-integrated grafts. The audition was significantly improved from pre-operatively (AC mean of 48.7 dBs with ranges from 24 to 90 dBs) to post-operatively (30.7 dBs AC with ranges from 10-80 dBs) (p = 0,002). The average postoperative audiometric Rinne was 18 dBs with a gain of 15.37 dBs. Discussion: Patients with bilateral perforations (tubal dysfunction, allergic rhinitis) are more likely to develop recurrences. Thus, the series considering many patients operated on twice has high failure rates. Good compliance with anti-allergic treatment and with hygiene rules (in particular ear sealing) is essential for the closure of anterior perforations. Conclusion: It seems through our study that there is no correlation between the size and location of the perforation and its postoperative closure. Risk factors such as smoking, anemia, intraoperative bleeding, and gastroesophageal reflux are important and determining in the healing process.