Effect of Packing vs No-Packing in Transperforation Myringoplasty for Chronic Tympanic Membrane Perforations

Introduction: To compare the operation times, graft survival and success rates, audiometric outcomes, and complications of patients who underwent trans-perforation myringoplasty with and without packing but without perforation rimming.

Methods: We conducted a randomized controlled trial that enrolled patients who underwent underlay myringoplasty. No patient underwent perforation rimming. Patients underwent myringoplasty with or without graft lateral packing. The operation times, graft survival and success rates, audiometric outcomes, and complications were compared between the two groups.

Results: A total of 60 patients with unilateral perforations were included. The mean neovascularization score at postoperative week 2 was significantly higher in the no-packing group than in the packing group (P < 0.01) but did not differ significantly at postoperative weeks 3 and 4 or postoperative month 3. Neither the graft healing rate (P = 0.313) nor the perforation closure rate (P = 0.640) significantly differed between the two groups. The mean air-bone gap improved by 8.91 ± 5.45 dB in the packing group and 8.17 ± 1.19 dB in the no-packing group (P = 0.758).

Conclusions: The long-term graft success and hearing improvements in trans-perforation myringoplasty with no rimming of the perforation and no-graft lateral packing were comparable to those in graft lateral packing group with no rimming the perforation, with a low incidence of complications. These results may change the traditional practice of packing EAC and rimming the perforation in underlay myringoplasty, even for all myringoplasty surgery.