Comparing Outcomes of Endoscopic Total Annular Excision Tympanoplasty and Conventional Tympanoplasty: A Randomized Controlled Trial

Introduction: Chronic suppurative otitis media (CSOM) is a significant cause of preventable hearing loss, and India has been classified as a high prevalence country for CSOM by WHO. Tympanoplasty is the mainstay for treatment of mucosal types of chronic otitis media. Total annular excision (TAE) tympanoplasty is one modification to conventional technique, aimed at reducing the incidence of granular myringitis and increasing the graft uptake rate.

Methods: The study was a single-blinded RCT done in patients of chronic otitis media of mucosal type, attending the Department of ENT and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India, during the period of January 2022 to March 2023. Patients with subtotal perforation with an AB gap of >/= 20 dB were included in the study. Thirty patients who were allocated to the trial arm underwent TAE tympanoplasty and the remaining 30 patients underwent conventional tympanoplasty. Graft uptake was measured by otoendoscopy at 6 months postoperative, hearing gain was measured by PTA and patient satisfaction by Chronic Ear Survey to asses quality of life.

Results: The median preoperative AC, BC, AB gap or speech reception threshold were also not significantly different among the groups. We found 25 patients (83.3%) of TAE had an intact neotympanum, compared to 24 (80%) in the control group (p-value=0.565). The median preoperative AC reduced from 43.0 to 31.0 in the intervention group and from 42.5 to 31.00 in the control group (p value < 0.001). The patients who underwent TAE tympanoplasty had a median reduction in AB gap of 12.50 dB, while those in the conventional tympanoplasty group had a median reduction of 8.0 dB (p value= 0.011). The median postoperative SRT in the total annular excision tympanoplasty group was 35, whereas in the control group it was 40 (p value=0.009)

Conclusions: TAE tympanoplasty is a safe and effective surgery for mucosal type of chronic otitis media with subtotal perforation, and correlates clinically. TAE also showed significantly better postoperative SRT and AB gap closure. However, a longer study may bring out significant long-term differences between the two techniques.