Functional Outcomes of Tympanoplasty Based on Graft Position: Medial Versus Lateral to the Malleus Handle

Abstract

Objectives:

This study compared the functional and anatomical outcomes of medial versus lateral graft placement techniques in type I tympanoplasty, focusing on hearing improvement and residual perforation rates. Tympanoplasty is a common surgical intervention for tympanic membrane (TM) perforations aimed at improving hearing and achieving tympanic closure. Debate continues regarding the optimal graft placement—medial or lateral to the handle of the malleus—for superior postoperative outcomes.

Methods:

A retrospective comparative study was conducted on 48 patients aged 15 to 50 years with central TM perforations and preoperative air-bone gap (ABG) > 25 dB. Group 1 (n = 23) underwent medial graft placement, and Group 2 (n = 25) underwent lateral placement. ABG changes at 3 months post-surgery were assessed using audiometry. Statistical analysis included independent and paired t-tests, Fisher’s Exact Test, 2-way ANOVAs, and Cohen’s d for effect size estimation. Ethical approval was obtained from the Institutional Ethical Committee (ECR/467/Inst/AP/2013/RR-19).

Results:

Both groups exhibited significant postoperative hearing improvement. Mean ABG gain was 21.6 dB in Group 1 and 20.1 dB in Group 2 (P = .567). No statistically significant difference was found in pre- or postoperative ABG values or residual perforation rates (P = 1.0). Effect sizes for all comparisons were negligible (Cohen’s d < 0.2). Demographics, including age and gender, showed no interaction effects on outcomes.

Conclusion:

Medial and lateral graft placements in tympanoplasty yield comparable functional and anatomical results. Given the negligible differences, graft positioning should be tailored to intraoperative findings and individual anatomical considerations. Larger, multicenter studies with varied graft materials and longer follow-up are warranted for definitive guidance.