Is malleolus nonlifting tympanoplasty makes any difference in hearing threshold versus conventional techniques?

Background: To achieve higher success of tympanoplasty procedure, different techniques have been developed, and a wide majority of grafting materials have been refined. One of thetechniques currentlyreceived considerable attention is not lifting the remainingof eardrumfrommalleus and embeddinggraft underit that can result in repairing theeardrumright in itsfirstplace as well as minimizing graft lateralization leading to progression of hearing rehabilitation. We compared the effects of tympanoplasty with and without malleus lifting on hearing loss in patients suffering from chronic otitis media.

Methods: In a randomized controlled trial, 30 consecutive patients diagnosed as chronic otitis media without cholesteatoma were randomly assigned to two groups undergoing tympanoplasty with and without malleus lifting. The air and bone conduction thresholds were recorded before and 45 days after the intervention.

Results: In both groups, except for 8000 Hz, the air conduction was significantly improved following surgery. According to air conduction there was no difference between the groups before surgery at different frequencies although conversely, it was more improved in the group without lifting at 250 Hz postoperatively (p = 0.019). The average postoperative air-bone gap (ABG) gain was significantly higher in all study frequencies in the target group comparing the control. As one of effects of this technique is inner ear protection from physical trauma to ossicular chain, it’s better to analyze bone conduction in these two groups, and discuss protective effects of this technique.

Conclusion: Higher hearing threshold and also higher ABG gain can be achieved by not lifting the remainingof eardrumfrommalleus and embeddinggraft underit especially in lower frequencies.