Shifting from postauricular to transcanal microscopic tympanoplasty may have similar frequency-specific improvements with better air-bone-gap closure at low frequencies and a minimal learning-curve effect.

Abstract

The shift from postauricular to transcanal microscopic tympanoplasty brings potential advantages of minimal morbidity, less postoperative pain, patient comfort, and surgical ease and speed, but also uncertainties of unfamiliar grafting material, an inadequate operation view, and an uncertain learning curve. These challenges might affect the successful repair rate and the frequency-specific hearing outcome, which is important for hearing perception. Rare studies reported frequency-specific hearing outcome with the learning curve for shifting from postauricular to transcanal microscopic tympanoplasty. Here, from Jul. 2013 to Nov. 2018, we compared patients in a shift from postauricular approach (35 ears) to transcanal approach (35 ears) of microscopic type-1 tympanoplasty. The results show that both of postauricular and transcanal microscopic tympanoplasties reduced the mean air-bone gap, 0.5k Hz gap, and 1k Hz gap after the surgery. The further analyses on gap change as a function of frequency (0.5, 1, 2, and 4k Hz) show that both of postauricular and transcanal tympanoplasties improved postoperative air-bone gap among the levels of frequency. The post hoc comparisons display a common gap reduction difference between 0.5k and 4k Hz. The successful repair rate did not differ between the 2 groups. There was no correlation between the postoperative mean gap change and the surgery date, suggesting a minimal learning-curve effect. The results of similar frequency-specific improvements and a minimal learning-curve effect may help to ease the concerns of those uncertainties before the shift.