Discussion:
Key findings : In line with our research, no notable contrast emerged between the per-meatal and post-aural groups based on patient responses after tympanoplasty surgery. The scar behind the ear posed a minimal concern for the majority of patients in both groups. The post-aural approach was well-tolerated, with negligible scar-related problems. Work absence and resumption were akin between groups. The COMBI questionnaire revealed no statistically significant difference in postoperative quality of life or symptoms. To the best of our knowledge, this is the first study comparing patient viewpoints, symptomatology, and quality of life tied to these two surgical techniques.
Limitations : Some patients underwent meatoplasty alongside the post aural approach, theoretically impacting post-operative results, particularly with hearing aid use. However, our study found no supporting evidence of this based on patient responses. Graft materials included cartilage, temporalis fascia, and fat graft, each could potentially yield different success rates and subsequent ongoing symptoms. Yet, as most patients received cartilage grafts (occasionally composite cartilage and fascia), and in only one case used a fat plug, generally high success rates of these graft materials mitigate significant result disparities. Procedures were performed or supervised by two experienced otologists. Selection criteria for choosing a surgical approach encompassed perforation size, site, ear canal diameter and curvature which could be a source of selection bias. While age displayed a statistically significant difference between per-meatal and post aural approach, this disparity would have less likely impacted the overall conclusions of the study.
Comparison with Prior Literature : The three recognized methods for tympanoplasty are post-aural, endaural, and per-meatal approaches1. Literature extensively covers these approaches, discussing indications, techniques, outcomes, and complications2. Studies compare per-meatal and post-aural approaches, examining graft success, hearing, surgery duration, recovery, and complications2,8. Perhaps our study is unique since it offers a patient perspective on experiences with these two surgical methods.
Clinical and Research Implications : This study provides preliminary data, potentially paving the way for a more extensive investigation with robust methodology and larger sample size. Clinicians can utilise our study findings within the study’s limitations.