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.