Vol. 7, Issue 2, Part A (2025)

Background: Myringoplasty is a surgical procedure to repair tympanic membrane (TM) perforations, primarily in chronic suppurative otitis media with intact ossicles. TM perforations disrupt sound conduction and reduce hearing by compromising middle ear aeration and membrane vibration. Hearing loss severity is influenced by perforation size, location, disease duration, and middle ear status. Myringoplasty restores the acoustic barrier, with hearing improvement commonly assessed via air conduction thresholds. The relationship between perforation size and hearing outcomes remains debated, with varying findings across studies regarding the extent of postoperative hearing gain.

Aim of the study: This study aims to evaluate the impact of myringoplasty on hearing thresholds in patients with different sizes of tympanic membrane perforations at a tertiary care hospital in Bangladesh.

Methods: This prospective observational study was conducted over 12 months, from June 2023 to June 2024 at ENT & Head Neck Surgery Department, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, involving 60 patients aged 10-60 years with chronic dry central tympanic membrane perforations undergoing myringoplasty. Patients with active discharge, ossicular pathology, prior surgeries, or sensorineural hearing loss were excluded. Perforation size was classified as small (<25%), medium (25-50%), or large (>50%). All patients underwent pre- and post-operative Pure Tone Audiometry. Surgery involved temporalis fascia grafting using the underlay technique. Follow-ups were conducted at 1 week, 1 month, and 3 months. Hearing improvement and graft status were assessed. Data were analyzed using SPSS with statistical significance set at p<0.05.

Results: Most patients were aged 18-45 years (76.7%) with a slight male predominance (56.7%). Medium-sized perforations were most common (43.3%). Pre-operative air conduction (AC) thresholds increased with perforation size, averaging 28.6 dB (small), 38.2 dB (medium), and 47.5 dB (large). Post-operative thresholds significantly improved to 15.4 dB, 21.8 dB, and 30.1 dB respectively. The greatest hearing gain was seen in large perforations (17.4 dB), followed by medium (16.4 dB) and small (13.2 dB), all statistically significant (p < 0.001). Graft uptake success was highest in small (100%) and lowest in large (75.0%) perforations. Post-operative complications were minimal, with infection being the most frequent (5.0%).

Conclusion: Myringoplasty effectively improves hearing across all perforation sizes, with the greatest gain in large perforations but better post-operative hearing and graft success in smaller ones. Minimal complications confirm its safety. The findings highlight perforation size as a key factor in outcomes, supporting myringoplasty’s role in tympanic membrane repair in Bangladesh.