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Abstract

Introduction: Tympanic membrane perforation represents a common pathology in otorhinolaryngology practice. Large perforations present significant surgical challenges, particularly regarding graft placement and stability. This study aims to compare the surgical outcomes of type-1 tympanoplasty with and without anterior tucking in cases of large tympanic membrane perforations.
Methodology: This prospective comparative study was conducted at Krishna Vishwa Vidyapeeth, a tertiary care hospital in Western Maharashtra from November 2023 to December 2025. Thirty patients with large tympanic membrane perforations (>50% of the membrane area) were included and equally divided into two groups: Group A (with anterior tucking) and Group B (without anterior tucking). All patients underwent type-1 tympanoplasty using temporalis fascia graft through a post aural approach. Audiological assessment was performed preoperatively and at 3 months postoperatively. Graft uptake was evaluated at 3 months follow-up. Statistical analysis was performed using appropriate tests with p<0.05 considered significant.
Results: The pre-operative air conduction thresholds (50.4±2.9 dB in Group A; 50.13±2.9 dB in Group B) improved significantly postoperatively (36.7±5.1 dB in Group A; 37±8.8 dB in Group B). The mean air-bone gap closure was comparable in both groups (13.8±5.4 dB in Group A; 13.7±8 dB in Group B). Graft uptake rates were 93.3% (14/15) in the tucking group and 86.7% (13/15) in the non-tucking group, a difference that did not reach statistical significance (p=0.47). Both techniques demonstrated statistically significant improvement in hearing parameters from baseline (p<0.001).
Conclusion: Both techniques (with and without anterior tucking) achieved comparable audiological outcomes and satisfactory graft uptake rates in large tympanic membrane perforations. While a slight trend toward better graft success was observed with anterior tucking, this difference was not statistically significant. The choice between these techniques should be guided by specific clinical scenarios, patient characteristics, and surgeon preference rather than a universal approach.