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Do we always need gelfoam packing in the middle ear cavity during tympanoplasty?

Presenting Author: Woo Jin Kim

Published online by Cambridge University Press:  03 June 2016

Woo Jin Kim ,
Ji Sun Kong ,
Jamil AL-Swiahb ,
So Young Park ,
Chang Yeong Jeong ,
Dong Kee Kim ,
Sang Won Yeo  and
Shi Nae Park
Woo Jin Kim
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
Ji Sun Kong
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
Jamil AL-Swiahb
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
So Young Park
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
Chang Yeong Jeong
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
Dong Kee Kim
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
Sang Won Yeo
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
Shi Nae Park
Affiliation:
Seoul St. Mary's Hospital The Catholic University of Korea, College of Medicine
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Abstract

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Learning Objectives:

Objectives: A modified overlay tympanoplasty, also known as a lift and repositioning tympanoplasty, has been developed to overcome the disadvantages of the conventional technique. Since fascia is placed over the annulus in this technique, a novel hypothesis that a support of gelfoam in the middle ear cavity would not be necessary has been formed.

Methods: We retrospectively analyzed the surgical outcomes of our modified overlay tympanoplasty to prove whether the outcomes depend on middle ear gelfoam packing during the surgery. A total of 227 chronic otitis media patients who underwent modified overlay tympanoplasty (Type I) with sandwich technique by a single surgeon were included in this study.

Results: The mean age was 49.0 years and the male: female ratio was 76:151. The mean follow up period was 26.3 months (6–94 months). Patients were divided into two groups according to whether or not gelfoam packing was performed in the middle ear cavity; the gelfoam (GG, N = 105) and no-gelfoam groups (NG, N = 122). Graft uptake rates, postoperative hearing levels, and complication rates were compared as the measures of surgical outcomes. The graft uptake rates of each group were up to 99.1% in GG (104/105) and 99.2% in NG (121/122). The air-bone gap significantly decreased after surgery without statistical difference between the groups. Postoperative complications such as epithelial cyst and lateralization occurred very rarely in both groups, and the rates showed no significant differences between two groups.

Conclusions: In conclusion, we suggest that gelfoam packing in the middle ear is not a mandatory procedure during a modified overlay tympanoplasty. Further investigation to find the clinical advantages of no-gelfoam technique during tympanoplasty is needed in a prospectively designed clinical trial.