Is it taboo to elevate the tympanomeatal flap? Outcomes of endoscopic transcanal type 1 cartilage tympanoplasty with double-layer crescent graft technique

Objective: In this study, we aimed to examine the surgical and functional results of tympanoplasty performed with a double-layer crescent graft technique. We also aimed to investigate the anatomical and functional results of type 1 tympanoplasty with a large series without elevation of the tympanomeatal flap. Methods: The anatomical and functional results of 245 patients treated with endoscopic type 1 tympanoplasty by double- layer crescent graft between January 2015 and January 2019 were retrospectively evaluated in terms of age, sex, tympanic membrane perforation size, complication, functional hearing before and after surgery, and duration of the operation. Results: The participant cohort was 59.2% women (n=145) and 40.8% men (n=100), and the average age was 30.8286 [+ or -] 10.29897 years (minimum 13, maximum 56). Overall, the anatomical success rate was 91.83%; in patients with medium tympanic membrane perforation of 25%-75%, it was 94.9%; and in patients with large perforation of > 75%, it was 88%. When complications were examined, the rates of graft perforation, lateralization, and retraction rates were 8.1%, 8.1%, and 3.6%, respectively. The average operation time was 33.0449 [+ or -] 3.02348 minutes. Conclusion: Endoscopic double-layer crescent graft tympanoplasty is a successful method to ensure anatomical and physiological results in medium and large tympanic membrane perforations. In addition, it was observed that the operation could be performed with a shorter surgical time without elevating the tympanomeatal flap, and its anatomical and functional results were successful. Keywords: Tympanoplasty, endoscopic tympanoplasty, perichondrium-cartilage composite graft, double-layer graft, tympanic membrane perforation, hearing