Does Anterior Tunnelling Really Help in Underlay Type I Tympanoplasty?

Introduction Stabilizing the graft can be difficult with the conventional method of underlay tympanoplasty when the tympanic membrane perforation is subtotal, large or anteriorly placed with thin anterior rim. Tympanoplasty with anterior tunnelling has been tried to overcome this problem. Materials and Methods A prospective study over two-year period was carried out with follow up for three months on 59 patients under two groups- the underlay tympanoplasty with anterior tunnelling and the conventional tympanoplasty with anterior tucking for comparison in terms of pre-and post-operative anatomical correction and physiological improvements Results Follow up at 6 weeks and 12 weeks post operatively gives statistically comparable graft take up, hearing result and residual perforations. Discussion Among various techniques of dealing with these types of perforations, statistical comparability of the two groups brings in an acceptability to this simple but satisfying procedure of the underlay tympanoplasty with anterior tunnelling. Conclusion Underlay tympanoplasty technique (type-I) for subtotal, large or anteriorly placed perforations with thin anterior rim, can be managed by combining with anterior tunnelling which provides at least comparable results (if not more security against graft medialization) in respect of anatomical closure of perforations and hearing outcomes.