Outcome Evaluation of Total Annulus Excision Tympanoplasty: A Prospective Study

Introduction: Chronic otitis media (COM) remains a leading cause of tympanic membrane (TM) perforation, contributing significantly to conductive hearing loss and reduced quality of life. Tympanoplasty, the surgical reconstruction of TM, has evolved with various techniques; however, persistent challenges such as graft failure and postoperative discharge persist. Total annulus excision (TAE), a novel interlay tympanoplasty technique, involves the complete removal of the residual annulus and TM, allowing precise graft placement between mucosa and canal epithelium. This study aims to evaluate the anatomical and functional outcomes of TAE, hypothesizing superior graft uptake, improved hearing restoration, and reduced postoperative complications in complex middle ear pathologies. Background: COM is a prevalent cause of TM perforation, often resulting in conductive hearing loss and recurrent ear discharge. Traditional tympanoplasty techniques are limited by complications such as graft lateralization and mucosalization. TAE tympanoplasty is a novel interlay technique involving complete annular removal, aiming to create a more anatomical and physiological neotympanum. Objectives: The objective of this study was to evaluate the outcomes of TAE tympanoplasty with respect to graft uptake rate, postoperative hearing gain, and ease of surgery in patients with mucosal-type COM. Materials and Methods: A prospective study was conducted on 75 patients (aged 18–50 years) with inactive mucosal COM undergoing TAE tympanoplasty at a tertiary care center. Pre- and postoperative pure-tone audiometry (PTA) was performed. Graft uptake was assessed at 3 months. Hearing gain was categorized as <20 dB or ≥ 20 dB. Surgical ease was recorded using a 5-point Likert scale. Statistical analysis was performed using SPSS v26, with significance set at P < 0.05. Results: Of the 75 patients, 60% were aged 18–27 years and 73.33% were female. Left ear disease predominated (37.33%). Postoperative PTA scores showed significant improvement: right ear from 34.53 ± 11.09 dB to 24.51 ± 7.94 dB and left ear from 35.70 ± 11.09 dB to 24.02 ± 8.08 dB ( P < 0.0001). Graft uptake was successful in 90.67% of cases. Hearing gain ≥20 dB was achieved in 57.33% of patients. Most surgeries were rated as “easy” (52%) or “very easy” (12%). No statistically significant associations were found between graft uptake and age, sex, or side of disease. Conclusion: TAE tympanoplasty is a safe and effective technique for TM reconstruction in mucosal COM, yielding high graft uptake rates and significant hearing improvement. Further comparative studies are recommended to establish its superiority over conventional techniques.