Exclusion Criteria

All the patients for the study were evaluated subjectively and objectively with detailed history, clinical examination including otomicroscopy, tuning fork test, pure tone audiometry preoperatively and documented in proforma followed by pre-anesthetic check-up and surgery after taking informed written consent in vernacular language.

All the cases were operated (tympanoplasty with or without cortical mastoidectomy) under general or local anaesthesia (with sedation) by mostly post-aural approach and few also by endaural and endomeatal approach using temporalis fascia as graft material. After meatotomy, soft tissue was elevated from the bony cortex, tympano-meatal flap was elevated circumferentially and was superiorly based. Canalplasty was done in cases with a bony overhang obscuring the view of annulus. Fibro–squamous layer of the remnant tympanic membrane along with the annulus was elevated leaving behind the mucosal layer. Ossicles were inspected for continuity and the mobility was checked. Temporalis fascia graft was placed in such a fashion that it rested on the mucosal layer and bony canal all around and below the handle of malleus (Interlay Technique). The tympano-meatal flap was reposited carefully, absorbable gel foams were kept in external auditory canal and the incision was sutured in two layers. Endaural tympanoplasty was performed by conventional Lempert’s endaural incision (Fig. ​(Fig.33).

a Large central perforation after tympanomeatal flap elevation circumferentially, b Post flap elevation—(1) Eustachian tube, (2) Annulus, (3) Mucosal layer of tympanic membrane, c Post flap elevation—(4) Annulus, (5) Mucosal layer of tympanic membrane, d Superiorly based tympanomeatal flap on circumferential elevation, e annulus positioned during interlay technique, f graft kept medial to handle of malleus by Interlay technique and then tympanomeatal flap repositioned supporting it, g graft placed by Interlay technique

Patients were discharged on 7th post-operative day after suture removal. They received appropriate antibiotics for 1 week during the hospital stay along with appropriate oral antihistaminic and oral analgesic. Antibiotics were continued in the follow up period. Patients were called for follow up weekly up to 1 month and on every 15th day for next 3 months for otoscopic examination and post-operative care. Post-operative PTA were done after 4 months.

In pure tone audiometry, hearing was assessed for air conduction sound and bone conduction sound at 0.5, 1, 2 and 4 kHz frequencies and mean hearing level and air bone gap were calculated.