Shafiullah1, Muhammad Habib Khattak1, Muhammad Salman Haider Qureshi1, Asadullah Arif2

1Department of Otorhinolaryngology, Kuwait Teaching Hospital, Peshawar - Pakistan
2Department of Otorhinolaryngology, Khyber Teaching Hospital, Peshawar - Pakistan


Objective: To determine the outcome of posterosuperior (PS) based flap in subtotal perforation of the tympanic membrane
in myringoplasty.
Material and Methods: It was a case series study, conducted in otorhinolaryngology department of Peshawar Medical
Collage at Kuwait Teaching Hospital from January 2015 to March 2016. A total of 100 cases were studied in which male
to female ratio was 3:2. All those cases where there was central, dry perforation of more than 6 months duration with
age range of 15 to 55 year of both the gender were included. The patients with persistent aural discharge, acute otitis
externa, active sinunasal disease, marginal perforation, with suspected cholesteatoma were excluded. In 60 patients
we used postero superior based flap along with temporalis facia graft and in 40 patients we used only temporalis facia
graft. 10 cases were operated through endaural approach while 15 cases were operated through postaural approach.
Remaining 75 cases were operated through transcanal approach. All cases were operated under local anesthesia.
Results: Out of 100 patients 60 were female and 40 were male. In 60 patients PS based flap was used along with
temporalis fascia graft and patients were followed up for 3 months. Only in 10 patients the perforation was not closed
and the patient present with persistent ear discharge while in 50 patients the perforation was closed with improve
hearing with no discharge. In these cases the success rate was 83.2%. Rest of the 40 patient were operated by under
lay technique. In all these cases temporalis facia was used as a graft material with no flap because of its low metabolic
requirement and easy availability. In 9 patients the perforation was not closed and the patients were having persistent
ear discharged. Success rate in these cases was 77.5%.
Conclusion: In subtotal perforation posterior superior based flap provide additional blood supply to the center of graft
and thus Improve the graft uptake rate and thus increase the percentage of success.

Keywords: Tympanic, membrane, flap, perforation, temporalis fascia, tragal cartilage, perichondrium

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