Effect of canal widening (type I tympanoplasty) on hearing sensitivity

Prakash Tumkur Kumaraswamy, Abhilash Shambulingegowda, Devi Neelanmegarajan


Background: Chronic otitis media (COM) is a chronic inflammation of the middle ear cleft that is characterised by discharge from the middle ear through a perforated tympanic membrane for at least 6 weeks. The pattern and degree of hearing loss greatly vary in individuals with COM. Conductive hearing loss is the most common pattern. This could be managed conservatively or surgically. Mastoidectomy and/or tympanoplasty are frequently used management procedures for COM. The study aimed to investigate the efficacy of the type I tympanoplasty through a canal widening procedure on hearing sensitivity.

Methods: Two groups participated in the study. Group I included 25 participants who underwent type I tympanoplasty with canal widening procedure and group II included 25 participants who underwent type I tympanoplasty without canal widening procedure. The audiometric results of pre-operative condition and post-operative condition at 1 month and 3 months were documented for further analysis.  

Results: The mean difference of pre-post (1 month) air conduction threshold was 12.68 dB in group I and 5.5 dB in group II participants. The mean difference of pre-post (3 month) air conduction threshold was 18.86 dB in group I and 8.24 dB in group II participants. There was a significant difference in thresholds that was obtained between the two groups and across conditions.

Conclusions: The study provides clear evidence that Type I tympanoplasty with canal widening procedure provides a better improvement in hearing sensitivity for individuals with COM, where surgical procedure is an indication.


Air and bone conduction thresholds chronic otitis media, Hearing sensitivity, Pre-post operation

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Mittal R, Lisi CV, Gerring R, Mittal J, Mathee K, Narasimhan G, et al. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015;64(10):1103-16.

Kamath MP, Sreedharan S, Rao AR, Raj V, Raju K. Success of myringoplasty: our experience. Indian J Otolaryngol Head Neck Surg. 2013;65(4):358-62.

World Health Organization. Chronic suppurative otitis media: burden of illness and management options. Geneve: World Health Organization. ‎2004. Available at: 10665/42941.

Shaheen MM, Raquib A, Ahmad SM. Chronic suppurative otitis media and its association with socio-econonic factors among rural primary school children of Bangladesh. Indian J Otolaryngol Head Neck Surg. 2012;64(1):36-41.

Khan NA. Repair of traumatic perforation of tympanic membranes by a new technique. Pak J Otolaryngol. 1992;8(177):9.

Ashfaq M, Ashfaq M, Aasim MU, Khan N. Myringoplasty: anatomical and functional results. Pak Armed Forces Med J. 2004;54(2):155-8.

Taneja MK. Role of canaloplasty. Indian J Otol. 2013;19(4):159.

Batni G, Goyal R. Hearing outcome after type I tympanoplasty: a retrospective study. Indian J Otolaryngol Head Neck Surg. 2015;67(1):39-42.

Patil BC, Misale PR, Mane RS, Mohite AA. Outcome of interlay grafting in type 1 tympanoplasty for large central perforation. Indian J Otolaryngol Head Neck Surg. 2014;66(4):418-24.

Mokhtarinejad F, Okhovat SAR, Barzegar F. Surgical and hearing results of the circumferential subannular grafting technique in tympanoplasty: a randomized clinical study. Am J Otolaryngol. 2012;33(1):75-9.

Carhart R, Jerger JF. Preferred method for clinical determination of pure-tone thresholds. J Speech Hear Disord. 1959;24(4):330-45.

American National Standards Institute. Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-1999; Rev. 2003 ed.). New York.

Wullstein HL. Functional operations in the middle ear with split-thickness skin graft. Arch Otorhinolaryngol. 1953;161:422-35.

Salén B. Tympanic membrane grafts of full-thickness skin, fascia and cartilage with its perichondrium. An experimental and clinical investigation. Acta Otolaryngol (Stockh). 1968:Suppl 244.

Zollner F. Audiologie. Georg Thieme Verlag; 1954.

Frenckner P. Pedicle graft from ear canal skin for myringoplasty. Acta Otolaryngol. 1955;45:19.

Shea JJ. Vein graft closure of eardrum perforations. Arch Otolaryngol. 1960;72(4):445-7.

Heermann H. Tympanic membrane plastic with temporal fascia. Hals Nas Ohren. 1960;9:136-9.

Mallick A, Bhalla V, Roy R. Effect of canalplasty on outcome of results in type I tympanoplasty. Bengal J Otolaryngol Head Neck Surg. 2016;24(1):15-20.

Vijayendra H, Ittop CJ, Sangeetha R. Comparative study of hearing improvement in type 1 tympanoplasty with and without canalplasty. Indian J Otolaryngol Head Neck Surg. 2008;60(4):341.

Yu JF, Chen YS, Cheng WD. Gain affected by the interior shape of the ear canal. Otolaryngol Head Neck Surg. 2011;144(6):945-9.

Olusesi AD, Opaluwah E, Hassan SB. Subjective and objective outcomes of tympanoplasty surgery at National Hospital Abuja, Nigeria 2005-2009. Eur Arch Otorhinolaryngol. 2011;268(3):367-72.