An outcome evaluation of 360-degree subannular tympanoplasty for subtotal and anterior tympanic membrane perforations: a prospective observational study from Eastern India

Abstract

Background: Subtotal and anterior tympanic membrane (TM) perforations remain a surgical challenge as the anterior tympanomeatal angle is prone to blunting, graft lateralization and residual perforation with conventional underlay tympanoplasty. This study evaluated the anatomical and functional outcomes of 360° subannular tympanoplasty in such perforations at a tertiary care centre in Eastern India.

Methods: This prospective observational study enrolled 52 patients aged 12-70 years with subtotal or anterior TM perforation, dry middle ear, normal middle ear mucosa, intact ossicular chain and no cholesteatoma, at our institution, a tertiary care centre in Eastern India, between June 2023 and May 2025. Patients with prior ear surgery or head-neck radiotherapy were excluded. All patients underwent 360° subannular tympanoplasty by a postaural, microscopic approach using a temporalis fascia graft, with anatomical and audiometric follow-up at 6 and 12 months. Data were analysed using the paired t test.

Results: The mean age was 45.9±10.4 years; 25 patients (48.1%) were male and 27 (51.9%) were female. Anatomical success was 92.0% at 6 months and 98.1% (51/52 ears) at 12 months. Mean air-bone gap (ABG) improved from 44.2±10.4 dB preoperatively to 14.3±8.3 dB postoperatively (p<0.001). ABG closure to ≤20 dB was achieved in 43/52 ears (82.6%). Granulations occurred in 4 ears (7.6%) and residual perforation in 1 ear (1.9%, 95% CI=0.3-10.1%); no graft medialization, lateralization or anterior blunting occurred.

Conclusions: The 360° subannular tympanoplasty is a reliable technique for subtotal and anterior TM perforations, providing a high graft uptake rate, significant hearing improvement and a low complication rate.