Efficacy of "Hammock'' Tympanoplasty in the Treatment of Anterior Perforations

Objectives/Hypothesis: Surgical repair of large anterior tympanic membrane (TM) perforations continue to be a challenge for the otologic surgeon. Lateral graft tympanoplasty, the recommended treatment, is technically difficult and is plagued with blunting of the anterior sulcus and lateralization of the TM, both of which can lead to conductive hearing loss. In this study, we evaluate the efficacy of "hammock'' tympanoplasty in the treatment of anterior perforation. Study Design/Methods: The "hammock'' tympanoplasty, a medial graft tympanoplasty, utilizes a large tympanomeatal flap incorporating anterior ear canal skin and the placement of a graft extending from the anterior to the posterior external auditory canal, akin to a hammock. In this retrospective study, the medical, surgical, audiological, and radiological records of 25 patients treated with hammock tympanoplasty were reviewed. Results: The average age of the patients was 40.6 +/- 20 years. The perforation involved the right ear of 17 patients, and at least two quadrants of the TM in 24 of 25 patients. The TM perforation was successfully closed in 24 of 25 patients, with improvement of the air conduction threshold in 22 of 25 patients. None of the patients experienced SNHL or lateralization of TM. There was one patient with blunting of anterior sulcus and another patient who experienced delayed facial paresis 9 days following surgery, which subsequently resolved. Conclusion: The hammock tympanoplasty is technically easy, highly effective in restoring the integrity of the TM, and shows improvement in postoperative hearing.