Outcome of Endoscopic Myringoplasty Using Gelfoam Versus no Gelfoam in Tympanic Cavity and External Auditory Canal.

Background Absorbable gelatin sponge (gelfoam) is used routinely during myringoplasty as a scaffold that supports tympanic membrane grafts and ossicular chain and to promote hemostasis. However, gelfoam could cause fibrosis, adhesions, granulations, new bone formation within the middle ear cavity and could obstruct the tympanic ostium of the eustachian tube and affects inner ear function and also interferes with the healing process of neodrum and middle ear cavity. Objective To compare the outcome of endoscopic myringoplasty with and without use of gelfoam in external auditory canal and tympanic cavity. Method Fifty patients, with 25 patients in each group who underwent endoscopic myringoplasty with and without gelfoam packing in middle ear cavity and external auditory canal were enrolled in the study. The hearing outcome was assessed by comparing pre-operative ABG (Air bone gap) with post-operative air bone gap and air bone gap closure in speech frequencies (0.5kHz,1kHz, 2kHz,4kHz). The status of graft and hearing results was evaluated on 3months of follow-up in both the groups. Result Out of total 25 patients enrolled for study in both non gelfoam packing group (NGFPG) and gelfoam packing group (GFPG), 24(96%) had graft uptake in each group. The audiological gain in non gelfoam packing group was 11.15±2.4dB whereas in gelfoam packing group it was 12.45±0.81dB. The audiological gain between the two groups did not show any statistically significant (p= 0.190). However, the pre and postoperative hearing difference was statistically significant(p=0.001) in both non gelfoam packing group and gelfoam packing group. Conclusion This study concluded that non gelfoam packing group has similar graft uptake and hearing gain when compared with gelfoam packing group in endoscopic myringoplasty. Hence, myringoplasty can be performed safely without using any gelfoam in the middle ear cavity.