Tympanoplasty is the surgical procedure in which disease from the middle ear is eradicated followed by the reconstruction of hearing mechanism with or without tympanic membrane grafting [5]. Canaloplasty is a surgical procedure that aims to widen the external auditory canal [8].Canaloplasty leads to better surgical visualization and hence improved graft uptake. Since the ear canal also plays an important role in modulating sound, thus the study was conducted to determine the additional improvement in hearing on combining canaloplasty with type I tympanoplasty.

In the present study, the confounding factors such as gender and age distribution along with the type of perforation and preoperative air bone gap did not show any significant statistical difference among the two groups.

There are very few studies which compared outcomes of tympanoplasty with or without canaloplasty when the graft is placed medial to the handle of malleus. After 12 weeks postoperatively, the success of graft uptake in group A was better than group B in the current study at 94.3% in group A compared to 88.57% in group B. This corroborates with the earlier studies done by Morrison et al. at the University of Alabama, who reported 91.6% graft uptake in patients with tympanoplasty with canaloplasty as compared to 69% in patients with tympanoplasty alone when the graft was placed medially. However, the success rate of graft uptake was higher in the patients with tympanoplasty with and without canaloplasty, but the p value was not significant in the present study, while it was significant in the study conducted by Morrison et al. [9].

Hearing outcomes at 12 weeks postoperatively showed air bone gap closure of 15.76 dB ± 6.75 in patients with tympanoplasty along with canaloplasty, while the air bone gap closure of 14.87 dB ± 5.99 was seen in patients who underwent tympanoplasty alone. However, in the study conducted by Morrison et al., the air bone gap of 8.7 dB ± 6.3 was seen in patients with medial tympanoplasty with canaloplasty as compared to 14.3 dB ± 11.1 air bone gap in patients with medial tympanoplasty alone, but the difference was statistically significant [9]. Similarly, Virendra et al. in their study had 9 dB improvement in hearing in cases with canaloplasty as compared to tympanoplasty alone [10]. Prakash et al. in their study also achieved 13.48 dB of air bone gap closure in cases with canaloplasty as compared to 11.26 dB air bone gap closure in cases without canaloplasty, and the difference was statistically significant too [11]. This is similar to what we have seen in the current study; however, the difference was not statistically significant with a p value of 0.606.

There are a few studies available which assessed the impact of canaloplasty in hearing outcomes in patients undergoing type 1 tympanoplasty. In the current study, confounding factors were removed as much as possible thus accessing the outcomes more accurately. However, the Eustachian function status is the confounding factor in this study. The results seen in the current study showed similar trends as seen in the previous studies as the percentage of graft uptake and air bone gap closure were better in patients undergoing canaloplasty along with medial graft tympanoplasty as compared to patients undergoing medial tympanoplasty alone.

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