title: Comparison of permeatal medial placement of graft without raising the tympano-meatal flaps to conventional methods of myringoplasty: An experience at tertiary care hospital in Pakistan.
abstract: OBJECTIVE
  To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty.
  
  
  METHODS
  This Quasi-experimental study was carried out in CMH (Combined Military Hospital) Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media (CSOM) with dry central; small, medium and large perforations were selected. They were divided into two groups depending upon the type of approach. In Group-A (n-200); permeatal approach without raising tympano-meatal flap was used; while in Group-B (n-150) end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17.
  
  
  RESULTS
  Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A(80%) and Group-B(85%) (p-0.261). Type of approach had a significant impact on duration of surgery(p<0.001) and post-operative recovery time(p<0.001).
  
  
  CONCLUSIONS
  The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently.
authors.affiliation: Dr. Saleem Asif Niazi, MBBS, MCPS, FCPS Department of ENT, Combined Military Hospital, Peshawar, Pakistan.
authors.forename: Saleem Asif
authors.initials: SA
authors.lastname: Niazi
authors.affiliation: Dr. Zaheer Ul Hassan, MBBS, FCPS Department of ENT, Combined Military Hospital, Peshawar, Pakistan.
authors.forename: Zaheer Ul
authors.initials: ZU
authors.lastname: Hassan
authors.affiliation: Dr. Khaula Atif, MBBS, MCPS(Family-Medicine), DPH, DMA. Department of General Administration, Combined Military Hospital, Peshawar, Pakistan.
authors.forename: Khaula
authors.initials: K
authors.lastname: Atif
authors.affiliation: Dr. Saeed Ullah, MBBS, FCPS Department of ENT, Combined Military Hospital, Quetta, Baluchistan, Pakistan.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ullah
keywords: End aural/Post aural; Myringoplasty; Permeatal