Clinical and Audiological Outcomes of the Circumferential Tympanomeatal Flap Technique in Type I Tympanoplasty: A Prospective Observational Study

Background: Chronic otitis media (COM) is a major contributor to preventable conductive hearing loss in developing nations. The circumferential tympanomeatal flap technique, which achieves 360-degree elevation of the meatal skin and annular tissue, has been advocated as a superior approach to ensure comprehensive graft support and improve surgical outcomes, particularly for anterior and large central perforations (LCPs). Dedicated prospective data characterizing its standalone clinical and audiological profile warrant further documentation. To evaluate graft uptake and postoperative hearing improvement following the circumferential tympanomeatal flap technique in type I tympanoplasty among patients with inactive mucosal COM. Methods: This prospective observational study was conducted at Department of Otorhinolaryngology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India from January 2024 to January 2025. Thirty patients with inactive mucosal COM, aged 15-55 years, satisfying predefined selection criteria, underwent type I tympanoplasty via the circumferential flap technique. Pure tone audiometry was conducted preoperatively and at 3 months postoperatively. Graft integrity was evaluated at 1 and 3 months. Results: The mean patient age was 28.0 years, with male predominance (70.0%). The mean preoperative air–bone gap (ABG) was 24.07 ± 7.38 dB. Postoperatively, the mean ABG was 12.73 ± 5.95 dB, yielding a mean hearing gain of 11.62 ± 6.23 dB. Successful graft incorporation was recorded in 93.33% of patients at both 1-month and 3-month assessments. Complication rates were minimal. Conclusion: The circumferential tympanomeatal flap technique produces satisfactory graft incorporation and substantial audiological benefit in patients with inactive mucosal COM. The 360-degree elevation of the tympanomeatal complex provides comprehensive graft coverage and stable annular support, particularly advantageous for anterior and LCPs.