Ear packing is thought to support grafts, control bleeding and facilitate healing. However, it is not without complications such as fibrosis and infection. The authors aimed at investigating the effect of middle ear packing on graft success rate in myringoplasty operations where a tympanomeatal flap is not raised. The study included 181 adults with dry central perforations. The patients were randomised into two groups blinded to the audiologists but, naturally, not the surgeon. In patients who were packed, the middle ear was filled with Gelfoam® to the level of the perforation and then the graft was inserted. The graft is formed from a cartilage as inlay and a still-attached perichondrium as an overlay. More Gelfoam® was applied to the ear canal. Postoperatively, oral antibiotics were given for one week and topical antibiotics and steroid drops were given for two weeks in both groups. The healing rates at six months were roughly similar in both groups, around 90%. There was no significant difference in hearing outcomes either. There was no significant difference in infection rates. The authors concluded that myringoplasty without ear packing is comparable in terms of graft take rates and hearing improvements to myringoplasty with ear packing. This study is helpful in counselling patients who might not want animal products in their ears. The use of topical and oral antibiotics is debatable and affects the generalisability of this study.
To pack or not to pack!
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