Methods
inflammation, perforation
CHOLESTEATOMA, INFLAMMATION, MIDDLE EAR, MALLEUS
Study subjects were recruited from consecutive adult patients diagnosed with chronic perforation who visited the Department of Otorhinolaryngology, Head and Neck Surgery. The inclusion criteria was included: no marginal small-or medium size perforation with no involving the malleus umbo; dry ear at least 3 months prior to surgery based on patient history, good pneumatization of the middle ear and mastoid region, as shown by high-resolution computed tomography (HRCT). Prior to enrollment, HRCT was performed, and audiograms were recorded in all patients. Exclusion criteria were active inflammation during the 3 months prior to surgery, revision surgery, cholesteatoma, and requiring ossiculoplasty. The perforation size was categorised as small (< 1/8 of the TM area), medium (1/8–1/4 of the TM area) [Audiometric data were obtained preoperatively and 6 months postoperatively. Pure-tone averages (PTAs) were calculated for both air conduction (AC) and bone conduction (BC) by averaging the thresholds at 500, 1000, 2000, and 3000 Hz; in most cases, a threshold of 4000 Hz was used to interpolate the threshold of 3000 Hz per the standards of the Hearing Committee of the American Academy of Otolaryngology-Head and Neck Surgery. Pre- and postoperative air bone gap (ABG) was calculated by subtracting the AC PTA from the BC PTA. ABG closure was calculated as preoperative ABG minus postoperative ABG [