The study "a study comparing the outcomes of graft placement medial and lateral to the handle of malleus in type 1 tympanoplasty underlay technique" will be conducted in the department of otorhinolaryngology, varun arjun medical college, and rohilkhand hospital, banthra, shahjahanpur, uttar pradesh.

a. study setting and participants

the research focuses on patients with tympanic membrane perforations due to chronic otitis media (com) of the mucosal type, attending the ent outpatient clinic of the aforementioned institution. the inclusion and exclusion criteria ensure that eligible participants are between 12 and 60 years old, present isolated conductive hearing loss, and exhibit inactive com with specific tympanic perforations. patients with recurrent com, ossicular disruption, or uncontrolled systemic conditions are excluded.

b. objectives

1. evaluate graft uptake success rates for medial versus lateral placement of temporalis fascia.

2. compare hearing improvement post-surgery.

3. assess complications associated with each grafting technique.

c. methodology

design: prospective randomized controlled trial.

duration: april 2024 to september 2025.

sample size: 40 patients (20 per group), randomly assigned to either medial or lateral graft placement groups.

procedures: all patients undergo type 1 tympanoplasty using a postaural approach with temporalis fascia grafting, followed by consistent follow-ups (up to six months post-surgery).

outcome measures: graft uptake, improvement in air-bone gap via pure tone audiometry, and incidence of post-op complications.

d. data analysis

spss software will be used to analyze categorical and quantitative variables. statistical significance is determined at a p-value < 0.05.

e. significance

the findings aim to guide surgeons in optimizing graft placement for better hearing outcomes and reduced complications in patients with com.