Objectives To identify the differences in hearing, anatomical success rate, functional success rate, and complications between over-under tympanoplasty and medial tympanoplasty procedures. Methods The clinical data of patients with tympanic membrane perforation repaired by medial tympanoplasty between January 2011 and December 2016 and by over-under tympanoplasty between January 2017 and December 2020 were retrospectively analyzed. We evaluated the differences between medial tympanoplasty and over-under tympanoplasty. Results The overall success rate of over-under tympanoplasty was higher than that of medial tympanoplasty (90.76% vs 81.31%). In large perforations, the success rate of over-under tympanoplasty was higher than that of medial tympanoplasty (89.80% vs 71.43%). There was no statistically significant difference in the success rate between the two treatment groups for moderate perforations. Furthermore, there was no statistically significant difference in the incidence of complications between the two groups ( P = .2637). Conclusions Over-under tympanoplasty is more suitable for large perforations of the tympanic membrane and has a higher success rate as compared to medial tympanoplasty.

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Highlight 1.  Patients with patulous Eustachian tube (PET) were older, had a shorter duration of disease, and were more likely to develop bilateral otitis media with effusion. 2. Patients with PET were more likely to develop comorbidities of gastroesophageal reflux and allergies.