Comparison of Endoscopic Modified and Typical Myringoplasty: A Randomized Controlled Trial

Abstract

ObjectiveHere, we aimed to compare the operation time, postoperative pain score, graft healing, graft success rate, cholesteatoma incidence, audiometric outcomes, and complications between endoscopic modified myringoplasty (EMM) and endoscopic typical myringoplasty (ETM).MethodsPatients with unilateral chronic tympanic membrane (TM) perforations undergoing myringoplasty were prospectively randomized to undergo EMM (n = 44) or ETM (n = 45). The operation time, postoperative pain score, graft healing, graft success rate, cholesteatoma incidence, audiometric outcomes, and complications were compared between these groups.ResultsIn total, 89 patients with unilateral chronic perforations were included (EMM group, 44; ETM group, 45). There were significant differences between the EMM and ETM groups in mean pain scores on the day after surgery (1.32 ± 0.56 vs. 2.58 ± 1.16, p < 0.001) and in the mean operation time (18.18 ± 2.43 vs. 51.53 ± 8.28 min, p < 0.001). There were no significant differences in graft success rates (93.18% vs. 88.89%, p = 0.735), pre‐ or postoperative air conduction pure‐tone averages or air bone gaps (ABGs), or changes in ABGs between the groups. However, the difference in graft healing was significant at postoperative week 2 (33/44 vs. 24/45, p = 0.033) but was nonsignificant at postoperative week 4 and month 6. Computed tomography revealed the middle ear and mastoid to be well pneumatized at 12 months in all patients.ConclusionWhile 12‐month graft and audiometric outcomes were comparable between EMM and ETM techniques, patients who underwent EMM had less postoperative pain, shorter operative times, faster healing, and a lower incidence of complications.Level of Evidence1 Laryngoscope, 133:2779–2785, 2023

Effect of Packing Versus No Packing in Transperforation Myringoplasty for Chronic Tympanic Membrane Perforations

“…It is traditional to remove scar tissue from the perforation margins prior to myringoplasty; the suggestion is that nonremoval would lower the graft success rate 5,7,21,22 . Our recent studies showed that the absence of perforation rimming did not compromise graft success 10,23 . The present study is novel in that it is the first to compare the graft outcomes and early graft neovascularization after underlay myringoplasty without rimming the perforation with or without lateral graft packing.…”

“…5,7,21,22 Our recent studies showed that the absence of perforation rimming did not compromise graft success. 10,23 The present study is novel in that it is the first to compare the graft outcomes and early graft neovascularization after underlay myringoplasty without rimming the perforation with or without lateral graft packing. We confirmed that underlay myringoplasty with no perforation rimming and no lateral graft packing did not affect the long-term graft outcomes.…”