Healing and hearing in uncomplicated myringoplasty

Abstract

In closing an uncomplicated central drum defect the technique known as an ‘underlay’is widely used. This method has certain advantages and yields good results as far as both healing and hearing are concerned. In an attempt further to improve reults the authors give an account of a series of myringoplasties and specifically discuss the unsuccessful cases. By a slight alteration in the operative technique used in the series presented, the authors believe that some failures can be avoided.

What's best in myringoplasty: underlay or overlay, dura or fascia?

“…3. Mendel and Kuylenstierna (1980) noted that graft failures occurred more frequently in front of the handle of the malleus and postero-inferiorly. They did not use gelfoam.…”

Preventing Graft Failures Anterior to the Handle of the Malleus: A Modified Surgical Technique for Underlay Grafting

“…Although there are strong advocates of both overlay and underlay tympanoplasty, the former has become less popular because it is time consuming; requires considerable expertise to master; and carries a greater risk of blunting, graft lateralization, and trapped epithelium in the middle ear. [1][2][3][4] Laying the graft under the drum remnant and over the malleus has been proposed to circumvent these difficulties. 6 Unfortunately this does not prevent the trap- ping of epithelium under the graft even in expert hands.…”

“…Additionally, large anterior and total TM perforations leave little or no drum remnant under which the underlay graft can be securely tucked, making them more susceptible to graft migration and failure. [1][2][3][4] A recent retrospective study of underlay grafting reported a meager 67% success with the repair of anterior or total perforations, compared with 90% success with posterior and inferior perforations, underscoring the difficulties of anterior perforations. 5 Not unexpectedly, large anterior and total perforations are more daunting to the occasional otologist.…”

“…There is therefore a greater likelihood of graft migration and graft failure anterior to the handle of the malleus. [1][2][3][4] A recent study reported a meager 67% rate of success with the repair of anterior and total perforations, compared with 90% success with posterior and inferior perforations. 5 Not surprisingly, the repair of such perforations remains daunting to the inexperienced otologic surgeon, although it may pose little concern to the expert otologist.…”