Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

Fink, M R; Mankekar, Gauri; Son, Leslie; Mehta, Rahul; Arriaga, Moisés A.

doi:10.1017/s0022215120001978

Cited by 9 publications

(3 citation statements)

References 41 publications

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“…In the investigation by Kazikdas et al, 23 the graft success rate was 95.7% by over‐under method with cartilage tympanoplasty, and 75% using temporal fascia in 51 patients with subtotal perforations. A retrospective study by Erbele et al 24 investigated the over‐under cartilage tympanoplasty technique. In this study, 68 patients were included.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the underlay and over‐underlay tympanoplasty: A randomized, double‐blind controlled trial

Shishegar

Faramarzi

Biniaz

et al. 2023

Laryngoscope Investig Oto

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Objective We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over‐underlay approaches. Methods This is a prospective double‐blind randomized controlled clinical trial with a parallel design. Patients aged 15–75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over‐underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6 months. Results The investigation was conducted on 84 patients in the underlay and 67 patients in the over‐underlay group. Although there was a higher rate of graft failure (9%) in the over‐underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant ( p ‐value = .34). No atelectasis was seen in both group. Although, between‐groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air‐bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over‐underlay technique, the difference was clinically negligible. Conclusion Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over‐underlay technique after the operation. Levels of Evidence 1b

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Section: Discussionmentioning

confidence: 99%

Comparison of the underlay and over‐underlay tympanoplasty: A randomized, double‐blind controlled trial

Shishegar

Faramarzi

Biniaz

et al. 2023

Laryngoscope Investig Oto

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“…Using an argon laser at 1500 mW for 200 ms per fire, any remaining squamous tissue was removed from the handle of the malleus. The technique used was a minor modification of that presented in Erbele et al( 8 ) to accommodate use of the endoscope. In contrast to that study, a postauricular incision was not made and an anterior canalplasty was not performed.…”

Section: Methodsmentioning

confidence: 99%

“…In previous study, we detailed the microscopic over-under cartilage tympanoplasty approach using a case series from one of our coauthors (M.A.A.). ( 8 ) The senior author for the present study (R.M.) is an endoscopic otologist who performs both 1) the over-under technique, where the tympanic membrane is elevated from the malleus, and 2) the underlay cartilage technique, where the tympanic membrane is left on the malleus.…”

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confidence: 99%

Endoscopic Over Under Cartilage Tympanoplasty Is Not Inferior to Underlay Cartilage Tympanoplasty

Fink

Mankekar

Son

et al. 2021

Otology &Amp; Neurotology Open

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Objective: Evaluate whether elevating the tympanic membrane from the malleus during endoscopic tympanoplasty may negatively affect postoperative hearing outcomes or perforation rates by comparing 2 similar endoscopic tympanoplasty techniques. Study Design: Retrospective cohort. Setting: Tertiary care center. Patients: Endoscopic over-under cartilage tympanoplasties age and gender matched to endoscopic underlay cartilage tympanoplasties between January 2015 and January 2019. Exclusion criteria included preoperative or intraoperative cholesteatoma, performance of mastoidectomy or ossicular chain reconstruction, and lack of postoperative audiogram. Interventions: Endoscopic cartilage tympanoplasty via over-under or underlay technique. Main Outcome Measures: Pre- and postoperative pure-tone average and word recognition score, graft success. Results: A total of 52 patients were evaluated: 26 endoscopic over-under cartilage tympanoplasties were matched to endoscopic underlay cartilage tympanoplasties. Both groups demonstrated a statistically significant improvement in air conduction hearing (9 dB [P < 0.001] and 6 dB [P < 0.01], respectively), and bone pure-tone average did not worsen in either group (P < 0.001 and P < 0.05, respectively). Postoperative air conduction pure-tone average was statistically noninferior in the over-under group compared with the underlay group (P < 0.05). Reperforation was present in 3 patients (12%) in the underlay group and none in the over-under group, but this difference was not statistically significant (P = 0.24). Conclusions: Endoscopic over-under cartilage tympanoplasty effectively closes tympanic membrane perforations and improves hearing, without greater risk than underlay tympanoplasty. Elevating the tympanic membrane from the malleus does not confer worsen hearing outcomes.

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Comparison of endoscopic underlay and over‐under tympanoplasty techniques for type I tympanoplasty

Bao

Zhan

Wick

2022

Laryngoscope Investig Oto

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Objective To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty. Methods Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG). Results Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p < .001) and a higher rate of anterior extension (95% vs. 22%, p < .001) than underlay technique. Perforation closure rate was not different between groups (95% vs. 96%). Patients experienced significant improvement in PTA and ABG in both groups. Conclusion The endoscopic over‐under tympanoplasty is comparable to endoscopic underlay tympanoplasty in terms of graft take and audiologic improvement. The over‐under technique is effective for repairing larger perforations or those with anterior extension. Level of evidence IV

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Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

Cited by 9 publications

References 41 publications

Comparison of the underlay and over‐underlay tympanoplasty: A randomized, double‐blind controlled trial

Comparison of the underlay and over‐underlay tympanoplasty: A randomized, double‐blind controlled trial

Endoscopic Over Under Cartilage Tympanoplasty Is Not Inferior to Underlay Cartilage Tympanoplasty

Comparison of endoscopic underlay and over‐under tympanoplasty techniques for type I tympanoplasty

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