Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

Abstract

Objectives/Hypothesis A hybrid variation of a tympanoplasty technique, termed over–under tympanoplasty (OUT), was evaluated to demonstrate the long‐term outcomes and complications compared to medial tympanoplasty. Study Design Retrospective review. Methods Patients who underwent a tympanoplasty between 2010 and 2015 were included. Primary outcome measures included graft healing at 18 months, change in air‐bone gap (ABG), and change in high‐frequency hearing at 8 kHz. The Shapiro‐Wilk test, Student t test, and nonparametric Mann‐Whitney test were used to compare results. Univariate logistic regression analysis was used to identify potential predictors of surgical success. Results One hundred eleven patients were included; 84 underwent the over–under technique and 27 underwent medial tympanoplasty. At the 18‐month follow‐up, 100% of patients in the medial tympanoplasty group had closure of the TM perforation compared to 84% (71/84) in the over–under group. In the over–under group, 12% of patients developed small or pinpoint perforations, and 4% developed larger, recurrent perforations. Mean improvement in ABG was similar between the two groups (11.6 dB for the medial group vs. 11.9 dB for the over–under group, P < .001). No hearing loss was noted in either group. No lateralization of the graft or anterior blunting was noted. Conclusions In this series, the OUT technique had a high success rate with TM perforations, including anterior, near total, and total perforations. Hearing loss from dissection on the malleus was not found. This approach blends the advantages and minimizes the disadvantages of the classic techniques and is well suited for all types of tympanic membrane perforations. Level of Evidence 3b Laryngoscope, 129:1206–1210, 2019

Clinical outcome of exclusive endoscopic tympanoplasty with porcine small intestine submucosa in 72 patients

“…The graft take rate of endoscopic tympanoplasty with SIS was comparable to that reported for autologous tissue (approximately 84%-100%). 5,6,9,16 The graft take rate of tympanoplasty was also similar to those reported by D Small intestine submucosa has several advantages as a grafting material. First, it eliminates donor-site morbidity, postoperative wound pain and numbness.…”

“…Furthermore, graft take rates of SIS in our study and other studies 3,8,18 are similar to those using autologous tissue grafts. 5,6,9,16 The advantages of SIS compared to graft with temporalis fascia are listed in Table 3. Therefore, SIS provides a relatively convenient and time-saving method to pursue a tissue graft for repairing perforations.…”

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

“…The ability to confidently close a perforation is a strong reason to consider this technique, particularly in patients undergoing revision. The 97 per cent closure rate presented compares well to the 84-95 per cent rate in over-under temporalis fascia grafts, [20][21][22] and the rate of 88-98 per cent in other over-under cartilage tympanoplasty procedures. 3,4,6,[11][12][13][14] This was reliable in younger patients as well, though we avoided performing tympanoplasty on young patients with active Eustachian tube dysfunction.…”

“…This technique has several other strengths. Similar to arguments in other studies, 20,21,23 raising the tympanic membrane from the malleus gives excellent visualisation of the entire mesotympanum, allowing for both the improved identification of pathology and the ability to address perforations of the anterior superior quadrant. Additionally, in patients with narrow middle-ear spaces from retraction or medially rotated mallei, placing a cartilage graft lateral to the malleus can be easier than placing it as an underlay, while still preserving some middle-ear space.…”

Comparison of the Functional Success of Fat Myringoplasty and Perifascial Areolar Tympanoplasty in Transcanal Endoscopic Ear Surgery

“…2,3 To improve the take rate, different techniques, and graft materials have been used to close membrane perforations. 4,5 Minimally invasive surgeries have gained popularity and endoscopic ear surgeries were introduced in the 1990s. 6 The combination of thin rigid otoendoscopes and full highdefinition camera systems has brought about a less-invasive transcanal approach to the middle ear with clear and high contrast views.…”