Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

Abstract

Objectives The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes.Methods Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed.Results A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P<0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%.Conclusion The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

Effect of Middle Ear Gelfoam on Hearing and Healing Process after Tympanoplasty: A Prospective Randomized Case-Control Study

“…However, the reportedstudy had a limitation in its rationale on theeffect of MEPM as the conditions were not controlled. Previous clinical studies without gelfoam during overlay tympanoplasty or ossiculoplasty demonstrated excellentsurgical results, which guided us to perform a more scientific and clinical study to demonstrate the effect of MEPM 3,17 . Our study is the first prospective randomized case-control study to investigatethe effects of middle ear packing using AGS in terms of surgical results and healing processes in humans.…”

“…All patients underwent swing-door overlay tympanoplasty 3 . Under general anaesthesia, the temporalis muscle facia harvested as usual.…”

“…Swing-door overlay tympanoplasty, which has been published recently with excellent surgical results, is a modified technique of classic overlay tympanoplasty 3 . In this surgical technique, clearly visible annulus plays a role as a splint and prevent falling of the graft material.…”

The Effect of Nitrous Oxide on the Outcomes of Underlay Tympanoplasty: A Prospective Study

“…Different tympanoplasty techniques have been shown successful outcomes. [7][8][9] Underlay tympanoplasty involves placing the graft under the remnant tympanic membrane and manubrium mallei. 10 In a meta-analysis, Tan et al reported that similar outcomes were observed between the underlay and the overlay techniques, but graft lateralization was observed mostly after the overlay technique.…”

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

“…Additionally, the graft success rate is high (more than 90%). The most major disadvantages are the blunting of the anterior portion of TM, iatrogenic cholesteatoma, and lateralization of the graft; however, this procedure needs more experience of the surgeon, and the recovery time is slower 11,12 …”