To evaluate and compare the results of over-underlay graft technique with conventional underlay myringoplasty

Panchal, Vineet; Gulia, Joginder Singh; Yadav, S. P. S.; Hernot, Sharad; Kathuria, Bhushan; Kaintura, Madhuri

doi:10.4103/0971-7749.164551

Cited by 10 publications

(17 citation statements)

References 8 publications

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“…It is easier to perform and has a high success rate. However, in anterior perforation repair, it has a higher risk of fall of the anterior portion of the fascia graft due to lack of anterior support with subsequent failure of closure and partial obliteration of the middle ear cavity [4]. In the overlay grafting technique, first described by Shea in 1960 [5] then modified by Sheehy and Glasscock in 1967 [6], the graft is placed lateral to the annulus, on top of the fibrous layer of the tympanic membrane remnant.…”

Section: Discussionmentioning

confidence: 99%

“…It is reported to be more successful in anterior and subtotal perforations, however, it is more technically challenging. It provides a wide exposure and high take rate but has a significantly higher risk of graft lateralization [4], blunting and canal stenosis, impaired vascular supply and delayed healing, as well as a higher risk of cholesteatoma formation than the underlay technique.…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature, the most challenging tympanic membrane perforations are the anterior or anterosuperior tympanic membrane perforations because of access difficulty, limited blood supply, and lack of support to the graft, keeping in mind the importance of surgeon experience in such perforations, hence the continuous search for the optimal technique for improved outcomes [4]. Some of the technique modifications published so far for that cause include the three-point fix technique [7], loop overlay tympanoplasty with a superiorly based tympanomeatal flap and overlay placement of the graft [8], sandwich graft tympanoplasty [9], over-under tympanoplasty where the graft is placed over the malleus and under the annulus [10], and mediolateral graft tympanoplasty [11] among others.…”

Section: Discussionmentioning

confidence: 99%

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Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review

Barake

Natout

Bassim

et al. 2019

J of Otolaryngol - Head & Neck Surg

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BackgroundThe study aims at reporting our experience with loop underlay tympanoplasty, a modification of the underlay technique previously reported, for the reconstruction of anterior, subtotal or total tympanic membrane perforations.MethodsA retrospective review of charts of patients who have undergone loop underlay tympanoplasty from January 2002 to January 2012 was performed. One thousand one hundred patients were included. Hearing test results preoperatively and postoperatively were reported. On follow up visits, the closure of the tympanic membrane perforation and the improvement of hearing compared to preoperative measurements with absence of complications were considered as successful outcomes of the surgery.ResultsAt the three-month follow-up visit, the perforation closure rate was found to be 99.3% and Air-Bone Gap closure rate to less than 10 dB was 99.5%. The complication rate, including post-operative infection, was 0.72%.ConclusionThe loop underlay technique combines advantages of both underlay and overlay techniques with excellent postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review

Barake

Natout

Bassim

et al. 2019

J of Otolaryngol - Head & Neck Surg

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“…They attained a 91.5% success rate and 14.67 dB improvement in ABG in these patients. Panchal et al 19 compared the results of the over‐underlay method with the underlay myringoplasty. Underlay myringoplasty was done for 20 patients underwent and 20 patients underwent over‐underlay myringoplasty.…”

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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“…in which required data were extracted from the six studies (11,(18)(19)(20)(21)(22), and a simple average is obtained.…”

Section: Outcomes Of Interestmentioning

confidence: 99%

Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis

2023

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Objectives To compare postoperative tympanoplasty outcomes between active versus inactive otitis media (OM) patients with tympanic membrane perforation. Databases Reviewed Medline via PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for studies published from inception to March 1, 2023. Methods Studies of 15- to 60-year-old patients undergoing microscopic/endoscopic myringoplasty using underlay/overlay technique with reported postoperative mean hearing gain and graft uptake were included. Studies requiring simultaneous surgical procedures, reporting patients with comorbidities and with non-English full text articles were excluded. Articles were independently screened by two researchers with data extracted according to a predetermined proforma in Microsoft Excel. Cochrane risk-of-bias assessment was used for risk of bias evaluation of randomized studies and Risk of Bias in Nonrandomized Studies of Interventions for nonrandomized studies. Similar studies were pooled for meta-analysis using the inverse variance random effects model to calculate the mean difference and corresponding 95% confidence interval (CI) for mean hearing gain and DerSimonian and Laird random effects model for graft uptake. Results Thirty-three studies comprising 2,373 patients met the inclusion/exclusion criteria, seven were pooled for meta-analysis. Included articles showed inactive OM patients have higher average postoperative mean hearing gain of 10.84 dB and graft uptake of 88.7% compared to active OM patients (9.15 dB and 84.2%). Meta-analysis of mean hearing gain (MD, –0.76 dB; 95% CI, −2.11 to 0.60; p = 0.27, moderate certainty) and graft uptake (OD, 0.61; 95% CI, 0.34–1.09; p = 0.10, moderate certainty) have an overall p value >0.05. Conclusion There were no statistically significant differences in postoperative mean hearing gain and graft uptake between active and inactive OM patients undergoing tympanoplasty. Hence, tympanoplasty procedures should not be postponed solely because of patients' preoperative ear discharge status.

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To evaluate and compare the results of over-underlay graft technique with conventional underlay myringoplasty

Cited by 10 publications

References 8 publications

Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review

Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review

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

Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis

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