Underlay tympanoplasty with the graft lateral to the malleus handle

Abstract

In conventional underlay tympanoplasty the graft is placed medial to the malleus handle. The present study evaluates the results of a modification of this technique, in which the graft is placed lateral to the malleus handle, which has been dissected from the drum remnants. 39 ears with predominantly large or anterior pars tensa perforations were operated upon in this manner. After a median observation time of 20 months one ear was found to have a small reperforation. All ears had normal tympanomeatal angles, but 12 ears showed a small degree of laterofixation of the graft from the malleus handle. Analysis of the hearing showed good hearing improvement and no adverse effects attributable to the dissection of the ossicular chain. It is concluded that the technique is a good alternative to conventional underlay myringoplasty in ears with perforations involving the area anterior to the malleus handle.

Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study

“…16 Sckolnick et al reported a poor success rate for chronic ear perforation. 4 A similar success rate (90 per cent) was achieved by Kartush et al in a series of 120 patients who underwent over-underlay tympanoplasty. No patient had vertigo or facial nerve palsy; decreased hearing and a history of ear discharge were the main presenting complaints.…”

“…[16][17][18][19] This study analysed the influence of age and illness duration on tympanoplasty success rate. 21 The aim of developing the modified over-underlay tympanoplasty technique (combining the underlay 4,6 In our patients, the tympanomeatal flap was elevated as described by Yung and fresh temporalis fascia was used for grafting. Similarly, Vartiainen and Nuutinen reported that age distribution did not influence the success rate in adults.…”

Tympanoplasty Using Pedicle Temporalis Fascia Graft- A Novel Modification of Underlay Technique

“…Over the years, several surgical techniques have been tried to improve the take-up rate and hearing results such as underlay, overlay, cartilage tympanoplasty, [5] Anterior tucking [anterior hitch], [8] over-under technique, [9,10] vein graft, [2] mediolateral tympanoplasty, [11] sandwich graft tympanoplasty, [12] modified window shade by Schraff et al, [13] paper patching, lobule fat graft, etc. We are presenting a modification of over-under tympanoplasty using a pedicle temporalis fascia graft to improve the graft take-up rate without jeopardising the hearing results.…”

“…[9] And hearing improvement varies from 70% [11] to 85.7%. [15] Nardone M et al reported 78% success rate in a critical analysis of long-term results in a 1,000-adult patient series.…”

The Anterior Interlay Myringoplasty

“…Anterior canal ''blunting'' and lateralization of the graft (20) can occur, particularly with onlay or lateral techniques (discussed later). Anterior canal ''blunting'' and lateralization of the graft (20) can occur, particularly with onlay or lateral techniques (discussed later).…”