The fibrous annulus in myringoplasty

Graft cholesteatoma is a serious complication of tympanic membrane grafting. It is due to burying keratinizing epithelium under the graft. Its occurrence in the anterior angle has been attributed to the presence of epithelial rests within the annulus in this area, and consequently is considered inevitable with overlay technique. In the present study we propose that this complication is due to inadequate surgical technique rather than due to factors inherent in underlying pathology or in the technique itself.