Myringoplasty, only Versus Underlay Technique
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This is a retrospective study of sixty patients to compare the results of onlay and underlay techniques of myringoplasty for the closure of subtotal tympanic membrane perforation. Thirty three (33) patients underwent myringoplasty by onlya and twenty seven (27) by underlay technique. Teh graft taken rate for underlay technique was better than that for onlay technique. Similarly the underlaytechnique gave better hearing results post operatively. The degree of pst operative high frequency sensorineural hearing loss was greater with the only technique. Postoperative complications such as retraction ofanterior angle, medical proplase of graft and squamous epithelal pearl formation were not reported with the underlay technique.Keywords:
Myringoplasty
Underlay
Perforation
Tympanic Membrane Perforation
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Objective: To evaluate the efficacy of over-underlay graft technique of myringoplasty and compare the results of over-underlay graft technique with conventional underlay myringoplasty. Methods: In this prospective study, 40 patients of either sex in the age group of 15–50 years with noncholesteatomatous chronic suppurative otitis media were recruited. The patients were initially managed medically to make the ear dry and after that they were operated upon. Twenty patients underwent conventional underlay myringoplasty and 20 patients underwent over-underlay myringoplasty. The follow-up period was 3 months. Results: Graft uptake and hearing improvement was comparable in both groups. Although the graft uptake was 5% lower in the group which underwent conventional underlay myringoplasty (90%) as compared to over-underlay myringoplasty (95%), however, the difference was not statistically significant (P = 0.5). However, there was statistically significant difference in gain in hearing threshold (gain in A-B gap) in the conventional underlay myringoplasty (14.5 dB ± 7.236) as compared to over-underlay myringoplasty (18.75 dB ± 5.349) (P = 0.04). Conclusion: The over-underlay technique, which is a hybrid of both overlay and underlay technique, allows the advantages of both methods. It improves the graft uptake rate and hearing in subtotal and large perforations.
Underlay
Myringoplasty
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Objective: To study the surgical technique of otoendoscopic-guided myringoplasty for marginal perforation.Methods:Twenty-four patients with marginal perforation were treated by otoendoscopic-guided myringoplasty .According to the perforation size , 9 cases received direct underlay method of myringoplasty via tympanic membrane perforation and 15 cases received underlay method via skin flap of external acoustic meatus.Results: All patients were followed up from 3 to 19 months. The rate of closure of tympanic membrane perforation was 87.5% after first operation, and 100% in the last.At three months after operation, the rate of thresholds between 500Hz to 4000Hz improved on pure tone audiometry over 10 dB was 87.5%, and the rate of air-bone gap under 10 dB was 91.7%. Conclusion:Otoendoscopic-guided myringoplasty for marginal perforation is a rapid, safe, reliable and efficient procedure.
Myringoplasty
Perforation
Underlay
Tympanic Membrane Perforation
Pure tone audiometry
Seedbed
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Introduction Myringoplasty is a commonly performed otologic surgery. Objectives The objective of this study is to evaluate the effect of prognostic factors like - size, site of perforation, status of operating ear, approach, status of contralateral ear, experience of surgeon, primary or revision myringoplasty, and smoking in graft uptake, as well as to evaluate the hearing results after myringoplasty. Methods This is a prospective study. We included in our sample patients aged over 13 years with a Tubotympanic Chronic Otitis Media diagnosis. The patients underwent preoperative evaluation and Pure Tone Audiogram within one week prior to surgery. We performed myringoplasty using temporalis fascia graft with conventional underlay technique. We evaluated postoperative graft uptake and various factors related to the study and did a Pure Tone Audiogram at one year after surgery. Results The graft uptake rate after myringoplasty was 83.1% at one year in 219 patients. Graft uptake with normal opposite ear was 88.2%, and with Tubotympanic Chronic Otitis Media was 75% (statistically significant). We found no statistically significant difference in graft uptake results with other factors. We calculated hearing results of 132 patients with normal ossicular status who underwent myringoplasty. The average Air Conduction Threshold improvement was 11.44dB (p < 0.001) and the average Air-Bone Gap closure was 8.89dB, highly statistically significant (p < 0.001). Conclusion Diseased contralateral ear was a statistically significant poor prognostic factor for graft uptake after myringoplasty. Other factors studied were not statistically significant determining factor for graft uptake. Hearing improves significantly after myringoplasty if the ossicles are normal.
Myringoplasty
Audiogram
Tertiary care
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Background:The remaining chronic non healing perforations result in recurrent ear discharge causing great discomfort to the patient and decreased hearing.Objectives: We aimed to assess and compare the results of the underlay and interlay techniques of tympanoplasty type I in cases of medium to large sized dry central tympanic membrane perforation.Patients and methods: : Prospective study was carried out on 54 patients having medium to large sized central tympanic membrane perforation who were divided randomly into two groups.Group I patients underwent for underlay tympanoplasty type I, while group II patients underwent for interlay tympanoplasty type I. Hearing results were assessed by comparing the preoperative and postoperative pure tone audiogram as well as closure of the air-bone gap.Results: In terms of graft uptake 3-months postoperatively, in the underlay group, the success rate was 92.6%, while in the interlay group, the success rate was 96.2%.In terms of hearing improvement at the end of the 3rd month, in the underlay group, 40.8% of the patients had hearing gain from 11-20 dB, while in the interlay group, 66.7% of the patients had hearing gain from 11-20 dB. Conclusion:The success rates for the interlay technique is better than the underlay technique and have been quite promising.Therefore, such technique should be more practiced among the surgeons.
Underlay
Audiogram
Tympanic Membrane Perforation
Perforation
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11:30 AM Objectives: Tympanic membrane (TM) perforation closure can present a problem in children, especially in anterior and total perforations, due the anterior lack of support for the graft. It was suggested that the Kerr flap (KF) myringoplasty, an underlay graft with an anterior tab under the anterior TM annulus, could provide better stability of the graft. We undertook a prospective, randomized, controlled study to compare the KF myringoplasty with the standard underlay (SU) myringoplasty in children. Methods: We randomly assigned 59 children to undergo KF myringoplasty and 52 to undergo SU myringoplasty at a tertiary care pediatric institution. Surgery was performed under general anesthesia in all patients. The primary outcome was the healing of the TM; the secondary outcomes were anterior blunting of the graft and presence of retraction of TM. One year follow-up was obtained in all enrolled children. Results: At 1 year follow-up, there were 55 stable TM closures in the KF arm and 44 in the SU arm. Although the TM closure was higher in the KF arm than in the SU arm (93.2% and 84.6%), respectively), the results were not statistically significant (OR = 0.4; 95%CI, 0.12-1.41). Anterior blunting and TM retraction were not encountered. Conclusions: The KF myringoplasty is a safe and effective method for TM closure in children. However, as compared with the SU myringoplasty, the KF myringoplasty is not associated with an overall decrease in the incidence of recurrent perforations. Further assessment in a larger study is proposed.
Myringoplasty
Underlay
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Myringoplasty is an established procedure. However, the quest is on to improve the results further by studying the different influencing factors, that could possibly affect the outcome. In the present randomized prospective study of one year’s duration, 60 patients having dry, large and subtotal perforations of the tympanic membrane were subjected to myringoplasty, 30 by the overlay technique and 30 by the underlay technique keeping all other influencing factors constant. The graft take-up rate was found to be the same (93.3 per cent) in both techniques but the underlay technique was judged to be better because of its technical ease, better assessment of ossicular chain integrity and mobility, less time consumption (55 minutes vs 90 minutes), earlier healing of graft (four to six weeks vs six to eight weeks), hearing gain in more patients (92.8 per cent vs 57.1 per cent) and fewer minor complications (6.6 per cent vs 33.3 per cent).
Myringoplasty
Underlay
Tympanic Membrane Perforation
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Myringoplasty
Endoscope
Perforation
Tympanic Membrane Perforation
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Background: Myringoplasty is a surgical technique used to restore the integrity of tympanic membrane and to improve hearing level.Objective: To compare the three surgical modalities for Myringoplasty -Overlay, Underlay and Interlay in cases of Chronic Suppurative Otitis Media with Inactive Mucosal Disease in large central perforation. Material and Methods:This is a prospective study of 18 months (January 2013 to June 2014) duration conducted in department of E.N.T, Era's Lucknow Medical College, Lucknow and data was collected from the 90 patients admitted for Myringoplasty.30 in each group.Results were calculated in terms of graft accepted or rejected and decrease in air bone gap.Result: Maximum number of graft rejection were observed in Overlay 5/30 and minimum in Interlay 2/30.Post operatively after 16 weeks mean air bone gap was maximum reduced in Interlay and minimum in Overlay Myringoplasty. Conclusion:The present study showed that Interlay technique had a better graft take and hearing improvement in large central perforation of Chronic Suppurative Otitis Media.
Underlay
Myringoplasty
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Myringoplasty
Underlay
Perforation
Statistical Analysis
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Citations (3)