Endoscopic cartilage underlay myringoplasty with or without balloon Eustachian tuboplasty for chronic perforation with Eustachian tube dysfunction
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Myringoplasty
Eustachian tube
Balloon dilatation
Underlay
Perforation
Objective: In this study, the two methods of myringoplasty (underlay and over-underlay technique) were compared. Methods: Total 100 patients of COM (inactive mucosal variety) were studied for 06 months duration from 1st Oct 2015 to 31st March 2016 in the Dept of ENT & Head Neck Surgery, CMH Dhaka. The diagnosed cases of COM patients were selected according to the eligibility criteria’s by purposive sampling. 100 patients were equally divided into two groups. Patients in group1 underwent underlay method and patients in group 2 underwent over-underlay technique of myringoplasty. Patients were followed up for 6 months. Results: Graft uptake and hearing improvement was compared in both groups. In group 1 (underlay myringoplasty) graft taken rate was 92% and graft failure rate was 8%. In group 2 (Over-underlay myringoplasty) graft taken rate was 94% and failure rate was 6%. Graft uptake was 2% lower in the group1 than group 2 .The gain in hearing threshold (gain in A-B gap) in the group 1 (underlay myringoplasty) was (23.74 dB ± 3.97) and in group 2 )over-underlay myringoplasty) was (23.64 dB ± 4.03) Conclusion: The present study emphasizes the fact that there is no significant difference in short term results between the two techniques (underlay and over-underlay). Bangladesh J Otorhinolaryngol; October 2017; 23(2): 133-139
Myringoplasty
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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.
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To evaluate the effect of over-under myringoplasty technique on repairing tympanic membrane perforation regarding with the rate of perforation closure, the frequency of postoperative complications occurrence and the level of hearing improvement.In this retrospective study, a total of 74 patients (77 ears) underwent myringoplasty and had been followed up for over 6 months, which was performed by means of the underlay technique in 44 patients (45 ears) and over-under technique in 30 patients (32 ears) from Jan 2002 to Jan 2007. In the underlay group, the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the over-under group, the grafted membrane was placed under the remaining drum and over the malleus. Comparatively evaluate the effect of the underlay technique and that of the over-underlay technique on repairing tympanic membrane perforation.The rate of perforation closure and hearing improvement in the underlay group of 45 ears was 89.0% and 57.5% respectively, while that in the over-under group of 32 ears were 87.5% and 71.9% respectively. The air-bone gap decreased by 4.9 dB in the underlay group, while it decreased by 9.7 dB in over-under group. After more than 6 months of following-up, the frequency of postoperative atelectasis of the underlay group and the over-under group was 17.8% and 6.25% respectively. Meanwhile, the frequency of postoperative reperforation of these two groups was 5.9% and 6.25% respectively. Blunting of the anterior angle of the tympanic membrane occurred in 3 ears in the over-under group. Lateralization of the graft was not observed in either group.Over-under technique could reduce the occurrence of the adhesions between the grafted membrane and promontorium tympani by placing the grafted membrane between the remaining drum and the malleus. Furthermore, the level of hearing improvement in over-under group was higher than that in underlay group. Over-under myringoplasty is a more effective technique as comparison to underlay myringoplasty for repairing middle to large tympanic membrane perforations.
Myringoplasty
Underlay
Tympanic Membrane Perforation
Perforation
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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.
Myringoplasty
Underlay
Perforation
Tympanic Membrane Perforation
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Myringoplasty
Eustachian tube
Balloon dilatation
Underlay
Perforation
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SummAry in this series of patients, the underlay or overlay positioning of a graft achieves successful outcome for both repair of perforation and hear ing function, with better hearing gain in the underlay group. in myringoplasty, the two most common techniques for positioning the graft relative to the remnant of both the tympanic membrane and the annulus are the “overlay” and the “underlay” techniques. 115 patients who underwent myringoplasty for tympanic membrane perforation secondary to chronic otitis media and/or trauma were included, and hearing function was evaluated. We prefer an overlay technique in subtotal perforations, in those involving the anterior and antero-inferior parts of the ear drum with respect to the handle of the malleus and in revision surgery. We reserve an underlay technique for smaller perforations and for those limited to the posterior part of the tympanic membrane. of 115 cases, 63 underwent an overlay myringoplasty and 52 underlay myringoplasty. in the former group, five cases were anatomically unsuccessful, whereas in the second group there were three failures. The air bone gap improved significantly in both groups with a better hearing gain in the underlay group.
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Myringoplasty
Tympanic Membrane Perforation
Perforation
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A sterile, fenestrated, circular disc of silicone for use on the outer surface of the graft during myringoplasty-tympanoplasty is described. It allows effective firm packing in the canal without distortion, displacement or lateralization of the graft.
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Myringoplasty
Inlay
Perforation
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There is still a controversial vision about the appropriate time to carry out myringotomy or tympanoplasty-1 on chronic otitis media. Some experts agree that the most appropriate time is two or three months after dry tympanic cavity (Classical method). Other experts state that it is not necessary to wait too long, even though there is still mucoid discharge, surgery can be directly caned out (Early method). The myringoplasty and tyrnpanoplasty-I was carried out on 72 cases of active chronic otitis media, of which 43 cases using Classical method and the rest of 29 cases using Early method. The criteria of successful myringoplasty and tympanoplasty-1 surgery was a positive graft take and followed by improvement of hearing. The successful result of myringoplasty and tympanoplasty-I with Classical method was 93.02 % and with Early method was 89.65%. The statistical analysis showed that there is no significant difference in the succesful of the myringoplasty and tymphanoplasty-I surgery, between the Classical and Early method. Key Words: myringoplasty tympanoplasty-I chronic suppurative otitis media classical method early method.
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About 80% of tympanic membrane tears consequential of middle ear infections or trauma restore spontaneously. Myringoplasty is the procedure to fix the perforation which fails to heal. It is of two types; overlay and underlay techniques. In former technique graft is placed lateral to the fibrous sheet of the tympanic membrane while in underlay technique the graft is placed medial to the tympanic membrane remnant. The published success rates of underlay and overlay myringoplasty varied. This study was conducted to evaluate the effectiveness of graft uptake by underlay and overlay technique in patients undergoing myringoplasty.This randomized control trial including 80 patients was carried out at Otorhinolaryngology department of Combined Military Hospital, Rawalpindi from April 2016 to September 2017. Patients going through myringoplasty for tympanic perforations were randomly allocated into two groups. Group-A underwent underlay while Group-B underwent overlay myringoplasty.The age of the patients ranged from 20 to 40 years with a mean of 29.58±5.92 years with a male to female ratio of 1.2:1. Hearing improvement was significantly higher (97.5% vs. 77.5%) in patients undergoing underlay versus overlay myringoplasty. The frequency of effectiveness in terms of graft uptake was significantly higher in patients undergoing underlay (95.0% vs. 57.5%) as compared to overlay myringoplasty.The underlay procedure is more effective in terms of graft uptake and lesser complications as compared to overlay myringoplasty.
Myringoplasty
Underlay
Tympanic Membrane Perforation
Perforation
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