Comparative study of the underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane

2003 ◽  
Vol 117 (6) ◽  
pp. 444-448 ◽  
Author(s):  
Mangal Singh ◽  
Ashutosh Rai ◽  
Sarmishtha Bandyopadhyay ◽  
S. C. Gupta
Keyword(s):  
Comparative Study ◽  
Prospective Study ◽  
Tympanic Membrane ◽  
Influencing Factors ◽  
Ossicular Chain ◽  
Time Consumption ◽  
Hearing Gain ◽  
Established Procedure ◽  
Graft Take ◽  
Overlay Technique

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).

Cartilage rim augmented fascia tympanoplasty: a more effective composite graft model than temporalis fascia tympanoplasty

2018 ◽  
Vol 132 (06) ◽  
pp. 497-504 ◽  
Author(s):  
A A Kolethekkat ◽  
R Al Abri ◽  
K Al Zaabi ◽  
N Al Marhoobi ◽  
S Jose ◽  
...  
Keyword(s):  
Comparative Study ◽  
Ossicular Chain ◽  
Composite Graft ◽  
Temporalis Fascia ◽  
Definite Advantage ◽  
Hearing Gain ◽  
Graft Healing ◽  
Graft Take ◽  
Significant Difference ◽  
Retrospective Comparative Study

AbstractObjectiveTo validate a newly introduced cartilage rim augmented temporalis fascia tympanoplasty technique by statistically comparing it with the morphological and audiological outcomes of traditional temporalis fascia tympanoplasty.MethodsA retrospective comparative study was conducted on 115 patients who underwent tympanoplasty during 2013 and 2015. Fifty-eight patients underwent temporalis fascia tympanoplasty and 57 underwent cartilage rim augmented fascia tympanoplasty.ResultsIn the cartilage fascia group, graft healing was achieved in 94.7 per cent of cases; in the temporalis fascia group, the graft take-up rate was 70 per cent. In those with a normal ossicular chain, the post-operative air–bone gap was within 20 dB in 92.6 per cent of cartilage fascia group cases and in 69.7 per cent of the temporalis fascia group cases, which was a statistically significant difference. Among the defective ossicular chain cases, the post-operative air–bone gap was within 20 dB in 76.9 per cent in the cartilage fascia group, as against 57.1 per cent in the temporalis fascia group.ConclusionCartilage rim augmented temporalis fascia tympanoplasty has a definite advantage over the temporalis fascia technique in terms of superior graft take up and statistically significant hearing gain in those with normal ossicular mobility.

A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media

2020 ◽  
Vol 134 (9) ◽  
pp. 773-778
Author(s):  
Z Lou ◽  
X Li
Keyword(s):  
Comparative Study ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Chronic Otitis Media ◽  
Success Rates ◽  
Hearing Gain ◽  
Tympanic Membrane Perforations ◽  
The Difference ◽  
Graft Success

AbstractObjectiveThe outcomes of dry and wet ears were compared following endoscopic cartilage myringoplasty performed to treat chronic tympanic membrane perforations in patients with mucosal chronic otitis media.MethodsPatients with chronic perforations, and with mucosal chronic otitis media with or without discharge, were recruited; all underwent endoscopic cartilage myringoplasty. The graft success rate and hearing gain were evaluated at six months post-operatively.ResultsThe graft success rates were 85.9 per cent (67 out of 78) in dry ears and 86.2 per cent (25 out of 29) in wet ears; the difference was not significant (p = 0.583). Among the 29 wet ears, the graft success rates were 100 per cent in 11 ears with mucoid discharge and 77.8 per cent in the 18 patients with mucopurulent otorrhoea.ConclusionThe wet or dry status of ears in patients with chronic perforations with mucosal chronic otitis media did not affect graft success rate or hearing gain after endoscopic cartilage myringoplasty. However, ears with mucopurulent discharge were associated with increased failure rates and graft collapse, whereas ears with mucoid discharge were associated with higher graft success rates.

scholarly journals Air bone closure and graft uptake, vis a vis tympanic reconstitution

2020 ◽  
Vol 6 (11) ◽  
pp. 2094
Author(s):  
Manish Munjal ◽  
Nitin Mathur ◽  
Parth Chopra ◽  
Shubham Munjal ◽  
Hemant Chopra ◽  
...  
Keyword(s):  
Prospective Study ◽  
Tympanic Membrane ◽  
Graft Rejection ◽  
Surgical Outcome ◽  
Study Group ◽  
Hearing Improvement ◽  
Temporalis Muscle ◽  
Suppurative Otitis Media ◽  
Overlay Technique ◽  
The Ideal

<p class="abstract"><strong>Background:</strong> Tympanoplasty involves reconstitution of the tympano-ossicular system with commonly. fascia of the temporalis muscle, situated in its proximity. The fascia is grafted on the residual tympanic membrane by placing it either over it or below it, after creating a raw surface. The former is the overlay and latter, the underlay technique. In this study on restitution of the ear drum utilizing the overlay and underlay techniques, an exhaustive analysis of the two modalities has been done, taking into consideration various variables individually. The surgical outcome wrt to graft uptake and hearing gain has been compared in "depth" with extensive studies undertaken in India and abroad. The unbiased tabulated comparison of each aspect is unique and would guide future researchers to opt the ideal modality.</p><p class="abstract"><strong>Methods:</strong> Tympanoplasty was undertaken in chronic safe suppurative otitis media with the underlay and overlay techniques in a study group of 40 patients in this prospective study. The patients were randomly divided into equal groups for either procedure.  </p><p class="abstract"><strong>Results:</strong> In the cohort of 40 subjects successful graft uptake was observed in 16 (80%) with overlay technique and 17 (85%) with underlay technique. Graft rejection was reported in 4 (20%) and 3 (15%) cases with overlay and underlay techniques respectively. Hearing improvement was 56.25% in 10-20 dB range in Overlay. Whereas, with underlay it was 47.05% in 10-2 dB.</p><p class="abstract"><strong>Conclusions:</strong> Overlay technique is ideal for anterior and central perforations while underlay for subtotal and posterior perforations. In terms of hearing improvement, the fibrosis during graft uptake makes the results of either technique unpredictable.</p>

scholarly journals Comparative study of different approaches of myringoplasty in chronic otitis media

2020 ◽  
Vol 22 (1) ◽  
pp. 21-25
Author(s):  
Km Nurul Alam ◽  
Md Monjurul Alam ◽  
Md Delwar Hossain ◽  
Md Abdul Karim ◽  
Md Abul Hossain ◽  
...  
Keyword(s):  
Comparative Study ◽  
Tympanic Membrane ◽  
Otitis Media ◽  
Surgical Approach ◽  
Chronic Otitis Media ◽  
Medical College Hospital ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Graft Take

Objectives: To determine the best surgical approach of myringoplasty regarding healing of tympanic membrane and improvement of hearing. Methods: This was a cross sectional comparative study carried out in the departments of Otolaryngology and Head-Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, Sir Salimullah Medical college Mitford Hospital and Shaheed Suhrawardy Medical College Hospital during the period of July’2009 to March 2011. A total number of 75 patients of age 15-45years having inactive mucosal chronic otitis media with central perforation were included in this study. All patients has undergone myringoplasty and patients were divided into three groups according to surgical approach such as postaural, transcanal and endaural. All patients were followed up postoperatively and all postoperative findings were recorded. The three groups were compared with regard to healing of tympanic membrane and improvement of hearing. Results: The success rate in this study was 80% . graft take rate in postaural, transcanal and endaural approaches were 92.5%, 66.67% and 63.64% respectively. Improvement of mean airbone gap in postaural, transcanal and endaural approaches were 19.04dB, 10.02dB and 11.36dB Conclusion: Graft take rate and hearing improvement is significantly higher in postaural approach than other approaches. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 21-25

A long term view of myringoplasty in children

1990 ◽  
Vol 104 (10) ◽  
pp. 758-762 ◽  
Author(s):  
J. D. Blanshard ◽  
A. K. Robson ◽  
I. Smith ◽  
A. R. Maw
Keyword(s):  
Success Rate ◽  
Significant Influence ◽  
Hearing Gain ◽  
Graft Take ◽  
Late Failure ◽  
Special Clinic ◽  
Long Term Follow Up

AbstractFifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiologicaloutcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.

scholarly journals Closure of small perforation in tympanic membrane by use of fat plug

2020 ◽  
Vol 6 (9) ◽  
pp. 1647
Author(s):  
Nehal R. Patel ◽  
Vaibhav V. Patel ◽  
Dimpal Padavi ◽  
Mayur Prajapati ◽  
Rachana M. Khokhani ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Ossicular Chain ◽  
Tympanic Membrane Perforation ◽  
Major Surgery ◽  
Graft Material ◽  
Middle Ear Mucosa ◽  
Suppurative Otitis Media ◽  
Membrane Perforation ◽  
Conventional Myringoplasty ◽  
Small Perforation

<p class="abstract"><strong>Background: </strong>Chronic suppurative otitis media presents mostly with ear discharge and associated decreased hearing. Tympanoplasty is the established surgery for tympanic membrane perforation. Most commonly used graft material for tympanoplasty is temporalis fascia. Others are fascia lata, tragal perichondrium, tragal cartilage, fat. The objective of the study was to compare the graft taken up and hearing improvement following myringoplasty with use of fat.</p><p class="abstract"><strong>Methods:</strong> Patients of CSOM aged 10 to 65 years old with small central perforation which is dry for at least 3 weeks with normal middle ear mucosa and intact ossicular chain with mild conductive hearing loss. The present study was carried out in Ear, neck and throat (ENT) Department of SCL hospital, Ahmedabad from July 2016 till September 2018 and 25 patients were randomly selected fulfilling the above criteria.</p><p class="abstract"><strong>Result: </strong>The choice of graft affects not only the outcome of surgery, but also determines the complexity of the procedure and the time taken for the same. Study proves that fat is also a one of the good grafting material which is easily available and keep to prevent from major surgery. The results have been quite encouraging.</p><p class="abstract"><strong>Conclusion: </strong>Study proves that fat is also a one of the good grafting material which is easily available and keep to prevent from major surgery. An added advantage of this technique was the excellent post-operative quality of life of the operated patients, assessed in terms of the chronic ear survey and evident by the absence of the usual post-operative complaints following a conventional myringoplasty.</p>

scholarly journals Improvement of Hearing After Myringoplasty: A Study on 50 Cases at HFRCMCH

2010 ◽  
Vol 15 (Number 2) ◽  
pp. 9-14
Author(s):  
Md. A Sikder ◽  
Md. Daulatuzzaman ◽  
SM K A Mazumder ◽  
N U Khan ◽  
Md. S Alam
Keyword(s):  
Tympanic Membrane ◽  
General Anaesthesia ◽  
Bone Conduction ◽  
Hearing Improvement ◽  
Hearing Gain ◽  
Study Population ◽  
Air Conduction

The aim of this study was to assess hearing improvement after myringoplasty within ten weeks following surgery. The study population consisted of 30 patients who were suffering from CSOM-77". Pre-operative and post-operative eraminations of the patients were conducted clinically as well as audiologically. Pre-and post-operative air-bone (A-B) gap were calculated by raking the averages of bone conduction and air conduction at the frequencies of 300. 1000 and 2000 Hz. Myringoplasty was done with underlay technique under general anaesthesia by postaural approach. Temporal 'muck fascia was used as grafting material for reconstruction of the tympanic membrane. Pre-operatively, air-bone gap of 30 db or more was observed in 39 (78%) patients whereas post-operatively A-B gap of 30 db or mare was observed in only one patient. Using hearings gain exceeding 15 dB as the criterion. 39 (78%) patients had their hearing gain exceeding 15 dB. Using post-operative A-B gap within 20 dB as the criterion. 42 (84%) patients had their A-8 gap within 20 dB. Myringoplasty is a beneficial procedure for hearing improvement. Using the proportion of patients with a post-operative A-B gap of 30 dB as the criterion, in this study. 98% of patients achieved their A-B gap closer within 30 dB. Using hearing gain exceeding 15 dB as the criterion, 78% patient had their hearing gain exceeding 15 dB.

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