Endoscopic Cartilage Myringoplasty with Inside Out Elevation of a Tympanomeatal Flap for Repairing Anterior Tympanic Membrane Perforations

Abstract

<jats:sec><jats:title>Objective:</jats:title><jats:p> We evaluated the graft take rate and hearing gain of endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap for repairing an anterior tympanic membrane perforation. </jats:p></jats:sec><jats:sec><jats:title>Study design:</jats:title><jats:p> A retrospective case series </jats:p></jats:sec><jats:sec><jats:title>Setting:</jats:title><jats:p> Tertiary university hospital </jats:p></jats:sec><jats:sec><jats:title>Materials and Methods:</jats:title><jats:p> The study population consisted of patients with an anterior perforation undergoing endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap. The primary outcome was the graft take rate at 6 months. The secondary outcomes were the air–bone gap (ABG) gain at 3 months and complications. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 51 patients with a unilateral anterior marginal perforation were included in this study. The mean operation time was 62.2 ± 8.3 minutes. The graft success rate was 92.2% (47/51) at 6 months. The mean preoperative ABG was 28.07 ± 5.13 dB, while the mean postoperative ABG was 12.24 ± 4.89 dB ( P &lt; .05). No patients reported sensorineural hearing loss, altered taste, facial nerve palsy, vertigo, or tinnitus. Two patients with a middle perforation developed postoperative purulent otorrhea that resulted in residual perforations. The cartilage graft was extruded into the anterior annulus in two patients with large perforations that resulted in graft lateralization in one patient and residual perforation in the other. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap is a useful procedure with a low reperforation rate for repairing anterior perforation. </jats:p></jats:sec>

Inside-out raising mucosal-tympanomeatal flap approach for the repair of large marginal perforations

“…The technique of elevating the medial ear canal skin anteriorly has been used to repair anterior perforations [ 5 – 7 ]. Bluher et al [ 5 ] described the “back-elevation” of the ‘‘window shade’’ technique for repairing anterior marginal perforations.…”

“…Their aim was to improve postoperative vascular supply to the anterior graft and reduce the amount of exposed bone compared to the traditional skin-graft-based lateral tympanoplasty technique. In a previous study, we used the inside-out elevation of a mucosal-tympanomeatal flap to repair anterior perforations, achieving a success rate of 92.2% at 6 months postoperatively [ 7 ].…”

“…In addition, the process of raising the mucosal-tympanomeatal flap can lead to complications, such as damage to the chorda tympani, EAC stenosis, iatrogenic cholesteatoma, delayed healing, and prolonged operation times [ 3 , 4 ]. Few studies have been conducted on raising a mucosal-tympanomeatal flap for repairing anterior marginal perforations [ 5 – 7 ]. To date, there has been minimal discussion regarding the technique of raising a mucosal-tympanomeatal flap without the need for additional EAC incisions when treating large marginal perforations.…”

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

“…10,29,34,44 Authors utilized a number of different graft techniques to repair anterior perforations, including overlay or lateral graft, 65,66 inlay graft, 33,67 circumferential subannular, 40 interlay, 68 window shade, 69 and medial or underlay graft (including over-underlay and inferior flap). 10,15,26,32,[34][35][36][37][38]44,65,66,[70][71][72][73][74][75][76][77][78] Although generally outcomes did not appear to differ, statistical analysis was not possible due to potential confounding variables such as differing graft materials. Six studies actually compared the use of different techniques.…”