Myringoplasty (Repair of Total or Subtotal drum perforations)

Background: 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.Methods: 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. Results: 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.Conclusions: 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.

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“…[7][8][9][10]13 Studies on hearing gain/Ab closure to 10-20 dB with overlay technique (Table 15). 14,[22][23][24] Perkin et al 87% 3.…”

Section: Part Bmentioning

confidence: 99%

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

Munjal

Mathur

Chopra

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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“…A retrospective study was made on 1500 consequative ears operated by the senior author. They constitute cases of total or large subtotal dry perforations operated by the same technique viz endaural onlay myringoplasty (Seifi, 1974) that were followed up for a minimum of three years.…”

Section: B Clinical Studymentioning

confidence: 99%

The fibrous annulus in myringoplasty

El-Seifi

Fouad

1992

J. Laryngol. Otol.

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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.

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