Tympanoplasty: Factors Influencing Surgical Outcome

Abstract

We reviewed the records of 183 patients who had undergone myringoplasty during a six year period at the Asir Central Hospital (ACH). This study was limited to cases of repair of uncomplicated perforation of tympanic membrane that did not require ossiculoplasty or mastoidectomy. One hundred and thirty-four (73.2%) were successful myringoplasty and 78 (75.7%) patients had their hearing improved postoperatively. Various factors liable to influence the success rate such as status of middle ear, size and site of perforations, surgical approach and presence of tympanosclerosis were analyzed. Only status of the middle ear and the presence of tympanosclerosis at the time of surgery were found to have a major effect on the final outcome of surgery. Ann Saudi Med 1994;14(6):483-485. SA Al-Ghamdi, Tympanoplasty: Factors Influencing Surgical Outcome. 1994; 14(6): 483-485 The repair of the tympanic membrane dates back more than a century. In 1878, Berthold 1 successfully closed a perforation with a full thickness skin graft and introduced the term "myringoplastik". Reports of similar work by Ely (1881) 2 and Tangemann (1884) 3 soon followed. The introduction of microsurgery and antibiotics in 1950 mark the era of ear surgery. New techniques in ear surgery were introduced at that time by Zollner and Wullstein.4 Although initially skin continued as the material of choice for tympanic membrane repair, it was not long before other tissues were introduced. Amniotic membrane, Schrimpf (1954) Ringenberg (1962) 10 and perichondrium, Goodhill (1963) 11 all proved of value and remained in use until the present time. In 1959, Ortegren 12 used fascia as a graft material and this gained wide and rapid acceptance and remains, over 20 years later, the most popular graft material. 13 The technique of myringoplasty also changes with time. The original "onlay" method is still practiced with progressive swing over the years towards the underlay technique introduced by Austin and Shea (1961). 13 In small size perforation, sandwich and plugging methods are still used. The present study analyzed a number or factors postulated to affect surgical outcome in order to assess their utility in selecting successful surgical candidates. Myringoplasty is a common surgical procedure and analysis of these factors will certainly help in future selection and care of patients. Material and MethodsThe charts of all patients undergoing tympanoplasty in the Otolaryngology Department of Asir Central Hospital (ACH) within the past six years (January 1987 to December 1992) were reviewed. More recent tympanoplasty procedures as well as those lost to follow-up were excluded to allow a minimum follow-up period of six months. There were a total of 361 cases of tympanoplasty but only those patients who underwent tympanoplasty type 1 (myringoplasty) were considered in this review. Cases in which ossiculoplasty or mastoidectomy were performed were excluded from this study. The information sought from the charts includes etiology of perforation, its duration, site (...

Comparing Myringoplasty to Type I Tympanoplasty in Tympanic Membrane Repair: A Systematic Review and Meta‐analysis

“…For example, some studies suggest that increased perforation size leads to poorer graft success results, 7,8 whereas others dispute this claim. [9][10][11] Furthermore, studies that compare the 2 procedure techniques have produced inconclusive results in terms of which procedure provides superior outcomes. [12][13][14][15][16][17][18] Given the gaps in the existing knowledge comparing these 2 procedure types, we sought to synthesize the available data on anatomic and functional outcomes.…”

“…Despite the significant volume of literature that has been published concerning tympanoplasty and myringoplasty, there exists a lack of consensus on some of the factors which influence anatomic and functional outcomes. For example, some studies suggest that increased perforation size leads to poorer graft success results, 7,8 whereas others dispute this claim 9‐11 . Furthermore, studies that compare the 2 procedure techniques have produced inconclusive results in terms of which procedure provides superior outcomes 12‐18 …”

Factors affecting myringoplasty success

“…demonstrated that the perforation site has a significant influence on the graft take rate, although they found that posterior perforations have a lower success rate 13 . In contrast, several studies have found no significant relationship between perforation site and graft take rate in adults 2 , 14 , 15 and in children 16 , 17 …”