Healing and hearing in uncomplicated myringoplasty

Failures in myringoplasty

We analyzed those failures occurring in 417 myringoplasties. Forty-four drum re-perforations were found (10.6%), half of which occurred immediately after operation. Causes of these early failures included necrosis in the middle of the graft without infection (10 ears) and blunting of the anterior margins of the graft (7 ears). Infection was the most common cause of re-perforations in the later failures. Re-perforations also occurred more frequently when larger perforations were closed in contrast to repair of small ones. We found that other pre-operative factors ("dry" or "wet" ear, site of the perforation) or grafting technique ("underlay" or "overlay") did not affect the graft take-rate. Adhesive eardrums were found in 23 ears (5.5%). These were more common when ears were infected pre-operatively, when middle ear mucosa was removed during the primary operation, or when squamous epithelium was present on the tympanic mucosa. Lateralization of the grafted eardrum was found in two cases (0.5%), both of which had been operated on using the sandwich technique.

Myringoplasty with simple mastoidectomy: results in eighty-two consecutive patients

Eighty-two patients underwent myringoplasty combined with simple mastoidectomy when preoperative indicators suggested an increased risk of failure with myringoplasty alone. Indications for mastoid exploration included (1) chronic aural discharge, (2) suspicion of cholesteatoma, (3) previous failed myringoplasty, and (4) small sclerotic mastoid. Healing of perforations was successful in 71 patients (86.6%), and the air-bone gap was closed to within 20 dB in 85%. No mastoidectomy-related complications occurred, nor was there a tendency to form postoperative cholesteatoma. Simple mastoidectomy is considered to be a safe and effective adjunct to myringoplasty in selected cases of chronic otitis media with perforation.

What's best in myringoplasty: underly or overlay, dura or fascia?

Results of 1065 operations (604 myringoplasties‡ and 461 tympanoplasties §) performed by a single surgeon using either underlay homograft dura, underlay autograft temporalis fascia or overlay autograft temporalis fascia are compared.

Pre-operative and operative conditions are analysed to determine which of these influence results.