Skip to main content
SpringerLink
Log in

Comparison of long-term outcome of two endoscopic transtympanic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

We compare the long-term efficacy of the cartilage–perichondrium modified over-underlay technique and transtympanic underlay alone technique using endoscopic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations.

Material and methods

Nine chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage–perichondrium modified over-underlay myringoplasty (MOUM, n = 55) and endoscopic cartilage–perichondrium transtympanic underlay alone myringoplasty (TUAM, n = 54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months.

Results

In total, 99 patients were finally analysed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0% vs 96.0%, p = 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%, p = 0.028). In addition, postoperative ABG < 10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group, the difference wasn’t significant (p = 0.953). CT examination revealed well-pneumatised middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed.

Conclusion

Endoscopic modified cartilage–perichondrium over-underlay myringoplasty without tympanomeatal flap elevating is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic cartilage–perichondrium transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Barake R, El Natout T, Bassim M, El Natout MA (2019) Loop underlay tympanoplasty for anterior, subtotal and total tympanic membrane perforations: a retrospective review. J Otolaryngol Head Neck Surg 48:12

    Article  Google Scholar 

  2. Plodpai Y (2018) Endoscopic vs microscopic overlay tympanoplasty for correcting large tympanic membrane perforations: a randomized clinical trial. Otolaryngol Head Neck Surg 159:879–886

    Article  Google Scholar 

  3. Babu S, Luryi AL, Schutt CA (2019) Over-under versus medial tympanoplasty: comparison of benefit, success, and hearing results. Laryngoscope 129:1206–1210

    Article  Google Scholar 

  4. Eren SB, Tugrul S, Ozucer B, Dogan R, Ozturan O (2014) A randomized prospective trial of a novel device for measuring perforation size during inlay ‘butterfly’ myringoplasty. Am J Otolaryngol 35:305–308

    Article  Google Scholar 

  5. Lubianca-Neto JF (2000) Inlay butterfly cartilage tympanoplasty (Eavey technique) modified for adults. Otolaryngol Head Neck Surg 123:492–494

    Article  CAS  Google Scholar 

  6. Alain H, Esmat NH, Ohad H, Yona V, Nageris BI (2016) Butterfly myringoplasty for total, subtotal, and annular perforations. Laryngoscope 126:2565–2568

    Article  Google Scholar 

  7. Celik H, Samim E, Oztuna D (2015) Endoscopic, “push-through” technique cartilage myringoplasty in anterior tympanic membrane perforations. Clin Exp Otorhinolaryngol 8:224–229

    Article  Google Scholar 

  8. Lou ZC (2020) Endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal to repair marginal perforations. J Otolaryngol Head Neck Surg 49:13

    Article  Google Scholar 

  9. Gülşen S, Erden B (2020) Comparison of endoscopic butterfly-inlay versus endoscopic push-through myringoplasty in repairing anterior perforations of the tympanic membrane. J Laryngol Otol 22:1–7. https://doi.org/10.1017/S0022215120000006

    Article  Google Scholar 

  10. El-Hennawi DEM, Ahmed MR, Abou-Halawa AS et al (2018) Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations. J Laryngol Otol 132:509–513

    Article  CAS  Google Scholar 

  11. Lou Z (2020) Endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap for repairing anterior tympanic membrane perforations. Ann Otol Rhinol Laryngol 129:795–800

    Article  Google Scholar 

  12. Atchariyasathian V, Suwannajak R, Plodpai Y, Pitathawatchai P (2020) A comparison of endoscopic transtympanic myringoplasty and endoscopic type I tympanoplasty for repairing medium- to large-sized tympanic membrane perforation: a randomized clinical trial. Eur Arch Otorhinolaryngol 277:2199–2207

    Article  Google Scholar 

  13. Lou Z (2020) Endoscopic transtympanic myringoplasty should be cautious for repairing large perforation. Eur Arch Otorhinolaryngol 277:3533–3534

    Article  Google Scholar 

  14. Bedri EH, Korra B, Redleaf M, Worku A (2019) Double-layer tympanic membrane graft in type I tympanoplasty. Ann Otol Rhinol Laryngol 128:795–801

    Article  Google Scholar 

  15. Simsek E, Ozkan O, Kucur C, Carlıoglu A (2016) Evaluation of the anatomical and auditory outcomes of minimally invasive cartilage myringoplasty: our technique and experience. Am J Otolaryngol 37:517–522

    Article  Google Scholar 

  16. Park MK, Kim KH, Lee JD, Lee BD (2011) Repair of large traumatic tympanic membrane perforation with a Steri-Strips patch. Otolaryngol Head Neck Surg 145:581–585

    Article  Google Scholar 

  17. Lou ZC, He JG (2011) A randomised controlled trial comparing spontaneous healing, gelfoam patching and edge-approximation plus gelfoam patching in traumatic tympanic membrane perforation with inverted or everted edges. Clin Otolaryngol 36:221–226

    Article  Google Scholar 

  18. Ahmed S, Raza N, Ullah S, Shabbir A (2013) Chondroperichondrial clip myringoplasty: a new technique for closure of tympanic membrane perforations. J Laryngol Otol 127:562–567

    Article  CAS  Google Scholar 

  19. Eavey RD (1998) Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 108:657–661

    Article  CAS  Google Scholar 

  20. Özdemir D, Özgür A, Mehel DM, Bedir A, Çelebi M, Aydemir S, Turgut NF (2020) Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly. Acta Otolaryngol 140:277–280

    Article  Google Scholar 

Download references

Funding

This study was supported by Health Commission of Zhejiang province, China (Grants#2021KY1186) and the Science and Technology Agency of Yiwu city, China (Grants#2018-3-76).

Author information

Author notes

  1. Zhengcai Lou and Zihan Lou contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Yiwu Central Hospital, 699, Jiangdong road, Yiwu, 322000, Zhejiang, China

    Zhengcai Lou, Kangfeng Jin & Junzhi Sun

  2. Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, China

    Zihan Lou & Zhengnong Chen

  3. Otolaryngology Institute of Shanghai Jiao Tong University, 600, Yishan Road, Shanghai, 200233, China

    Zhengnong Chen

Authors
  1. Zhengcai Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zihan Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kangfeng Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junzhi Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhengnong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ZL designed the study and performed the surgical operations. Data collection were accomplished by KJ and JS. Data analysis and interpretation of data were performed by ZL. The first draft of the manuscript was written by ZL, and ZC. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhengcai Lou or Zhengnong Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the local Ethics Committee of YiWu central hospital review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all of the participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lou, Z., Lou, Z., Jin, K. et al. Comparison of long-term outcome of two endoscopic transtympanic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations. Eur Arch Otorhinolaryngol 279, 2293–2301 (2022). https://doi.org/10.1007/s00405-021-06913-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-06913-3

Keywords

Search

Navigation