Short-term evaluation of over-under myringoplasty technique

  • Ozgur Yigit
  • Seyhan Alkan
  • Ebru Topuz
  • Berna Uslu
  • Ozlem Unsal
  • Burhan Dadas


Over-under tympanoplasty is a technique aimed at eliminating the disadvantages of the two classical techniques of overlay and underlay myringoplasty, which are employed in repairing the tympanic membrane. In this retrospective study, a total of 104 patients underwent myringoplasty, which was performed by means of the underlay technique in 46 patients and over-under technique in 58 patients. The mean follow-up period was 11 months. In the first group of patients, the underlay technique was performed; the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the second group, the over-under technique was performed; the grafted membrane was placed under the remaining drum and over the malleus. The rate of success in the first group of 46 patients was 91.5%, and that of atelectasis was 19.5%. The rate of success in the second group of 58 patients was 94.9% and 12%, respectively. Lateralization of the graft was not observed in either of the groups. In the patients operated on by means of the underlay technique, the air-bone gap decreased by 16.55 dB this rate was 16.96 dB in those operated on by the over-under technique. The authors consider over-under tympanoplasty to be superior to the other two classical methods not only because of its effectiveness, but also because of the results achieved by this technique.


Tympanoplasty Myringoplasty Tympanic membrane 


  1. 1.
    Doyle PJ, Schleuning AJ, Echevarria J (1972) Tympanoplasty: should grafts be placed medial or lateral to the tympanic membrane. Laryngoscope 82:1425–1430PubMedGoogle Scholar
  2. 2.
    Glasscock ME III (1973) Tympanic membrane grafting with fascia: overlay vs. undersurface technique. Laryngoscope 83:754–770PubMedGoogle Scholar
  3. 3.
    Gibb AG, Chang SK (1982) Myringoplasty (a review of 365 operations). J Laryngol Otol 96:915–930PubMedGoogle Scholar
  4. 4.
    Gupta SC (2000) Myringoplasty with a single flap. Ear Nose Throat J 79:946–948PubMedGoogle Scholar
  5. 5.
    House WF (1960) Myringoplasty. Arch Otolaryngol 71:399–404PubMedGoogle Scholar
  6. 6.
    Karlan MS (1979) Gelatin film sandwich in tympanoplasty. Otolaryngol Head Neck Surg 87:84–86PubMedGoogle Scholar
  7. 7.
    Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ (2002) Over-under tympanoplasty. Laryngoscope 112:802–807CrossRefPubMedGoogle Scholar
  8. 8.
    Packer P, Mackendrick A, Solar M (1982) What’s best in myringoplasty: underlay or overlay, dura or fascia? J Laryngol Otol 96:25–41PubMedGoogle Scholar
  9. 9.
    Rizer FM (1997) Overlay versus underlay tympanoplasty. Part I: historical review of the literature. Laryngoscope 107:1–25CrossRefGoogle Scholar
  10. 10.
    Rizer FM (1997) Overlay versus underlay tympanoplasty. Part II: the study. Laryngoscope 107:26–36CrossRefPubMedGoogle Scholar
  11. 11.
    Schwaber MK (1986) Postauricular undersurface tympanic membrane grafting: some modifications of the “swinging door” technique. Otolaryngol Head Neck Surg 95:182–187PubMedGoogle Scholar
  12. 12.
    Shea JJ (1960) Vein graft closure of eardrum perforations. J Laryngol Otol 74:358–362PubMedGoogle Scholar
  13. 13.
    Sheehy JL, Anderson RG (1980) Myringoplasty. A review of 472 cases. Ann Otol Rhinol Laryngol 89:331–334PubMedGoogle Scholar
  14. 14.
    Singh M, Rai A, Bandyopadhyay S, Gupta SC (2003) Comparative study of the underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane. J Laryngol Otol 117:444–448CrossRefPubMedGoogle Scholar
  15. 15.
    Stage J, Bak-Pedersen K (1992) Underlay tympanoplasty with the graft lateral to the malleus handle. Clin Otolaryngol 17:6–9Google Scholar
  16. 16.
    Vartiainen E, Nuutinen J (1993) Success and pitfalls in myringoplasty: follow-up study of 404 cases. Am J Otol 14:301–305CrossRefPubMedGoogle Scholar
  17. 17.
    Wehrs RE (1999) Grafting techniques. Otolaryngol Clin N Am 32:443–455Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Ozgur Yigit
    • 1
    • 2
  • Seyhan Alkan
    • 1
  • Ebru Topuz
    • 1
  • Berna Uslu
    • 1
  • Ozlem Unsal
    • 1
  • Burhan Dadas
    • 1
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgerySisli Etfal Teaching and Research HospitalIstanbulTurkey
  2. 2.IstanbulTurkey

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