European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 10, pp 2791–2795 | Cite as

Endoscopic butterfly inlay myringoplasty for large perforations

  • Emine DemirEmail author
  • Zerrin Ozergin Coskun
  • Metin Celiker
  • Suat Terzi
  • Ozlem Celebi Erdivanli
  • Gokce Aydin Balaban
  • Engin Dursun



Nowadays, the use of otoendoscopy is becoming increasingly popular in ear surgery. Data on endoscopic tympanoplasty are quite current but not yet sufficient. This study aims to present the anatomical and functional results of endoscopic butterfly inlay myringoplasty in large perforations.


The graft success rates and audiological outcomes of 26 ears of 23 patients who underwent endoscopic cartilage inlay myringoplasty due to large perforation (more than two-thirds of the area of tympanic membrane) from March 2016 to August 2018 were evaluated.


The mean follow-up period was 13.3 ± 7.1 (6–32) months. Graft success rate was 96% (25/26 ears). The preoperative mean air–bone gap (ABG) was 21.4 dB and postoperative mean was 14.4 dB. Significant improvement was observed in postoperative air–bone gap values compared to preoperative period (p 0.005).


Endoscopic inlay butterfly myringoplasty is a safe surgical technique and has satisfactory anatomic and audiological outcomes in large tympanic perforations.


Butterfly Inlay myringoplasty Endoscopic myringoplasty Perforation 



The authors thank Prof. ME. Durakoğlugil for his contribution.



Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.


  1. 1.
    Ayache S (2013) Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol 270:853–860CrossRefGoogle Scholar
  2. 2.
    Eavey RD (1998) Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 108:657–661CrossRefGoogle Scholar
  3. 3.
    Alain H, Esmat NH, Ohad H, Yona V, Nageris BI (2016) Butterfly myringoplasty for total, subtotal, and annular perforations. Laryngoscope 126:2565–2568CrossRefGoogle Scholar
  4. 4.
    Akyigit A, Karlidag T, Keles E et al (2017) Endoscopic cartilage butterfly myringoplasty in children. Auris Nasus Larynx 44:152–155CrossRefGoogle Scholar
  5. 5.
    Özgür A, Dursun E, Terzi S et al (2016) Endoscopic butterfly cartilage myringoplasty. Acta Otolaryngol 136:144–148CrossRefGoogle Scholar
  6. 6.
    Hod R, Buda I, Hazan A, Nageris BI (2013) Inlay "butterfly" cartilage tympanoplasty. Am J Otolaryngol 34:41–43CrossRefGoogle Scholar
  7. 7.
    Karabulut B, Mutlu F, Sahin S, Cirik AA (2018) Anatomical and functional long-term results of endoscopic butterfly inlay myringoplasty. Eur Arch Otorhinolaryngol 275:2653–2658CrossRefGoogle Scholar
  8. 8.
    Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD (2006) Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope 116:1813–1816CrossRefGoogle Scholar
  9. 9.
    American Academy of Otolaryngology Head and Neck Surgery Foundation, Inc (1995) Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 113:186–187CrossRefGoogle Scholar
  10. 10.
    Eren SB, Tugrul S, Ozucer B, Veyseller B, Aksoy F, Ozturan O (2015) Endoscopic transcanal inlay myringoplasty: alternative approach for anterior perforations. Otolaryngol Head Neck Surg 153:891–893CrossRefGoogle Scholar
  11. 11.
    Shrestha BL (2013) How I do it? Endoscopic modified inlay butterfly cartilage perichondrium myringoplasty. Kathmandu Univ Med J 11:185–187CrossRefGoogle Scholar
  12. 12.
    Omran AA (2012) Endoscopic bivalve inlay cartilage myringoplasty for central perforations: preliminary report. Egypt J Ear Nose Throat Allied Sci 13:37–42CrossRefGoogle Scholar
  13. 13.
    Yu MS, Yoon TH (2010) Bilateral same-day surgery for bilateral perforated chronic otitis media: inlay butterfly cartilage myringoplasty. Otolaryngol Head Neck Surg 143:669–672CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Faculty of MedicineRecep Tayyip Erdogan UniversityRizeTurkey

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