title: Over-under tympanoplasty.
abstract: OBJECTIVE
  Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures.
  
  
  METHODS
  This study was a retrospective case review.
  
  
  METHODS
  Tertiary referral center with hospital-setting surgery and outpatient ambulatory patient visits.
  
  
  METHODS
  One hundred twenty patients who underwent over-under tympanoplasty were included in this study. Average follow-up was 1.8 years.
  
  
  METHODS
  Over-under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included.
  
  
  METHODS
  Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy.
  
  
  RESULTS
  All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB.
  
  
  CONCLUSIONS
  Over-under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.
authors.affiliation: Michigan Ear Institute, Farmington Hills 48334, USA.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Kartush
authors.forename: Elias M
authors.initials: EM
authors.lastname: Michaelides
authors.forename: Zoran
authors.initials: Z
authors.lastname: Becvarovski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaRouere
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D002908:Chronic Disease; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006314:Hearing Loss, Conductive / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D010033:Otitis Media / Q000601:surgery*; D012086:Reoperation; D018058:Tympanic Membrane Perforation / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*