title: Loop overlay tympanoplasty for anterior or subtotal perforations.
abstract: OBJECTIVE
  To report our experience with "loop overlay" tympanoplasty, a modified overlay technique with a superiorly based skin flap, for the reconstruction of anterior, subtotal or total tympanic membrane (TM) perforations.
  
  
  METHODS
  Retrospective review of patients undergoing loop overlay tympanoplasty from March 1998 to February 2007 was performed. Four hundred and twenty-nine patients who underwent loop overlay tympanoplasty and then follow-up visits a minimum of 6 months later were included in this study. Hearing test results were reported using a four-frequency (0.5, 1, 2, and 3kHz) pure tone average air-bone gap. The outcome was considered successful if the TM was intact without lateralization or anterior blunting after the follow-up visit.
  
  
  RESULTS
  There was a 98.8% success rate. There was no graft lateralization, anterior blunting, neocholesteatoma, or sensorineural hearing loss. The mean preoperative to postoperative four-tone air-bone gap improved from 23.5 to 8.1dB, which is a mean gain of 15dB; this was statistically significant (p<0.001, paired sample t-test).
  
  
  CONCLUSIONS
  The loop overlay graft method is a safe and effective technique for reconstruction of anterior, subtotal or total TM perforations, with excellent graft take and significant improvement of hearing. It provides a precise replacement of the flap and a preserved healing plane.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Heung-Yeup
authors.initials: HY
authors.lastname: Lee
authors.forename: Hyeon-Jin
authors.initials: HJ
authors.lastname: Auo
authors.forename: Jun-Myung
authors.initials: JM
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D001844:Bone Conduction; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009225:Myringoplasty / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D018058:Tympanic Membrane Perforation / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult