title: Myringoplasty in simple chronic otitis media:  critical analysis of long-term results in a 1,000-adult patient series.
abstract: OBJECTIVE
  Investigate the recurrence of chronic otitis media after primary and revision myringoplasty, compare long-term anatomic and audiologic results of underlay and overlay myringoplasty, and examine the prognostic factors.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Approximately 1,040 adult patients with chronic simple otitis media undergoing a myringoplasty (overlay and underlay) by different surgeons at a single institution (ENT Department of Bergamo Ospedali Riuniti) between May 1999 and March 2009.
  
  
  METHODS
  The cumulative recurrence rate of chronic otitis media during 10-year follow-up period was calculated using a Kaplan-Meier survival analysis. A multivariate analysis was used to evaluate different prognostic factors based on long-term outcome in myringoplasty.
  
  
  RESULTS
  The overall 10-year graft success rate was 78% in 1,040 patients. The 10-year recurrence rate of chronic otitis media was 15% in overlay myringoplasty and 26% using the underlay technique (p < 0.05). In revision myringoplasty, the overlay technique showed a better success rate than underlay (p < 0.05). Significant recovery was observed in the air conduction thresholds and air-bone gaps in both groups with no statistical difference between techniques (p = 0.1). Multivariate analysis demonstrated that the underlay myringoplasty technique, a pathologic contralateral ear and an anterior or subtotal perforation, using a perichondrial graft or age of surgery younger than 40 years were statistically significant (p < 0.01) factors that negatively influenced the myringoplasty outcomes.
  
  
  CONCLUSIONS
  More successful outcomes in primary and revision surgery for chronic otitis media occurred using overlay myringoplasty, although there were more minor postoperative complications. Both clinical and technical variables affected the success rate of myringoplasty.
authors.affiliation: ENT Department and Microsurgery of Skull Base, Ospedali Riuniti, Bergamo, Italy. mnardone@ospedaliriuniti.bergamo.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Nardone
authors.forename: Ryan
authors.initials: R
authors.lastname: Sommerville
authors.forename: James
authors.initials: J
authors.lastname: Bowman
authors.forename: Giovanni
authors.initials: G
authors.lastname: Danesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D004429:Ear Ossicles / Q000473:pathology; D004432:Ear, Middle / Q000473:pathology; D004848:Epithelium / Q000473:pathology; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009225:Myringoplasty / Q000379:methods*; D010033:Otitis Media / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology; D018058:Tympanic Membrane Perforation / Q000150:complications / Q000601:surgery; D055815:Young Adult