"Mucosal pocket" myringoplasty: a modification of underlay technique for anterior or subtotal perforations.
OBJECTIVE
Chronic otitis media surgery is the most common procedure in otology in developing countries. Subtotal and total tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rate of graft failure. It was the goal of this study to test the anatomical and functional outcomes of a modified underlay myringoplasty technique.


METHODS
In a prospective clinical study, 45 patients with subtotal or total TM perforation and inadequate anterior remnant underwent tympanoplasty (+/-mastoidectomy). The anterior tip of the temporalis fascia was secured in a mucosal pocket on the lateral wall of eustachian tube orifice. Data on graft take rate, preoperative and postoperative hearing status, and intraoperative findings were analyzed.


RESULTS
We achieved the graft success rate of 91.1%, without lateralization, blunting, atelectasia, or epithelial pearls. Approximately 24% patients had air-bone gap within 25 dB before intervention, which increased to 71% postoperatively (P < .001).


CONCLUSIONS
We believe that this technique could be a convenient and suitable method for cases with subtotal or total TM perforation and inadequate anterior remnant.
Otolaryngology Head and Neck Surgery, Shiraz University of Medical Sciences, Iran.
Abolhassan
A
Faramarzi
Seyed Basir
SB
Hashemi
Ahmadreza
A
Rajaee
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005064:Eustachian Tube / Q000601:surgery; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009225:Myringoplasty / Q000379:methods*; D011446:Prospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D018058:Tympanic Membrane Perforation / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult