title: Inferior flap tympanoplasty: a novel technique for anterior perforation closure.
abstract: OBJECTIVE
  To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure.
  
  
  METHODS
  A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support.
  
  
  RESULTS
  A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB), compared to 26.5 dB (10 to 55 dB) postoperatively. All perforations were found to be closed but one (92.3% success rate).
  
  
  CONCLUSIONS
  The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel. haim.ga@012.net.il
authors.forename: Haim
authors.initials: H
authors.lastname: Gavriel
authors.forename: Ephraim
authors.initials: E
authors.lastname: Eviatar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000175:diagnosis* / Q000601:surgery*; D014433:Tympanoplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D058106:Wound Closure Techniques / Q000295:instrumentation*; D055815:Young Adult