title: Lateral-to-malleus underlay tympanoplasty: surgical technique and outcomes.
abstract: OBJECTIVE
  The lateral-to-malleus underlay tympanoplasty (LMUT) involves dissection of the tympanic membrane remnant from the malleus with subsequent graft placement medial to the annulus but lateral to the malleus. The objective of the current study is to describe the clinical outcomes using the LMUT technique.
  
  
  METHODS
  One hundred forty-one ears undergoing LMUT. To isolate the effects of tympanoplasty on audiometric outcome, only cases with an intact and mobile ossicular chain were evaluated; ears with ossicular discontinuity, fixation, and/or ossicular chain reconstruction were excluded.
  
  
  METHODS
  Lateral-to-malleus underlay tympanoplasty.
  
  
  METHODS
  1) Change in air-bone gap and bone conduction thresholds; 2) tympanic membrane lateralization; and 3) primary and delayed graft failure.
  
  
  RESULTS
  One hundred forty-one tympanoplasties were analyzed. In the early postoperative period, 140 (99%) of 141 grafts were intact and, at a mean of 32.1 months, 121 (85.8%) remained without significant retraction or reperforation. There were no cases of early or delayed graft lateralization. The mean preoperative and most recent postoperative air-bone gaps were 23.7 dB and 14.1 dB, respectively (p < 0.001). Surgery was not associated with a transient or long-term bone conduction threshold shift.
  
  
  CONCLUSIONS
  The LMUT technique offers improved exposure of the tympanic space and a low rate of graft failure. The risks of sensorineural hearing loss with ossicular chain manipulation and tympanic membrane lateralization from graft placement lateral to the malleus are very low.
authors: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.
authors: Robert J
authors: RJ
authors: Yawn
authors: Matthew L
authors: ML
authors: Carlson
authors: David S
authors: DS
authors: Haynes
authors: Alejandro
authors: A
authors: Rivas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D002908:Chronic Disease; D004210:Dissection; D004429:Ear Ossicles / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008307:Malleus / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000601:surgery*; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D018058:Tympanic Membrane Perforation / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*; D055815:Young Adult