Over-Under Myringoplasty

The over-under myringoplasty is a technique which com-bines the advantages of both the over and underlay variants and at the same time avoids their complications. By placing the graft deep to the drum remnants, complications of the overlay myringoplasty such as blunting, lateralization and pearl formation are avoided and by passing superficial to the handle of the malleus the main disadvantage of the underlay namely atelectasis is minimized. The present study evaluates this technique and at the same time compares it with the underlay counter part. Fifty two patients undergoing the over-under procedure and 20 the underlay variant showed a high take rate but the former behaved better regarding fewer incidences of atelectasis (4.9 to 20%) and superior postoperative hearing improvement as evidenced by the reduction in the air bone gap by 9.7 and 4.9 dB respectively.