Myringoplasty: A Comparative Study of Different Graft Materials and Various Surgical Techniques

Background: Myringoplasty is a surgical procedure to repair a perforation in the tympanic membrane. Various surgical techniques and graft materials are in practice. Current study aims at determining the efficacy of different surgical techniques and surgical approaches and the effect of size of perforation and graft materials on take rate at our institution. Objective: To determine the comparative outcome of myringoplasty by overlay and underlay techniques, and to determine the take rate of graft for perforations of different size, graft materials and surgical techniques. Design: Comparative study. Place And Duration of Study: Department of ENT, Pakistan Institute of Medical Sciences Islamabad from January 2006 to June 2008. Materials And Methods: 215 ears with tympanic membrane perforation were surgically managed in 195 patients and were followed for minimum of two months. 20 patients underwent myringoplasty in both ears. An intact graft at the end of two months was considered a success. Patients with purulent discharge, marginal perforation, suspected ossicular disease and suspected cholesteatoma were excluded from the study. Tragal perichondrium was used as graft material in 158, temporalis fascia in 49 and fat from ear lobule in 08 cases. Transmeatal approach without flap elevation was employed in 158 cases, transmeatal approach with flap elevation in 12 cases and postaural approach in 45 cases. Overlay technique was used in 145 ears and underlay in 70 ears. Results: There were 104 female patients and 91 males. Perforation was of small size in 16 ears, medium size in 165 and subtotal in 34 ears. Take rate was 100% in small sized perforations while it was 85% and 71% in medium and large sized perforations respectively. Take rate for tragal perichondrium was 85%, temporalis fascia 75% and fat from ear lobule was 100%. No significant difference was found for take rate between overlay and underlay techniques and for surgical approaches. Overall success rate was 84%. Graft failed in 35 (16%) ears. Conclusion: Small and medium size perforation carry a better take rate. Tragal perichondrium is superior to temporalis fascia. Surgical approach and position of the graft do not significantly influence the outcome. Overall success rate in our study was 84%