Can myringoplasty close the air-bone gap?

Abstract

Objective: The aim of this study is to evaluate whether closure of a tympanic membrane perforation with an intact ossicular chain results in a closure of the air-bone gap.

Study design: Prospectively collected data from 154 patients undergoing temporalis fascia myringoplasty for chronic otitis media simplex were identified.

Setting: Tertiary referral center.

Patients: Between 2001 and 2009, overall, 106 patients with a central tympanic membrane perforation and, an intact ossicular chain were further analyzed.

Interventions: All patients underwent myringoplasty using temporalis fascia in an underlay technique.

Main outcome measures: Comparison of the preoperative and postoperative hearing results in patients undergoing myringoplasty for chronic otitis media simplex.

Results: The mean postoperative air-bone gap (ABG) was 8.2 dB for the frequencies 0.5 to 4 kHz. Eighty-three patients (78%) showed postoperatively a mean ABG of 10 dB or lower. The ABG difference (improvement) was statistically significant for each single frequency (0.5, 1, 2, 3, and 4 kHz) (p < 0.0001). There is a linear correlation between the preoperative tympanic membrane perforation size and the postoperative ABG (p = 0.0017) for the frequencies 0.5 to 4 kHz. No statistical significant correlation was seen between the state of the middle-ear mucosa, temporal bone pneumatization, tympanometric middle-ear/mastoid volume, and the postoperative ABG.

Conclusion: Complete ABG closure by myringoplasty could be achieved in only approximately 20% of the cases. 80% respectively presented with a mean residual ABG of 8 dB. We found a significant linear correlation between the preoperative size of the tympanic membrane perforation and the postoperative ABG, whereas mastoid volume, temporal bone pneumatization, and the condition of the mucosa did not affect the outcome.