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. 2024 Feb;76(1):971-978.
doi: 10.1007/s12070-023-04338-4. Epub 2023 Nov 10.

A Comparative Study of Button Hole Technique Versus Underlay Technique in Type 1 Tympanoplasty

M D Prakash  1 , Lyra Joy  2 , G Chethan Kumar  2
Affiliations

A Comparative Study of Button Hole Technique Versus Underlay Technique in Type 1 Tympanoplasty

M D Prakash et al. Indian J Otolaryngol Head Neck Surg. 2024 Feb.

Abstract

Background: Tympanoplasty is the most common operation performed by an Otolaryngologist worldwide.Type 1 tympanoplasty involves repair of pars tensa of tympanic membrane, when the middle ear is normal. The most widely used method is underlay technique using temporalis facia. In buttonhole tympanoplasty, the temporalis fascia is anchored to the handle of malleus through the buttonhole.

Objective: To compare and analyze graft uptake and hearing outcome in button hole technique and underlay technique.

Material and method: It is a comparative study done at tertiary care center, where patients suffering from tubotympanic type of chronic otitis media with medium sized perforation with moderate conductive hearing loss, within age group of 18-60 years,were selected.

Results: In Button hole tympanoplasty group the mean hearing gain was 9.3dB, and 8.17 dB in Underlay tympanoplasty group which was statistically significant (p < 0.05) but P value between Button hole and Underlay tympanoplasty was not statistically significant.With regard to graft uptake 96.7% showed graft uptake in Buttonhole tympanoplasty group and in underlay tympanoplasty the graft uptake was 93.3%.

Interpretation and conclusion: Buttonhole technique is better in terms of graft uptake since the graft is anchored to the handle of malleus, and postoperatively medialisation of graft and other complications like lateralization of graft, epithelial pearl formation and anterior blunting is prevented. Both techniques are good in terms of hearing improvement for chronic otitis media with medium sized perforation with moderateconductive hearing loss.

Keywords: Button hole Technique; Chronic Otitis Media; Tympanoplasty; Underlay Technique.

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Conflict of interest statement

Conflict of interestNone declared.

Figures

Fig. 1
Fig. 1
Preoperative otoendoscopy
Fig. 2
Fig. 2
Endoscopic picture of 3rd month otoendoscopy
Fig. 3
Fig. 3
Making mark on the graft at the level of superior half of malleus handle
Fig. 4
Fig. 4
Temporalis fascia with button hole
Fig. 5
Fig. 5
Tip of malleus passed through the buttonhole
Fig. 6
Fig. 6
Closure of perforation after graft
Fig. 7
Fig. 7
Graft repositioned to cover the annulus
Chart 1
Chart 1
Age distribution in two groups of patients studied
Chart 2
Chart 2
Gender distribution in two groups of patients studied
Chart 3
Chart 3
Tympanic membrane perforation distribution in two groups of patients studied
Chart 4
Chart 4
Post op PTA distribution in two groups of patient’s studied
Chart 5
Chart 5
Graft uptake in two groups of patients studied
See this image and copyright information in PMC

References

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    1. Browning GG. Chronic otitis media. Browning GG. In: Merchant SN, Kelly G, Swan IR, Canter R, McKerrow WS, editors. Scott-brown’s otorhinolaryngology, head and neck Surgery. 7. Great Britain: edward arnold publishers ltd; 2008. pp. 3396–3439.
    1. Aristides AS (2010) Tympanoplasty: tympanic membrane repair. In: Aina JG, Lloyd B, Dennis SP (eds) Glasscock-Shambaugh Surgery of the ear, 6th edn. USA: People’s Medical Publishing House, pp 465–488
    1. Shankar G. A Narendranath A Buttonhole Tympanoplasty j Otolaryn. 2014;3(5):81–83.
    1. .Wallstein H (1952) Fusktionelle Operationen in Mittelohr Mit Hilfe Des Freien Spalt lappen transplantes. Arch Ohren Naseen-u-Kehlkoph, pp 161–242

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