Myringoplasty: A comparison of inlay and underlay techniques

Abstract

Purpose: Myringoplasty aims to improve hearing and prevent otorrhea, making graft uptake rates and hearing crucial considerations. This study analyzed the factors associated with unsuccessful graft uptake and hearing improvement to guide the selection of optimal surgical approaches for myringoplasty.

Methods: We retrospectively reviewed 56 ears with chronic otitis media. All patients were followed up for >6 months after tympanic membrane closure surgery. We compared the underlay method using the transcanal approach with the inlay method using the retroauricular approach for myringoplasty in patients with chronic otitis media. The underlay and inlay methods were used for 23 and 33 ears, respectively. The primary outcomes were graft uptake rate and hearing improvement. Additionally, factors such as the location of tympanic membrane perforation, patient age, and the degree of mastoid development were evaluated.

Results: The perforation rate was high when the transcanal underlay method was employed to repair perforations in the anterior inferior quadrant. Both the underlay and inlay methods significantly improved hearing. However, the success rate of the inlay method was lower. Within the cases performed using the inlay method, outcomes tended to be poorer in older age groups. There were no significant differences in surgical success rates related to mastoid development.

Conclusion: The inlay method using the retroauricular approach is a favorable option for repairing perforations involving the anterior inferior quadrant. However, older patients presented lower rates of hearing improvement when the inlay method was used.

Keywords: Chronic otitis media; Inlay method; Myringoplasty; Underlay method.

Fig. 1

A: The transcanal underlay method with the temporalis fascia. B: The inlay method via the retroauricular approach.

Fig. 2

Reperforations occurred in 26% of patients treated with the underlay method and in 0% of patients treated with the inlay method using the retroauricular approach.

Fig. 3

Reperforation site observed with the underlay method. Among the cases, 66.7% of reperforations occurred in the anterior lower quadrant, 16.7% occurred in the anterior lower and posterior lower quadrants, and 16.7% occurred in the posterior lower and posterior superior quadrants.

Fig. 4

Hearing improved in 100% of cases using the transcanal underlay method and in 81.8% of cases using the inlay method with the retroauricular approach.

Fig. 5

Approximately 73.3% of the patients with MC0, 100% with MC2, 81.8% with MC2a, and 100% with MC3a had successful hearing improvement using the inlay method.