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. 2025 Aug;282(8):4041-4048.
doi: 10.1007/s00405-025-09337-5. Epub 2025 Mar 28.

Preliminary results of a new endoscopic underlay cartilage tympanoplasty with lateral malleolar flap

Pinar Atabey  1 , Burcu Vural Camalan  2 , Hasan Demirel  3 , Mehmet Beyhan Balur  4 , Sumeyra Doluoglu  5
Affiliations

Preliminary results of a new endoscopic underlay cartilage tympanoplasty with lateral malleolar flap

Pinar Atabey et al. Eur Arch Otorhinolaryngol. 2025 Aug.

Abstract

Background: A new endoscopic tympanoplasty technique for large and medium-sized central perforations via a transcanal approach, without tympanomeatal flap elevation compared the preliminary postoperative graft success and hearing outcomes with other techniques in the literature.

Methods: The study involved 75 patients aged 12 to 44 who underwent tympanoplasty with the lateral malleolar flap technique from 2014 to 2017. Pre-operative otoscopy recorded perforation sizes, and pure tone averages were calculated at 500, 1000, 2000, and 4000 Hz. The procedure was performed under general anesthesia via a transcanal approach using tragal cartilage, without tympanomeatal flap elevation. A control otoscopy was conducted six months post-operation to assess reperforation and graft position. Pure tone averages were measured, and pre-operative and post-operative audiological values were compared.

Results: Post-operative six-month graft success rate was 94.6%. Reperforation was observed in one patient (1.3%), while another patient (1.3%) exhibited lateralization, and two patients (2.6%) demonstrated medialization. The pre-operative mean hearing level was recorded at 33.3 ± 7.0 dB, accompanied by an Air-Bone Gap (ABG) of 24.0 ± 6.6 dB. Post-operative measurements indicated an improvement in these values, with the mean hearing level decreasing to 18.0 ± 4.8 dB and the ABG reducing to 16.3 ± 5.3 dB (p < 0.05).

Conclusion: The endoscopic underlay cartilage tympanoplasty with lateral malleolar flap is a safe technique that avoids elevating the tympanomeatal flap. It offers shorter operation time, easier postoperative dressing, and high graft success rates similar to other tympanoplasty techniques.

Keywords: Cartilage tympanoplasty; Chronic otitis media; Endoscopic tympanoplasty; Lateral malleolar flap.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The report was approved by the Local Ethics Committee (Date: 23.03.2021 approval no: 269) and complied with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Conflict of interest: The authors declare that they have no confict of interest.

Figures

Fig. 1
Fig. 1
(a) De-epithelization and diagrammatic representation of perforation edges. (b) Island flap and diagrammatic representation. (c) The elevation and schematic representation of the membrane remnant on the lateral of the malleus. (d) Placement and diagrammatic representation of the island graft
Fig. 2
Fig. 2
(a) Laying and diagrammatic representation of lateral malleus flap. (b) Postoperative 7th day. The arrow shows lateral malleus flap and vascularity. (c) Postoperative 15th day. (d) Postoperative second month
See this image and copyright information in PMC

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