Comparison of Long-Term Outcome of Two Endoscopic Transtympanic Myringoplasty for Repairing Large Chronic Perforations

Introduction: We compare the long-term efficacy of the over-underlay technique and transtympanic underlay alone technique using endoscopic cartilage-perichondrium myringoplasty for repairing large chronic perforations.

Methods: In total, 109 chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage-perichondrium modified over-underlay myringoplasty (MOUM, n=55) (Fig.1) and endoscopic cartilage-perichondrium transtympanic underlay alone myringoplasty (TUAM, n=54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months.

Results: In total, 99 patients were finally analyzed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0%vs 96.0%,P = 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%, P= 0.028). Additionally, postoperative ABG <10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group; the difference wasn’t significant (p = 0.953). CT examination revealed well-pneumatized middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed .

Conclusions: Endoscopic modified cartilage-perichondrium over-underlay myringoplasty is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal.