Bilateral myringoplasty in chronic otitis media

A theoretical risk of iatrogenic sensorineural hearing loss (HL) during surgery has induced a reluctance to perform bilateral myringoplasty/tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 26 patients.

Twenty-six patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral myringoplasty/tympanoplasty type I (52 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 13.3 years, and the male to female ratio was 1.36. All but one ear were operated through a transcanal approach, and the onlay technique was used most frequently (83%), with use of fascia (56%), tragal perichondrium (38%), or cartilage palisades (6%) as graft material. Follow-up examination and hearing tests (pure tone and speech audiometry) were performed at a mean of 13.8 months after surgery.

Perforation closure was obtained in 49 (94%) of the 52 ears. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur.

We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.