"Mucosal pocket" myringoplasty: a modification of underlay technique for anterior or subtotal perforations

Chronic otitis media surgery is the most common procedure in otology in developing countries. Subtotal and total tympanic membrane (TM) perforation with inadequate anterior remnant is associated with higher rate of graft failure. It was the goal of this study to test the anatomical and functional outcomes of a modified underlay myringoplasty technique.

In a prospective clinical study, 45 patients with subtotal or total TM perforation and inadequate anterior remnant underwent tympanoplasty (+/-mastoidectomy). The anterior tip of the temporalis fascia was secured in a mucosal pocket on the lateral wall of eustachian tube orifice. Data on graft take rate, preoperative and postoperative hearing status, and intraoperative findings were analyzed.

We achieved the graft success rate of 91.1%, without lateralization, blunting, atelectasia, or epithelial pearls. Approximately 24% patients had air-bone gap within 25 dB before intervention, which increased to 71% postoperatively (P < .001).

We believe that this technique could be a convenient and suitable method for cases with subtotal or total TM perforation and inadequate anterior remnant.