Over-under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

A hybrid variation of a tympanoplasty technique, termed over-under tympanoplasty (OUT), was evaluated to demonstrate the long-term outcomes and complications compared to medial tympanoplasty.

Retrospective review.

Patients who underwent a tympanoplasty between 2010 and 2015 were included. Primary outcome measures included graft healing at 18 months, change in air-bone gap (ABG), and change in high-frequency hearing at 8 kHz. The Shapiro-Wilk test, Student t test, and nonparametric Mann-Whitney test were used to compare results. Univariate logistic regression analysis was used to identify potential predictors of surgical success.

One hundred eleven patients were included; 84 underwent the over-under technique and 27 underwent medial tympanoplasty. At the 18-month follow-up, 100% of patients in the medial tympanoplasty group had closure of the TM perforation compared to 84% (71/84) in the over-under group. In the over-under group, 12% of patients developed small or pinpoint perforations, and 4% developed larger, recurrent perforations. Mean improvement in ABG was similar between the two groups (11.6 dB for the medial group vs. 11.9 dB for the over-under group, P < .001). No hearing loss was noted in either group. No lateralization of the graft or anterior blunting was noted.

In this series, the OUT technique had a high success rate with TM perforations, including anterior, near total, and total perforations. Hearing loss from dissection on the malleus was not found. This approach blends the advantages and minimizes the disadvantages of the classic techniques and is well suited for all types of tympanic membrane perforations.

3b Laryngoscope, 129:1206-1210, 2019.