Postauricular undersurface tympanic membrane grafting: some modifications of the "swinging door" technique

Following Palva's original description of the technique, the "swinging door" tympanoplasty was modified and reported by several otologic surgeons, including Glasscock, Fisch, Smyth, and Pennington. The basic technique involves the elevation of superiorly based and inferiorly based canal skin flaps, or "swinging doors." After dividing the posterior anulus, the flaps are rotated anteriorly, a maneuver that provides ample exposure of the middle ear and greatly simplifies underlay fascia grafting. The purpose of this article is to review this basic technique and to describe additional modifications that further simplify tympanoplasty grafting. These modifications include canal flap advancement, the use of multiple fascia grafts, techniques for securing the graft to the malleus handle, and the use of tragal cartilage in grafting. With this technique, a 95% take rate was observed at 3 months, and the graft was firmly attached to the malleus handle in all cases.