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Push-Through Myringoplasty Versus External Auditory Canal Flap Tympanoplasty for Chronic Marginal Perforations
Junzhi Sun1, Zihan Lou2,3,4,5, Zhengcai Lou1
1Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, Zhejiang, China.
Objective:
We compared the operation times, graft success rates, and hearing gains between push-through (PT) myringoplasty and external auditory canal (EAC) flap tympanoplasty in patients with chronic marginal perforations.
Materials And Methods:
A total of 77 patients with chronic marginal perforations were randomly allocated to endoscopic perichondrium-cartilage myringoplasty with raising of the EAC flaps (n = 39) and PT technique (n = 38) groups. The graft outcomes, mean operation times, and postoperative complications were compared 6 months after operation.
Results:
The graft success rate was 97.4% (38/39) in the EAC group and 81.6% (31/38) in the PT group; the difference was significant (P = .056). The mean operation time was 40.7 ± 10.4 min in the EAC group and 42.4 ± 8.3 min in the PT group (P = .741). In the EAC group, the mean pre- and postoperative air-bone gap (ABG)s were 29.3 (range: 28.4 ± 8.6) and 12.1 (range: 11.8 ± 2.4) dB (P < .01), respectively; the respective values were 29.5 (range: 29.1 ± 5.4) and 12.6 (range: 12.0 ± 1.3) dB (P < .01) in the PT group. No significant group difference was observed in the pre- (P = .794) or postoperative (P = .689) ABG values or mean ABG gain (16.7 ± 5.3 vs 17.1 ± 7.7 dB; P = .526). In addition, graft medialization occurred in 7.9% patients in the PT group. However, graft lateralization, significant blunting, deteriorative sensorineural hearing loss, vertigo, or tinnitus were not encountered in either group. No taste change was reported and no inclusion cholesteatoma was seen in the EAC group.
Conclusion:
Endoscopic perichondrium-cartilage myringoplasty with raising of an EAC flap is useful and minimally invasive to repair chronic marginal perforations; the technique is simple, has a high graft success rate in comparison to the PT technique.
Insights
External auditory canal (EAC) flap tympanoplasty shows a higher graft success rate for chronic marginal perforations compared to the push-through (PT) technique. Both methods offer significant hearing improvement with comparable operation times and minimal complications.
Area of Science:
- Otolaryngology
- Surgical Techniques
- Tympanoplasty
Background:
- Chronic marginal perforations can impair hearing and quality of life.
- Traditional tympanoplasty techniques have varying success rates.
Purpose of the Study:
- To compare the efficacy of endoscopic external auditory canal (EAC) flap tympanoplasty versus push-through (PT) myringoplasty for chronic marginal perforations.
- To evaluate graft success rates, operation times, and hearing outcomes.
Main Methods:
- A randomized controlled trial involving 77 patients with chronic marginal perforations.
- Patients were allocated to either EAC flap tympanoplasty (n=39) or PT myringoplasty (n=38).
- Outcomes including graft success, operation time, and air-bone gap (ABG) were assessed at 6 months.
Main Results:
- The EAC flap technique demonstrated a significantly higher graft success rate (97.4%) compared to the PT technique (81.6%).
- Both techniques yielded comparable mean operation times and significant improvements in postoperative ABG.
- No significant differences were observed in hearing gain between the groups, and serious complications were rare.
Conclusions:
- Endoscopic EAC flap tympanoplasty is a minimally invasive and effective technique for chronic marginal perforations.
- The EAC flap method offers a superior graft success rate compared to the PT technique.
- Both surgical approaches provide comparable hearing restoration and safety profiles.
