Residual perforations after tympanoplasty: office technique for closure

Area of Science:

• Otolaryngology
• Surgical Innovation
• Medical Treatments

Background:

• Central tympanic membrane perforations are a common otologic condition.
• Surgical repair (myringoplasty/tympanoplasty) can sometimes fail, leading to residual or recurrent perforations.
• Identifying factors contributing to surgical failure is crucial for improving outcomes.

Purpose of the Study:

• To evaluate the efficacy of office closure treatment for central tympanic membrane perforations.
• To identify predisposing factors for surgical failure in tympanic membrane repair.
• To advocate for specific surgical approaches based on visualization and patient factors.

Main Methods:

• Retrospective review of 1449 healed central tympanic membrane perforations treated over 36 years.
• Analysis of 247 cases of residual or recurrent perforations following tympanoplasty that were successfully treated with office closure.
• Review of surgical failures to identify predisposing factors and assess operative approaches.

Main Results:

• Office closure treatment successfully healed 1449 central tympanic membrane perforations over 36 years.
• 247 residual or recurrent perforations post-surgery were successfully managed with office closure, avoiding reoperation.
• Inadequately treated upper respiratory tract allergy and poor visualization of the anterior annulus during surgery were identified as factors predisposing to surgical failure.

Conclusions:

• Office closure remains a highly effective treatment for central tympanic membrane perforations, including post-surgical cases.
• Management of upper respiratory tract allergy and optimizing surgical visualization (e.g., via endaural approach) are key to successful tympanic membrane repair.
• The endaural approach with meatoplasty is favored for ensuring adequate visualization of the anterior annulus, potentially reducing surgical failure rates.