Residual perforations after tympanoplasty: office technique for closure

The author and his associates still strongly recommend an office closure treatment for central tympanic membrane perforations, which has resulted in 1449 healed perforations over a period of 36 years. A particularly gratifying segment of the healed perforation population has been the 247 residual or recurrent perforations following myringoplasty or tympanoplasty surgery that were closed by office treatment. Thus, the patients were spared a second operation. After reviewing his own and his associates' surgical failures, the author found two factors that seem to predispose to surgical failure. Primary failures or recurrent perforations following surgical repair occur most frequently in patients with neglected or inadequately treated upper respiratory tract allergy. There also appears to be a higher incidence of primary failure or recurrent perforations when an operative approach does not provide an excellent view of the anterior annulus during surgery. This would seem to be the case with the routine use of the transcanal or endomeatal approach. Furthermore, the author also objects to the routine use of a combined endomeatal and postauricular approach, which may permit an unobstructed view of the anterior annular region by tilting the patient away from the surgeon during surgery. If there is a prominent anterior bony canal wall bulge, and there is an anterior graft failure or recurrence, reoperation, rather than a few office treatments, is the only recourse. The visualization problems both during and following surgery as described have led the author to continue his use of the endaural approach and meatoplasty learned during years of fenestration surgery and to adhere to the surgical technique described.