DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201687

Comparative study between over underlay with classical underlay techniques of tympanoplasty

Prashanth Kudure Basavaraj, Manjunatha H. Anandappa, Veena Prabhakaran, Nishtha Sharma, Shreyas Karkala

Abstract


Background: The objective of the study was to compare the over underlay tympanoplasty technique with classical underlay tympanoplasty in terms of hearing impairment, graft acceptance and complications.

Methods: 60 patients of chronic otitis media, mucosal, inactive, aged between 16-60 years who presented to ENT OPD with small, medium, large and subtotal perforations having mild to moderate conductive hearing loss were included in the study. After taking informed consent, patients were randomly divided into 2 groups containing 30 patients each. In group A, graft was placed medial to the handle of malleus and medial to the annulus (underlay technique), while in group B, graft was placed lateral to the handle of malleus and medial to the annulus (over underlay technique). Both groups were reviewed after 6 months. Pre-operative and post-operative air bone gap were compared. Surgery was considered successful based on post-operative graft uptake, hearing improvement and maintenance of middle ear space.  

Results: In group A, re-perforation was seen in 8 cases (26.7%) whereas only 3 cases (10%) in group B had re-perforation. Medialization was noted among 4 patients in group A (13.3%), and was absent in group B. Lateralization was absent in both the groups. Post-operative hearing threshold in group A was 6.2±4.56 dB and in group B was 11.45±7.38 dB.

Conclusions: Over underlay tympanoplasty is a safer technique as compared to classical underlay, showing lower rates of re-perforation or medialization and a significant improvement in hearing. Hence over-underlay is an effective method, having higher success rates.


Keywords


Tympanoplasty, Underlay, Over underlay

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References


Sergi B, Galli J, Corso DE, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital. 2011;31(6):366-71.

Kartush JM, Mechaelides EM, Becvarovski Z, Rouere LMJ. Over-under tympanoplasty. Laryngoscope. 2002;112(5):802-7.

Indorewala S, Adedeji TO, Indorewala A, Nemade G. Tympanoplasty outcomes: a review of 789 cases. Iran J Otorhinolaryngol. 2015;27(79):101-8.

Panchal V, Joginder SG, Sharad H, Bhushan K, Kaintura M. To evaluate and compare the results of over-underlay graft technique with conventional underlay myringoplasty. Ind J Otol. 2015;21:274-9.

Prakash MD, Viswanatha B, Kaur J, Sanyal S. Comparative Study of the Underlay and Over-Underlay Techniques of Tympanoplasty in Perforations of the Tympanic Membrane. Res Otolaryngol. 2014;3(5):65-69.

Yigit, Ozgur, Alkan, Seyhan, Topuz, Ebru, et al. Short-term evaluation of over-under myringoplasty technique. European archives of oto-rhino-laryngology. Official J of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngol Head Neck Surg. 2005;262:400-3.

Sarkar S. A review on the history of tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2013;65(3):455-60.

Aslam MA, Aslam MJ. Comparison of over-underlay and underlay techniques of myringoplasty. Pak Armed Forces Med J. 2009;3.