Overlay and underlay tympanoplasty revisited: a review

Authors

  • Manish Munjal Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Shubham Munjal Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Vineeta Arora Guru Teg Bahadur Hospital Ludhiana, Punjab, India
  • Swati Chauhan Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Garima Bansal Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Rubaldeep Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Manik Kaushal Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Sakshi Jariwal Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Prachee Budhiraja Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Mehmeet Sawhney Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Ananya Sood Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India
  • Muskan Ahluwalia Department of Ear, Nose, Throat-Head and Neck Surgery, Dayanand Medical College, Ludhiana, Punjab, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20252269

Keywords:

Myringoplasty, Overlay, Underlay, Medialization, Lateralization

Abstract

Myringoplasty conventionally is the reconstitution of the perforated tympanic membrane with placement of the graft either on the external or internal side of the residual eardrum The first recorded attempt to close tympanic membrane perforation was by Banzer in 1640; with a pig’s bladder membrane stretched over an ivory tube. Paper patching, perforation margin cauterization, the overlay or underlay, skin, fascia, perichondrium, cartilage or dural grafting were the developments in the repair of the ear drum. The temporalis fascia is superior to other grafts as it has a better uptake because of a low basal metabolic rate and, minimal shrinkage due to its low elasticity. Lateralization or medialization are the likely issues respectively of either technique. The technique and its development historically have been elaborated upon

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References

Hajar R. The air of history early medicine to Galen (Part I). Heart views. 2012;13(3):120-8. DOI: https://doi.org/10.4103/1995-705X.102164

Hippocrates (460-377 B.C.): The tympanic membrane hearing cited by Storrs L. Laryngoscope. 1996;76:185-95.

Imperatori CJ. Gabriello fallopius. Laryngoscope. 1948;58(5):431-47. DOI: https://doi.org/10.1288/00005537-194805000-00006

Adelmann HB. The “De Ovorum Gallinaceorum Generationis Primo Exordio” of Volcher Coiter (Part I). Ann Med History. 1933;5(4):327.

Najeeb T, Bangash WU, Siddiqui N. Temporal fascia versus tragal perichondrial graft in myringoplasty and tympanoplasty. Int J Otorhinolaryngol. 2019;5(1):15-9. DOI: https://doi.org/10.11648/j.ijo.20190501.14

Yearsley J. Deafness practically illustrated. John Churchill Publisher. The British Library. 1863.

Mudry A. History of tympanoplasty. Otol Neurotol. 2005;26(3):554-5.

Golz A, Goldenberg D, Netzer A, Fradis M, Westerman ST, Westerman LM, et al. Paper patching for chronic tympanic membrane perforations. Otolaryngol Head Neck Surg. 2003;128(4):565-70. DOI: https://doi.org/10.1016/S0194-59980300124-4

Rossa DB. Diseases of the ear. 3rd edition, William Wood and Co., New York. 1876;334-40.

Goldman NC. Chemical closure of chronic tympanic membrane perforations. ANZ J Surg. 2007;77(10):850-1. DOI: https://doi.org/10.1111/j.1445-2197.2007.04256.x

Jino ME, Kumar C, Kingsly DG. A study on chemical cauterization for small tympanic membrane perforation. Int J Surg. 2021;5(1):343-6. DOI: https://doi.org/10.33545/surgery.2021.v5.i1f.634

Pohlman ME. IX The Artificial Ear Drum. Annal Otol Rhinol Laryngol. 1951;60(1):117-21. DOI: https://doi.org/10.1177/000348945106000109

Hough JV. Tympanoplasty with the interior fascial graft technique and ossicular reconstruction. Laryngoscope. 1970;80(9):1385-413. DOI: https://doi.org/10.1288/00005537-197009000-00006

Glasscock III ME, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: A follow‐up report. Laryngoscope. 1982;92(7):718-27. DOI: https://doi.org/10.1288/00005537-198207000-00002

Arshad M, Shahnaz A, Bashir M, Zaman A. Comparison of graft uptake in patients undergoing myringoplasty/tympanoplasty by overlay and underlay procedure. Professional Med J. 2019;26(11):1861-5. DOI: https://doi.org/10.29309/TPMJ/2019.26.11.2913

Bluestone CD, Cantekin EI, Douglas GS. Eustachian tube function related to the results of tympanoplasty in children. Laryngoscope. 1979;89(3):450-8. DOI: https://doi.org/10.1288/00005537-197903000-00013

Sheehy JL, Anderson RG. Myringoplasty: a review of 472 cases. Ann Otol Rhinol Laryngol. 1980;89(4):331-4. DOI: https://doi.org/10.1177/000348948008900407

Ophir D, Porat M, Marshak G. Myringoplasty in the pediatric population. Arch Otolaryngol Head Neck Surg. 1987;113(12):1288-90. DOI: https://doi.org/10.1001/archotol.1987.01860120034003

Smyth GD. Surgical treatment of cholesteatoma: the role of staging in closed operations. Ann Otol Rhinol Laryngol. 1988;97(6):667-9. DOI: https://doi.org/10.1177/000348948809700616

Koch WM, Friedman EM, McGill TJ, Healy GB. Tympanoplasty in children: the Boston Children's Hospital experience. Arch Otolaryngol Head Neck Surg. 1990;116(1):35-40. DOI: https://doi.org/10.1001/archotol.1990.01870010039013

Komune S, Wakizono S, Hisashi K, Uemura T. Interlay method for myringoplasty. Auris Nasus Larynx. 1992;19(1):17-22. DOI: https://doi.org/10.1016/S0385-8146(12)80197-0

Stage J, Bak‐Pedersen Kr. Underlay tympanoplasty with the graft lateral to the malleus handle. Clin Otolaryngol Allied Sci. 1992;17(1):6-9. DOI: https://doi.org/10.1111/j.1365-2273.1992.tb00978.x

Aoyagi M, Yokota M, Nakamura T, Tojima H, Kanayama R, Fuse T, Koike Y. Effects of aging on hearing results in tympanoplasty. Acta Oto-Laryngologica. 1994;114(511):81-6. DOI: https://doi.org/10.3109/00016489409128306

Scally CM, Allen L, Kerr AG. The anterior hitch method of tympanic membrane repair. Ear Nose Throat J. 1996;75(4):244-7. DOI: https://doi.org/10.1177/014556139607500412

Strauss P, Kress M, Hinz R, Wöhl K. Medial or lateral placement of the graft in myringoplasty comparative studies of both operation techniques using electronic data processing. Laryngol Rhinol Otol. 1975;54(3):183-90.

Sheehy JL, Glasscock ME. Tympanic membrane grafting with temporalis fascia. Arch Otolaryngol. 1967;86(4):391-402. DOI: https://doi.org/10.1001/archotol.1967.00760050393008

García RB, Suárez-Varela MM, Conejeros JM, Porras GA, Puchades VM, Galofre JD. Myringoplasties. A retrospective analysis of our surgical outcomes. Acta Otorrinolaringol. 2011;62(3):213-9. DOI: https://doi.org/10.1016/j.otoeng.2010.12.003

Sakai N, Kokubun T, Asai T, Kurihara H, Nishizawa N, Matsushima JI, et al. Simple in-office closure of small intractable tympanic membrane perforations after myringoplasty. Auris Nasus Larynx. 1997;24(1):43-6. DOI: https://doi.org/10.1016/S0385-8146(96)00010-7

Gibb AG, Chang SK. Myringoplasty: A review of 365 operations. J Laryngol Otol. 1982;96(10):915-30. DOI: https://doi.org/10.1017/S0022215100093270

Vartiainen E, Kärjä J, Karjalainen S, Härmä R. Failures in myringoplasty. Arch Oto-rhino-laryngol. 1985;242:27-33. DOI: https://doi.org/10.1007/BF00464402

Livi W, Piane R. Comparison of 2 materials in the reconstruction of the tympanic membrane. Our experience in 300 patients. Revue de Laryngol Otol Rhinol. 1992;113(2):137-9.

Gimenez F, Marco-Algarra J, Carbonell R, Morant A, Cano S. Prognostic factors in tympanoplasty: a statistical evaluation. Revue de Laryngol Otol Rhinol. 1993;114(5):335-7.

Gersdorff M, Garin P, Decat M, Juantegui M. Myringoplasty: long-term results in adults and children. Otol Neurotol. 1995;16(4):532-5.

Podoshin L, Fradis M, Malatskey S, Ben-David J. Tympanoplasty in adults: a five-year survey. Ear Nose Throat J. 1996;75(3):149-56. DOI: https://doi.org/10.1177/014556139607500310

Berger G, Ophir D, Berco E, Sadé J. Revision myringoplasty. J Laryngol Otol. 1997;111(6):517-20. DOI: https://doi.org/10.1017/S0022215100137818

England RJ, Strachan DR, Buckley JG. Temporalis fascia grafts shrink. J Laryngol Otol. 1997;111(8):707-8. DOI: https://doi.org/10.1017/S0022215100138423

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Published

2025-07-25

How to Cite

Munjal, M., Munjal, S., Arora, V., Chauhan, S., Bansal, G., Rubaldeep, Kaushal, M., Jariwal, S., Budhiraja, P., Sawhney, M., Sood, A., & Ahluwalia, M. (2025). Overlay and underlay tympanoplasty revisited: a review. International Journal of Otorhinolaryngology and Head and Neck Surgery, 11(4), 487–490. https://doi.org/10.18203/issn.2454-5929.ijohns20252269

Issue

Vol. 11 No. 4 (2025): July-August 2025

Section

Review Articles
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