Myringoplasty: underlay versus overlay techniques- a comparative study


  • Mahesh S. G. Department of ENT, A.J Institute of Medical Sciences, Mangalore, Karnataka, India
  • Vishwas K. Pai Department of ENT, A.J Institute of Medical Sciences, Mangalore, Karnataka, India
  • Pallavi Pavithran Department of ENT, Indiana Hospital, Mangalore, Karnataka, India
  • Nithin P. S. Department of ENT, A.J Institute of Medical Sciences, Mangalore, Karnataka, India



Myringoplasty, Overlay, Underlay


Background: Chronic suppurative otitis media is an inflammation of the mucoperiosteal lining of the middle ear cleft. 10% of Indian population suffers from hearing impairment.

Methods: The study comprises of 60 patients admitted in the department of ENT and head and neck surgery, AJIMS, Mangalore between June 2015 and May 2017. All patients suffered from CSOM, tubotympanic type. Selection criteria was patients with CSOM, TTD type with no or minimal SNHL, AB gap more than 20dB, absence of ossicular defects, no history of previous ear surgery and was operated on worse hearing ear. Exclusion criteria were atticoantral disease, ossicular defects, previous ear surgery, otomycosis and systemic diseases.  

Results: The majority of the patients were between the age group of 20-40 years. Out of the 60 patients, 28 were male and 32 female. 8 patients with moderate size and 20 with large perforations underwent underlay myringoplasty. For onlay corresponding numbers were 17 and 13. 26 patients (86.7%) who underwent underlay and 27 patients (90%) who underwent overlay had good hearing improvement. 43.3% of the group had significant hearing improvement at 6 months follow up. 20 patients had pneumatised and 40 patients had sclerotic mastoids in the study. Graft take up was 90% for underlay and 96.6% for overlay. The hearing loss was more with larger perforations.18 patients with large perforations who underwent underlay had good hearing improvement versus 13 for overlay whereas for moderate perforations, only 8 patients had good hearing improvement for underlay versus 15 for overlay.

Conclusions: The hearing improvement obtained with underlay and overlay myringoplasty are comparable. The cellularity of mastoid has no influence on the hearing improvement. The size of the perforation correlates well with the degree of hearing loss. Underlay myringoplasty seems to give better results for large perforations, overlay for moderate sized ones.



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Original Research Articles