The role of anterior tucking of graft in subtotal perforation of tympanic membrane


  • Mylanahalli Doddarangaiah Prakash Department of Otorhinolaryngology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Somashekhar Abhilasha Department of Otorhinolaryngology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India



Anterior tucking, Tympanoplasty, Subtotal perforation


Background: Tympnaoplasty has been well accepted as the surgery of choice for chronic otitis media. Since the introduction of tympanoplasty, there has been many modifications in terms of technique, approach, and materials used for grafting the tympanic membrane; each with their respective advantages and disadvantages. But irrespective of procedure done, very large and subtotal perforations have always posed a problem with failure after surgery. This demands further modification of the procedure to support the graft. This study was done to know the role of Anterior tucking of graft in subtotal perforation of tympanic membrane in terms of graft uptake rate and hearing outcome.

Methods: A systemic retrospective analysis of case files was done. The case files of patient who fulfilled the inclusion criteria were selected. Detailed preoperative and postoperative clinical and audiometric findings were noted down.  

Results: Total of 40 cases with 3 cases being bilateral, 43 ears were operated by cortical mastoidectomy with tympanoplasty along with anterior tucking of the graft. Our success rate was 95.3% (n=40). 40 patients had showed the improvement in hearing with average air bone gap gain of 12.7 dB HL.

Conclusions: Underlay grafting for subtotal perforations of tympanic membrane is a surgically challenging and results in poor outcome. Modification to this method by anterior tucking of the graft is an effective surgical technique with satisfactory outcomes and hence is advocated for the routine practice.


Singh BJ, Sengupta A, Sudipkumar Das, Ghosh D, Basak B. A comparative study of different graft materials used in myringoplasty. Indian J Otolaryngol Head Neck Surg. 2009;61:131-4.

Vadiya SI, Shah SK, Chaudhary M. Comparison of canal wall incisions for tympanoplasty for large central perforations. Indian J Otol. 2015;21:186-9.

Jackson CG, Kaylie DM, Glasscock ME, III, Strasnick B. Chapter 12- Tympanoplasty—Undersurface Graft Technique: Postauricular Approach. In: Derald EB, Clough S, Arriaga MA, editors. Otologic Surgery (Third Edition). Philadelphia: W.B. Saunders; 2010: 149–160.

Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ. Overunder tympanoplasty. Laryngoscope. 2002;112:802–7.

Singh M, Rai A, Bandyopadhyay S, Gupta SC. Comparative study of the underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane. J Laryngol Otol. 2003;117:444–8.

Faramarzi A, Hashemi SB, Rajaee A. “Mucosal pocket” myringoplasty: a modification of underlay technique for anterior or subtotal perforations. Am J Otolaryngol. 2012;33(6):708-13.

Gerlinger I, Rath G, Szanyi I, Pytel J. Myringoplasty for anterior and subtotal perforations using KTP-532 laser. Eur Arch Otorhinolaryngol. 2006;263:816–9.

Lee HY, Auo HJ, Kang JM. Loop overlay tympanoplasty for anterior or subtotal perforations. Auris Nasus Larynx. 2010;37:162-6.

Gersdorff M, Gerard J, Thill M. Overlay versus underlay tympanoplasty: comparative study of 122 cases. Rev Laryngol Otol Rhinol. 2003;24:15-22.

Pradeep P, Abhimanyu A, Priti L. Circumferential Elevation of Tympanomeatal Flap: A Novel Technique for subtotal and Anterior Perforation Closure. Ann Otolaryngol Rhinol. 2015;2(7):1052.

Schraff S, Dash N, Strasnick B. “Window shade” tympanoplasty for anterior marginal perforations. Laryngoscope. 2005;115:1655-9.

Hosamani P, Ananth L, Medikeri SB. Comparative study of efficacy of graft placement with and without anterior tagging in type one tympanoplasty for mucosal-type chronic otitis media. J Laryngol Otol. 2012;126(2):125-30.






Original Research Articles