Muhammad Rafique, Muhammad Shuja Farrukh, Atif Hafeez Siddiqui.
Underlay Versus Onlay Myringoplasty and its Outcome: Experience at Tertiary Care Hospitals.
Pak J Otolaryngol Jan ;30(1):11-4.

OBJECTIVE: To determine the outcome of different types of myringoplasty regarding hearing improvement and closure of perforation. PLACE & DURATION OF STUDY: This study was conducted in the departments of E.N.T – Head & Neck Surgery, Liaquat University Hospital Hyderabad and Dow University of Health Sciences & Civil Hospital Karachi from January 2008 to December 2011. STUDY TYPE: Descriptive study. SUBJECTS & METHOD: Fifty cases of tubo-tympanic type of CSOM with dry central perforation for last 8-12 weeks, having good cochlear reserves and air bone gap not more than 40dB were included in this study. Patients of either sex with age ranged from 12-40 years were included. Detailed history was acquired and thorough clinical examination was performed with main consideration that ear should be dry for around 8-12 weeks with no primary infection and no pathology in nose, nasopharynx and oropharynx. Patients with active ear discharge, mastoiditis or any other impending complication, history of recent infection within last 8 weeks, with sensori-neural deafness or air bone gap more than 40 dB, patients having eustachian tube insufficiency or having gross abnormality in nearby anatomical structures were excluded from the study. The data was analysed by SPSS version 21 using Pearson Chi-Square test for statistical significance. RESULTS: A total of 50 cases were included in this study, among which 34 were males and 16 were female patients (ratio 2.1:1). The mean age was 26.4 years. Majority of the patients (78%) had past history of discharging ear with central perforation while 10% of patients had subtotal perforation. In this study 25 patients were operated by underlay technique among them graft uptake was successful in 22 patients and failed in 3 patients. In 25 patients myringoplasty was performed by onlay technique, graft uptake was successful in 23 patients and failed in 2 patients. The result shows that graft uptake was successful in 45 (90%) out of 50 patients and failure was encoutered only in 05 (10%) patients. Complete closure of perforation was achieved in 33 cases (66%). The reduction in the size of perforation or partial uptake of the graft was achieved in 12 cases (24%). In 5 cases, graft was rejected resulting in re-perforation as before. In our study 30 patients (60%) showed 20db to 30db improvement in hearing after surgery whereas 15 patients (30%) showed betterment between 10db to 20db in their hearing while 5 patients (10%) had less than 10db improvement in hearing after surgery. CONCLUSION: The ultimate goal of myringoplsty is to have a new reconstructed healed tympanic membrane with restoration of hearing as much as possible. In our study, there was no significant difference in achieving these goals by using two different techniques of myringoplasty.

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