Endaural Over-Underlay Cartilage Tympanoplasty for Repair of Dry Subtotal Perforations

Comparison of the underlay and over‐underlay tympanoplasty: A randomized, double‐blind controlled trial

Objective

We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over-underlay approaches.

Methods

This is a prospective double-blind randomized controlled clinical trial with a parallel design. Patients aged 15-75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over-underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6 months.

Results

The investigation was conducted on 84 patients in the underlay and 67 patients in the over-underlay group. Although there was a higher rate of graft failure (9%) in the over-underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant (p-value = .34). No atelectasis was seen in both group. Although, between-groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air-bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over-underlay technique, the difference was clinically negligible.

Conclusion

Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over-underlay technique after the operation.

Levels of Evidence

1b.

General anaesthetic vs local anaesthetic myringoplasties: a systematic review and meta-analysis

AIMS

To assess all available data and determine the success rates and tolerability of local anaesthetic myringoplasty in comparison with those undertaken under general anaesthetic myringoplasty.

MATERIALS AND METHODS

The study was designed following a PRISMA-P protocol and registered with the PROSPERO database. MEDLINE, Cochrane Library (CDSR/Central), EMBASE and CINHAL-were directly searched for studies, which met the inclusion criteria.

OBJECTIVES

Primary objective was to compare perforation closure rates between patients undergoing myringoplasty under local anaesthetic and those under general anaesthetic from all available published data. Secondary outcomes include complications, such as 'any minor complications', infection rates in the first 6 month post-op, facial nerve weakness, dysgeusia and patient satisfaction.

RESULTS

27 studies were included in the final analysis and found that myringoplasty had an overall perforation closure rate of 89%. The pooled proportion of closures after myringoplasty under local anesthesia was 87% and for myringoplasties under general anesthesia was 91%. Analysis of myringoplasty under local anaesthesia focusing on 'in-office' performed procedures only, found a closure rate of 88%.

CONCLUSIONS

There is no significant difference in the success rate of myringoplasty surgery when performed under local or general anaesthetic as measured by perforation closure rates. However, there are other factors, which can drive choosing local anaesthetic surgery, such as minimising anaesthetic risks, reducing costs and reducing environmental impact.