Myringoplasty: A comparison of inlay and underlay techniques

Purpose: Myringoplasty aims to improve hearing and prevent otorrhea, making graft uptake rates and hearing crucial considerations. This study analyzed the factors associated with unsuccessful graft uptake and hearing improvement to guide the selection of optimal surgical approaches for myringoplasty.

Methods: We retrospectively reviewed 56 ears with chronic otitis media. All patients were followed up for >6 months after tympanic membrane closure surgery. We compared the underlay method using the transcanal approach with the inlay method using the retroauricular approach for myringoplasty in patients with chronic otitis media. The underlay and inlay methods were used for 23 and 33 ears, respectively. The primary outcomes were graft uptake rate and hearing improvement. Additionally, factors such as the location of tympanic membrane perforation, patient age, and the degree of mastoid development were evaluated.

Results: The perforation rate was high when the transcanal underlay method was employed to repair perforations in the anterior inferior quadrant. Both the underlay and inlay methods significantly improved hearing. However, the success rate of the inlay method was lower. Within the cases performed using the inlay method, outcomes tended to be poorer in older age groups. There were no significant differences in surgical success rates related to mastoid development.

Conclusion: The inlay method using the retroauricular approach is a favorable option for repairing perforations involving the anterior inferior quadrant. However, older patients presented lower rates of hearing improvement when the inlay method was used.