TECHNIQUE TO SIMPLIFY MYRINGOPLASTY
Introduction
Simple underlay myringoplasty (SUM) has been widely performed over the last 23 years in Japan as a less invasive procedure of myringoplasty than conventional methods. SUM has been gradually recognized in the world since an original article in English was published1 and the detail of the procedure had been introduced into AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) for the last six years.
Surgical procedures
A transcanal approach is applied. No skin incision is necessary except to harvest subcutaneous connective tissue for the graft from the retro-auricular region. After the topical anesthesia of the tympanic membrane, the perforation edge is removed for both the debridement and the vascularization to the graft (Fig. 1A). Calcified tissue around the perforation is also removed. When the perforation edge involves the malleus handle, the mucosa behind the handle is removed. The pressed graft is inserted into the tympanic cavity through the perforation, and then the graft is elevated to touch the perforation edge. The graft is fixed to the tympanic membrane with a little fibrin glue (Fig. 1B). Packing is not necessary either in the tympanic cavity or in the external auditory canal. The surgery is performed under local anesthesia except in cases with children because thirty minutes is sufficient to accomplish the surgery for one ear by this method. Although SUM is generally performed under a microscope, an endoscope is sometimes necessary when the anterior part of the perforation edge cannot be treated under the microscope due to a protrusion of the anterior region of the external auditory canal. For the persistent perforation after this method, re-closure is attempted in the outpatient clinic by the same procedure using frozen autologous tissue which has been harvested in the initial surgery.
Fig. 1. Scheme of surgical procedures. A: Removal of the perforation margin. B: Grafting by underlay method.
The rate of initial closure was 478/621 (77.0%). Overall success rate after the re-closure was 595/621 (95.8%). There was no significant difference of the success rate among any size of the perforation or any frequency of otorrhea. There was no serious complication such as sensorineural hearing loss.
Indications
SUM is indicated for the case as follows: (1) Any size of the central dry perforation; (2) No pathology in the tympanic cavity; (3) A sufficient hearing gain after the patch test using thin wet cotton. The case of cho-lesteatoma or adhesive otitis media is contra-indicated. Because the post-operative hearing deterioration is extremely rare, SUM is also indicated for cases with the only hearing ear or with the same-day surgery for bilateral diseases.2,3 Additionally, this method is applied to tympanoplasty by the transcanal approach.
References
1.Sakagami M, Yuasa R, Yuasa Y. Simple underlay myringoplasty. J Laryngol Otol 121:840–847, 2007
2.Yuasa Y, Yuasa R. Postoperative results of simple underlay myringoplasty in better hearing ears. Acta Otolaryingol 128:139–143, 2009
3.Sakagami M, Mishiro Y, Tsuzuki K, Seo T, Sone M. Bilateral same day surgery for bilateral perforated chronic otitis media. Auris Nasus Larynx 27:35–38, 2000
Address for correspondence: Yu Yuasa, yyuasa@sendai-surg.gr.jp
Cholesteatoma and Ear Surgery – An Update, pp. 189–190
Edited by Haruo Takahashi
2013 © Kugler Publications, Amsterdam, The Netherlands