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Myringoplasty.

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Child↗

Out-patient myringoplasty.

A simple technique for closing small-to-medium sized perforations of the tympanic membrane in the Out-Patient Department has been described. Homograft temporalis fascia was used as a graft material. In a series of eighteen patients a closure rate of 78.2 per cent was obtained. The advantages of the method have been discussed.

Adult↗

Myringoplasty (A review of 365 operations).

A series of 365 cases of tympanic membrane repair by the same surgeon is analysed, comparing the results of different techniques and grafting materials. A detailed study of 206 of these cases employing the underlay technique with temporal fascia is reported. In this group a graft take rate of 91.4 per cent in dry ears, and of 89.3 per cent in all cases, was achieved. Various factors liable to influence the success rate are analysed and discussed. No cases of conductive or sensori-neural hearing loss resulting from the operation were encountered.

Fascia↗

A long term view of myringoplasty in children.

Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiological outcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.

Adolescent↗

Myringoplasty for the anterior perforation: experience with the Kerr flap.

Surgical closure of the anteriorly located tympanic membrane perforation can present a problem. The lack of anterior support for the graft frequently leads to graft failure if an underlay method is used whereas anterior blunting is a complication of onlay techniques in this situation. The experience with the Kerr flap, an underlay graft fashioned to include a tab of fascia which is placed laterally under the annulus and the anterior meatal skin, is presented. This method gave a 97.5 percent closure rate with no cases of anterior marginal blunting and a mean auditory threshold gain of 8.5 dB (95 percent confidence limits 5 to 11.9 dB, P less than 0.01) was achieved at the frequencies tested. The use of the Kerr flap is recommended when repairing the anteriorly placed tympanic membrane perforation.

Adolescent↗