Interlay Myringoplasty With Anterior Subannular Grafting Technique for Anterior and Subtotal Perforations
Hirokazu Kawano
Abstract
OBJECTIVE: To describe the interlay myringoplasty with anterior subannular grafting technique and evaluate postoperative hearing and complications of this technique. STUDY DESIGN: Retrospective chart review. PATIENTS: We included 141 patients with anterior and subtotal tympanic membrane (TM) perforation. Patients who underwent concurrent ossicular chain reconstruction were included in graft success and complication rates evaluations, and were excluded from audiometric evaluation. INTERVENTIONS: Only squamous layer of the TM continuous with posterior meatal skin is elevated except one of anterioinferior annulus. The inner tympanic remnant is released from the anterioinferior annulus and then the subannular mucosa is separated from the annulus to fashion a subannular pocket. The anterior edge of the graft is inserted into the pocket, and the rest of the graft is sandwiched between the two divided layers of the TM. MAIN OUTCOME MEASURES: Graft success rate and hearing results were evaluated at 6 months postoperatively. Postoperative complications were also noted. RESULTS: The technique was successfully performed in 132 (93.6%) cases. Graft success rate was 98.3% (111/113) and the mean improvement of the air-bone gap was 9.5 dB, which was statistically significant (p < 0.001). There was no anterior blunting or TM lateralization. The pearl formations were found in six (5.3%) patients. All of them were easily removed at follow-up examination. CONCLUSIONS: The present study showed the interlay myringoplasty with anterior subannular grafting technique produces excellent results to repair anterior or subtotal TM perforations with few risk of anterior blunting and lateralization of the TM.