The professional medical journal | 2019
Comparison of graft uptake in patients undergoing myringoplasty/ tympanoplasty by overlay and underlay procedure.
Abstract
.. Objectives: To determine which method underlay or overlay has higher results in graft uptake in Tympanoplasty. Study Design: It was experimental study. Setting: it was carried out at ENT Department of Benazir Bhutto Hospital, Rawalpindi. Period: One year from March 2017 to February 2018. Material and Methods: It consisted of a total of 27 patients presenting with chronic otitis media with dry perforation. Two groups of patients were made. Group A had 14 members who undergone underlay technique while the 13 patients in group B undergone overlay technique. Comparison was made on basis of successful graft uptake the main criteria of which was absence of lateralization, atelectasis, blunting or formation of retraction pockets by the end of 6 weeks of follow up. Result: Out of the 27 surgeries, 70.37% of the Myringoplasties were successful. The percent graft uptake came out to be 61.5% with overlay and 78.5% with underlay myringoplasty. In 15 out of the 27 surgeries temporalis fascia was used with a graft uptake rate of 80%, the 12 grafts taken from tragus had a graft uptake rate of 58.33%. Conclusion: Underlay myringoplasty technique has higher results than overlay myringoplasty technique. Key word: Graft, Myringoplasty, Overlay, Perforation, Tympanic Membrane, Temporalis Fascia, Underlay. 1. FCPS ENT Assistant Professor ENT Rawalpindi Medical University Benazir Bhutto Hospital. 2. MBBS House Officer BBH Hospital. 3. MBBS House Officer BBH Hospital. 4. FCPS ENT Senior Registrar Department of ENT BBH Hospital. Correspondence Address: Dr. Muhammad Arshad House No. B-11 Staff Colony Rawalpindi Medical College Rawal Road Rawalpindi. [email protected] Article received on: 26/12/2018 Accepted for publication: 28/03/2019 Article Citation: Arshad M, Shahnaz A, Bashir M, Zaman A. Comparison of graft uptake in patients undergoing myringoplasty or tympanoplasty by overlay and underlay procedure. Professional Med J 2019; 26(11):1861-1865. DOI: 10.29309/TPMJ/2019.26.11.2913 INTRODUCTION Myringoplasty is a surgical procedure which is per formed to repair the damaged tympanic membrane (TM) and to prevent possible future complications of chronic otitis media (COM) with middle ear infections.1 Myringoplasty was first introduced and then it was further improved by Wullstein and Zollner.2 Recurrent otorrhea, dry ear for swimming and better hearing are chief indications for surgery. There are two established methods of myringoplasty, overlay technique and underlay technique.3 The success of surgery depends upon various factors that include Eustachian tube dysfunction, size and site of perforation, active middle ear infection, and history of previous ear surgery, experience of surgeon, presence of tympanosclerosis, graft material, nasal allergy, and age of the patient.4 There are three different goals of Myringoplasty which are to prevent middle ear contamination; good serviceable hearing and middle ear aeration.5 Microscopic assisted endoscopic myringoplasty has highest success rate.6 In myringoplasty a graft is to be placed to close the perforation in the ear drum. In the underlay myringoplasty the graft is placed completely on the medial aspect of whats left of the tympanic membrane and malleus. On the other hand in overlay myringoplasty a graft is placed lateral to the remaining ear drum following the deepithelialization and removal of middle fibrous layer of tympanic membrane. The simple and easier approach of underlay technique is responsible for its widespread use by surgeons whereas because of its grueling nature overlay myringoplasty is usually reserved for total or anterior perforations or in case of a previous failed underlay surgery.7 It is still matter of debate that which surgical method has higher results despite the results DOI: 10.29309/TPMJ/2019.26.11.2913