Modified inlay butterfly cartilage myringoplasty: An outpatient minimally invasive procedure for closure of central perforation-graft success rate and hearing outcome

Am J Otolaryngol. 2022 May-Jun;43(3):103399. doi: 10.1016/j.amjoto.2022.103399. Epub 2022 Feb 17.

Abstract

Objective: The objective of this was to evaluate anatomical and hearing results of modified inlay butterfly perichondrium-cartilage myringoplasty for repairing central perforation in an office setting.

Material and methods: We performed a prospective study in 81 patients with chronic central perforations who underwent modified inlay butterfly perichondrium-cartilage myringoplasty in an office setting. The graft success rate, hearing outcome, and complications were evaluated at postoperative 3, 6 and 24 months.

Results: 81 patients with 81chronic perforations were included in this study. The graft success rate was 100.0% (81/81) at postoperative 3 months. At postoperative 24 months, 16 patients lost follow-up, the graft success rate was 98.5% (64/65). The mean preoperative ABG was 23.0 ± 2.6 dB, while the mean postoperative ABG postoperatively 12 months was 11.4 ± 3.1 dB; the difference between these values was significant (P < .05). No graft-related complications (e.g., graft lateralization, graft medialization, graft keratin pearl, middle ear cholesteatoma) were encountered during the follow-up period. In addition, excess perichondrium lateral to the superficial layer of TM remnant became necrotic and crust at postoperative 2-3 months. However, graft keratin pearl and intra-tympanic cholesteatoma/epithelial inclusion cyst weren't found in any patients at postoperative 24 months. Granular myringitis with minimal moistness but without infection has been noted in 6 patients.

Conclusions: Modified inlay butterfly perichondrium-cartilage myringoplasty is a viable and less invasive option for closure of central perforations in an office setting because this technique does not require tympanomeatal flap elevation and general anesthesia.

Keywords: Cartilage; Endoscope; Myringoplasty; Tympanic membrane perforation.

MeSH terms

  • Cartilage / transplantation
  • Cholesteatoma, Middle Ear* / surgery
  • Endoscopy / methods
  • Hearing
  • Humans
  • Keratins
  • Myringoplasty / methods
  • Outpatients
  • Postoperative Complications / epidemiology
  • Postoperative Complications / surgery
  • Prospective Studies
  • Treatment Outcome
  • Tympanic Membrane Perforation* / etiology
  • Tympanic Membrane Perforation* / surgery

Substances

  • Keratins