Retromyringal Myringoplasty

Overview

The submitted retrospective study evaluates the results of myringoplasties made atthe Clinic for ENT and Head and Neck Surgery of the Motol Faculty Hospital, First Medical ClinicCharles University, Chair of the Institute of Postgraduate Medical Training in 1996 - 1997. A groupof 147 patients in involved - 101 primary operations and 46 revisions. As to revisions the first revisionwas made 26 times (57% of the total number of revisions, incl. 11 revisions of operations made inanother department (42%). A 2nd revision was made 13 times (28% of the total number of revisions)incl. 6 times revision of operations performed in another department (46%). A 3rd revision was made7 times (15% of the total number of revisions), incl. 3 of operations made elsewhere (43%). In allinstances the underlay technique was used with a tympanomeatal flap. As graft a temporal fasciawas used, perichondrium and chondroperichondrium which was taken mostly from the tragus. Themean follow up period was 8.3 months. The success rate of primary operations was 77%. The fasciawas used in 96%, perichondrium and chondroperichondrium in 2% each. During the 1st revisiona fascial graft was used in 62% with a success rate of 75%, perichondrium and chondroperichondri-um in 35% and in one instance a chondrofascial graft was used (4%) with a success rate of 60%. Duringthe 2nd and 3rd revision a fascial graft was used in 50% with a success rate of 60%. Condroperochon-drium and perichondrium were used in 50% with a success rate of 80%.In unsuccessful myringoplasties more frequent dehiscence in the anterior lower quadrant wasfound. In subtotal perforations there was a lower rate of successful healing (64 %) similarly as inperforations which developed as a result of scaling.In one instance despite incorporation of the graft hearing deteriorated and ten times it did notimprove (incl. 7 cases where a non-fascial graft was used). In one instance marked dysaesthesia inthe area of the auditory meatus was observed and in one instance marked tinnitus.In conjunction with successful healing of myringoplasties various prognostic factors are mentioned.The most frequently quoted ones are the pathogenesis of development of the perforation, the sizeof the perforation, site of the perforation, type of graft used, patient’s age, experience of the surgeon,number of previous operations, previous adenotomies in children and immunological state of thepatient. The influence of these factors is discussed.

Key words:
myringoplasty, perforation of the tympanic membrane, retromyringal technique,fascial graft, perichondral graft, chondroperichondral graft, revision myringoplasty.