TMSS Medical College Journal

This study was carried out to assess the graft take rate as well as hearing improvement after myringoplasty with temporal fascia graft by underlay technique. In this study graft take rate was 85% (51 out of 60) and graft failure was 15% (9 out of 60). The age range of the patients was 10 to 50 years. Highest number of patients was in the age group of 21 to 30 years and graft take was also maximum in this age group. Graft take rate of small size perforation (100%) and medium size perforation (93.23%) had more than subtotal perforation (77.77%). Success rate of posterior perforation was maximum (93.75%) followed by anterior perforation (88.23%). In case of approach of operation postaural approach had maximum success rate (88.09%) followed by endaural (75%) and transcanal approach (80%). In this study the mean pre and postoperative air conduction threshold in the successful cases were 34 dB and 24 dB respectively, with a mean audiological improvement of 10 dB. Improvement of mean air bone gap was 11 dB. Of the successful cases hearing was improved in 31 patients (60.78%) and 20 patients (39.21%) showed no significant hearing improvement. From this study it can be concluded that myringoplasty is a successful treatment modality for tympanic membrane perforation

In Bangladesh like all developing countries the incidence of chronic suppurative otitis media (CSOM) is very high because of poor socioeconomic standard, over crowding, poor nutrition and lack of health education. Among the two types of chronic suppurative otitis media. Tubotympanic variety is the commonest and is called safe variety as the risk of developing complications are less and the name tubo tympanic indicate disease of Eustachian tube and tympanic cavity'. Tubotympanic disease is always charac-terized by central perforation involving the pars tensa of varying size and shape but with a narrow margin of intact annulus and usually with part or all of the membrane of the malleus remaining. The perforation of the tympanic membrane is associated with aural discharge and hearing loss. Aural discharge is always mucoid or mucopurulent and varies with upper respiratory tract infection. Discharge is usually intermittent recurring whenever there is a fresh head cold or water enters in to the ear’. Hearing loss in tubotympanic disease is usually conductive in nature but a few case of sensorineural hearing loss is found . Hearing loss with intact ossicular chain is approximately 10-30 dB. But more when ossicular chain is disrupted. Myringoplasty is the operation specially designed to repair or reconstruct the tympanic membrane. The earliest reported successful myringoplasty was done by Berthold in 1978, using full thickness skin graft’. Since then, myringoplasty has gone through many changes in technique and materials. Shea in 1960, first introduced underly technique for myringoplasty but using vein graft. And autologus temporal fascia used as graft material firstly by Heerman in 1960. The surgical outcome of myringoplasty is influenced by many factors. The reported success rate of myringoplasty is therefore variable, partly because of differences in the inclusion and exclusion criteria’, In a study overall success rate of myringoplasty was 86%. Posterior and inferior perforations had a 98% success rate for repair compaired to only 67% of anterior perforation. The success rate of subtotal perforation closure was (92.5%)° . But the graft failure was more in younger patients. A study found better success with advancing age’. This is due to lower incidence of upper airway infection and better Eustachian tube function in later age and the relative immaturity of system in younger children, Lorenzo Pignataro found better success rate in underlay technique than overly technique’. The success rate was 82.3% in the former and 79.1% in the later. At present, myringoplasty is a common operation in the Otolaryngology Department, having microsurgical facilities. The present study aims to evaluate the surgical and audiological outcome of myringoplasty using underlay technique with temporal fascia graft in selected patients with tympanic membrane perforation and to assess the factors potentially influencing those outcomes.