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Introduction: Patients with a mucosal type of chronic otitis media (COM) usually have recurrent ear discharge and conductive hearing loss. It is characterized by the central perforation of the tympanic membrane. Myringoplasty is an operation performed to repair tympanic membrane perforation when there is no ossicular damage. It helps to prevent ear discharge and improves hearing. Different techniques used for myringoplasty are underlay and overlay. Underlay technique is an effective procedure for tympanic membrane repair. Methods: 125 patients who underwent underlay myringoplasty over two years in a tertiary care center in Kerala were included in the study. Patients with actively discharging ears were excluded from the study. Results: The majority of the patients were in the age group of 20-29 years (49.6%). There were 47 males (37.6%) and 78 females (62.4%). In 63 patients the surgery was done on the right side (50.4%) and in 62 patients on the left side (49.6%). Maximum preoperative hearing loss was in the range of 30-34 dB (39.2%). 100 patients (80%) showed successful graft uptake with the improvement of hearing in the range of 10-15 dB. Eight patients (6.4%) showed small residual perforation with the improvement of hearing. In 17 patients (13.6%) there was a complete rejection of graft with continuous ear discharge and no improvement in hearing. Conclusion: Underlay myringoplasty is an effective surgical technique for the repair of tympanic membrane perforations in terms of graft take up and improvement of hearing.

Introduction The objective of this study was to evaluate underlay tympanoplasty technique of perichondrium cartilage graft according to the position of the graft with respect to the handle of malleus and remnant of tympanic membrane. Patients and Methods In all, 150 patients with chronic suppurative otitis media (safe type) underwent tympanoplasty with or without mastoidectomy. The patients were divided into three groups (50 patients in each group). Group I graft was placed medial to the handle of malleus, group II graft was placed at the plane of malleus, group III graft was placed lateral to the malleus between it and remnant of tympanic membrane. Results Success rate (graft taken with no residual perforation) in all cases is 98% (147 cases). Success rate in groups I–III is 98% (49 cases), 100% (50 cases) and 96% (48 cases), respectively. There is significant statistical improvement of postoperative pure tone audiogram. Conclusion Underlay cartilage tympanoplasty was associated with a high rate of graft taken and good hearing results despite the position of the graft in relation to the handle of malleus.

Background: Transtympanic myringoplasty is an alternate technique that allows graft placement medial to tympanic membrane remnant through the perforation without the need for tympanomeatal flap elevation. Objectives: The aim of this study is to evaluate the efficacy and compare the results of transtympanic myringoplasty without tympanomeatal flap elevation with the usual method of graft placement by the elevation of a tympanomeatal flap. Materials and Methods: This is a prospective study done on fifty patients divided into two groups, each consisting of 25 patients. Group I patients underwent transtympanic myringoplasty without elevation of tympanomeatal flap and group II patients underwent tympanomeatal flap elevation myringoplasty. Both the procedures were done by underlay technique through transcanal approach using only tragal perichondrium as graft material. Results and Observations: Graft uptake was successful in 88% and 92% ears while hearing improvement was seen in 84% and 91.3% in the group I and II patients respectively. The mean hearing gain was 15.04 dB and 15.57 dB in group I and II respectively. Conclusion: Transtympanic myringoplasty is a simple and less traumatic yet equally effective approach for the repair of tympanic membrane perforation. It has the added advantages of minimal post-operative pain, cost-effectiveness, no potential risk of injury to chorda tympani and results comparable to conventional techniques of myringoplasty.

Background: Chronic suppurative otitis media is one of the most common otological problems in developing countries. It affects all age groups. Type-1 tympanolpasty is simple repair of tympanic membrane. The objectives of this study were to describe the outcome of type-1 tympanoplasty in terms of graft take rate, hearing improvement and complications. Material & Methods: This quasi-experimental study was carried out in Department of ENT, Al-Noor Specialist Hospital, Makkah, Saudi Arabia from February 2005 to July 2005. Patients with dry central perforations were included in the study. Pre-operative audiogram and x-ray mastoid were performed for all the cases. Results: Out of 40 patients, 21(52.5%) were males and 19(47.5%) females. The mean age was 29 (15-45) years. Out of 40 cases, 22(55%) tympanoplasties were performed on right ear and 18(45%) on left ear. Twelve (30%) patients had large size, 24(60%) medium size, one (2.5%) pin hole size and 3(7.5%) had subtotal tympanic membrane perforation. Fourteen (35%) patients had anterio-inferior perforation, 22(55%) had central, and 4(10%) had posterior-inferior perforation of tympanic membrane. The graft was intact in 35(87.5%) patients while it failed in 4(10%) cases. One (2.5%) case had small residual pinhole perforation. Hearing improvement was documented in 26(65%) patients. There were no complications. Conclusion: Type-1 tympanoplasty has a good outcome in the management of chronic suppurative otitis media, using temporalis fascia as graft material by underlay technique.