The anterior interlay myringoplasty: outcome and hearing results in anterior and subtotal tympanic membrane perforations.

Abstract

To describe a new technique, anterior interlay myringoplasty, to secure the anterior edge of a graft in tympanic membrane perforations with an anterior component. Consecutive patients undergoing anterior interlay myringoplasty were identified from the prospective otology database of the senior author. A tympanomeatal flap is elevated from the posterior canal wall, the annulus is elevated, and the tympanic membrane (TM) dissected off the malleus handle. The anterior "pocket" is fashioned using the Hughes dissector to elevate the mucosa medially from the fibrous layer of the narrow anterior rim of the perforation leaving the anterior annulus undisturbed; the elevation of mucosa medially is continued into the Eustachian tube orifice, which is matched by the angulation of the Hughes. Releasing incisions are necessary through the mucosal layer allowing the posterior portion of the graft to lie as an underlay and secured between the TM and malleus handle. Primary outcomes of tympanic membrane perforation closure rates and hearing outcome averaged over frequency thresholds 0.5, 1, 2, and 4 kHz at 12 months. One hundred sixteen patients were included for analysis, and 50 were pediatric cases. The overall tympanic membrane perforation closure rate in all cases was 91% (105/116) at outpatient appointments closest to 12 months and a mean hearing threshold improvement of 9.98 dB (SD 9.63, range 43.8 dB improvement to 20 dB loss) was seen. The anterior interlay technique is a valuable method to achieve anterior support for a tympanic membrane graft and is associated with good closure rates and audiological outcomes.