Modified technique of underlay myringoplasty

Abstract

Two classic methods for Myringoplasty are underlay and overlay techniques each having its advantages and disadvantages.4–5 In the overlay technique, after the elevation of squamous tissue, the graft is positioned lateral to the annulus and fibrotic layer of the tympanic membrane residue. Overlay technique carries a risk of graft lateralization, anterior blunting, delayed healing, stenosis of the external canal, epithelial pearls, and iatrogenic cholesteatoma.6 Despite its higher success in repairing anterior and subtotal perforations, there is a consensus concerning the overlay technique being more technically challenging.7 The underlay technique is perhaps more commonly used worldwide, this technique is easier to perform, lower risk for lateralization, less time consuming, with more acceptable success rate even in the hands of less-experienced surgeons. In this technique, the graft is placed medial to the entire tympanic membrane remnant and also to the malleus handle and is more suitable for posterior perforations.8 This technique has disadvantages including a decreased mesotympanic space, medial displacement of the graft, synaechae formation between graft and promontory and lower success rate in subtotal and anterior perforations.6