Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes.
- Author:
So Young PARK
1
;
Hyuk Jae LEE
;
Myung Joo SHIM
;
Dong Kee KIM
;
Byung Do SUH
;
Shi Nae PARK
Author Information
- Publication Type:Original Article
- Keywords: Tympanic Membrane Perforation; Temporal Fascia; Malleus; Onlay Tympanoplasty; Underlay Tympanoplasty
- MeSH: Follow-Up Studies; Hearing; Hearing Loss; Humans; Male; Malleus; Numismatics; Postoperative Complications; Retrospective Studies; Tertiary Care Centers; Transplants; Tympanic Membrane; Tympanic Membrane Perforation; Tympanoplasty*
- From:Clinical and Experimental Otorhinolaryngology 2018;11(3):186-191
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVES: The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes. METHODS: Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed. RESULTS: A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P < 0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%. CONCLUSION: The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.
