Butterfly myringoplasty for total, subtotal, and annular perforations

Objectives/Hypothesis

The inlay "butterfly" cartilage tympanoplasty was first described as a treatment for small, central ear drum perforations. This technique can also be applied in large, marginal perforations, whereas the cartilage graft is anchored on the bony annulus. The aim of this study was to present the technique, to evaluate the results of butterfly tympanoplasty in marginal perforations, and to compare with the results of butterfly tympanoplasty in patients with nonmarginal perforations.

Study Design

Retrospective case series.

Methods

The files of patients who underwent inlay butterfly cartilage tympanoplasty for subtotal and total perforations from May 2011 to May 2013 were reviewed. Patients were followed with otoscopy and audiometry, and their results were compared with those of patients who underwent butterfly tympanoplasty for nonmarginal perforations.

Results

Forty-eight patients underwent butterfly tympanoplasty for subtotal and total perforations during the study period. Exclusion criteria included: active inflammation during the 3 months prior to surgery, cholesteatoma, lack of follow-up, incomplete data, ossicular chain anomaly/discontinuity, and significant sensorineural hearing loss (average bone-conduction threshold at 500,1000 and 2,000 Hz poorer than 20 dB). Thirty-three patients were included. The mean age at surgery was 34 years (range, 19–76 years); 17 patients (51%) were male. Four patients were treated previously by tympanoplasty (revision surgery), whereas the other 29 had primary surgery. None of the patients had intraoperative or immediate postoperative complications such as sensorineural hearing loss on the operated ear or facial nerve palsy. One month after surgery, two patients had a residual perforation (94% success rate), and the mean speech recognition threshold (SRT) improved from 38 dB to 24 dB. The pure tone audiogram improved from 37.7 dB to 10.6 dB, and the word recognition score improved from 97.7 to 99.75. These results are comparable with our results in nonmarginal perforations, whereas a 92% success rate and a postoperative SRT of 26 dB were achieved in a cohort of 42 patients.

Conclusions

Inlay butterfly cartilage tympanoplasty is safe and effective in patients with total or subtotal perforations, and the results are comparable to those seen in nonmarginal perforations.

Level of Evidence

4. Laryngoscope, 2016

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