This document discusses myringoplasty, a surgical procedure to repair perforations of the eardrum. It describes common otologic procedures, objectives and prerequisites of myringoplasty, graft materials including biological options, advantages of different graft types like temporalis fascia, and classifications of myringoplasty techniques including advantages and disadvantages of onlay and underlay approaches. The aim of myringoplasty is to close perforations and improve hearing by restoring the eardrum and middle ear function.

2. DR.ASMATULLAHACHAKZAI
MBBS.DLO.MCPS.FCPS
SENIOR REGISTRAR ENT
SANDEMAN(Prov) Hospital
Quetta

3. MYRINGOPLASTY

4. COMON OTOLOGIC PROCEDURES
 Myringotomy and Grommet insertion
 Myringoplasty
 Tympanoplasty
 Cortical Mastoidectomy
 Modified radical mastoidectomy
 Radical mastoidectomy
 Stapedectomy

5. MYRINGOPLSTY
 Myringoplsty is surgical procedure
performed to repair or reconstruct the
tympanic membrane with a suitable graft
material.
 It does not include removal of disease or
reconstruction of hearing mechanism.

10. Objectives of Myringoplasty
 To make the ear dry and trouble free
 To improve hearing
 To enable proper hearing aid usage

11. Contraindications for Myringoplasty
 Acute URTI, Otitis externa
 Children below 12 years
 Only hearing ear with severe SNHL of opposite side
 Perceptive deafness more then 30 Db
 Marked loss of speech discrimination
 Uncontrolled systemic diseases like HTN, DM etc
 pregnancy

12. Prerequisites for Myringoplasty
 Ear should be dry for at least for 3 months
 Healthy ear mucosa
 Patent Eustachian tube
 There should no focus of infection in the nose PNS and
Nasopharynx
 Good cochlear reserve

13. Graft materials
1. Biological
2. Non-biological

14. Biological
Types Sources
1. Autograft Same person
2. Isograft Genetically identical
3. Homograft
(allogenous)
Another person
(same species)
4. Heterograft
(Xenograft)
Animal (another species)
e.g: calf fetal serosa,
Bovine jugular vein

15. Advantages of Autograft
 No immunological reaction.
 Inexpensive.
 No risk of HIV or other infections.

16. Types of Autografts
 Temporalis fascia
 Tragal perichondrium
 Conchal perichondrium
 Tragal
 Periosteum
 Vein

17.  Fatty tissue from ear lobule
 Subcutaneous tissue
 Fascia tissue from ear lobule
 Subcutaneous tissue
 Fascia lata
 External auditory canal skin
 Heterotrophic skin
 Dura

18. Advantages of Temporalis Fascia
 Location of donor site
 Easy to harvest
 Close histological
 Low BMR
 No size limitation
 The only suitable autologous membrane for
reconstruction of tympanic cavity and ear canal.
 It can be used as onlay
 It can be used as more then one piece.
 It can be used in sandwich techniques as one of the grafts
with canal skin on the fascia.

19. Aim of Myringoplasty
 Permanent closure of perforation with production of dry
trouble free ear.
 To improve hearing function by restoration of
hydraulic ratio and protection of round window.
 To restore a smooth continuous migratory tract to
external auditory canal (EAC).

20. Classification of Myringoplasty
Techniques
Myringoplasty Techniques are classified into:
 Onlay
 Underlay techniques, based on the following:
 Placement of graft in relation to lamina
propria of drum remnants and fibrous annulus.
 Underlay below (medial to) the annulus.
 Overlay over (lateral to) the annulus.

21. Advantages of Onlay
 Anterior recess can be visualized.
 Anterior over hang can be drilled out.
 Take up rate should be high as graft bed is broad.
 Middle ear space is not reduced.

22. Disadvantages of Onlay
 Poor exposure of vital areas of tympanic cavity.
 Delayed healing.
 Epithelial pearls from remnants of drum epithelium.
 Blunting
 Lateral displacement of graft
 Inclusion or residual Cholesteatoma.
 Retraction pocket due to E.T dysfunction.

23. Advantages of Underlay
 Simple and easy to perform, when perforation is small.
 Avoids extensive dissection of anterior meatel skin, thus
preventing blunting of anterior recess.
 Ensures healings of drum at correct level relative to
fibrous
annulus and osseous remnant.

24. Disadvantages of underlay
 Reduction of middle ear space.
 Limited bed of raw area for graft reception.
 Difficult graft placement if perforation extends more anteriorly.
 Three layer formation of TM is unlikely.
 Anterior reperforation.
 Anterior tympanomeatal Cholesteatoma.
 Blunting of anterior tumpanomeatel angle can
occur if anterior tympanic annulus has been separated
from sulcus.

25. Other procedures for closure of tympanic
membrane perforation
 Splintage
 Cautery patching
 Fat graft myringoplasty

26. Thank You