The Outcomes of Myringoplasty According to Lesion Location in Chronic dry Perforation

Objective We evaluated the outcomes of endoscopic cartilage myringoplasty according to lesion location in the repair of chronic dry tympanic membrane (TM) perforations. Methods and materials The local lesion was defined as visible keratinized/cornified epithelium, keratin debris, adhesive tissue, or cholesteatoma involving the TM remnant or mesotympanum without extension to the attic, tympanic antrum, or mastoid cavity. The perforation was classified into TM remnant type, umbo type, and tympanic cavity type according to lesion location. In total, 29 chronic TM perforations with a local lesion underwent endoscopic cartilage underlay myringoplasty. Graft success, hearing improvement, and cholesteatoma recurrence were assessed at 24 months postoperatively. Results Of the 29 patients, mastoid cavity opacification was present in 7 patients, a pneumatized mastoid cavity in 7 patients, a sclerotic mastoid in 4 patients, and a history of prior mastoidectomy in 11 patients. TM remnant type was identified in 7 patients, umbo type in 11 patients, and tympanic cavity type in 11 patients. The graft success rate was 100.0% in the TM remnant type, 90.9% in the umbo type, and 72.7% in the tympanic cavity type. The mean air-bone gap improvement was 17.9 ± 3.0 dB (95% confidence interval [CI], 15.1–20.7 dB) in the TM remnant type, 16.6 ± 3.5 dB (95% CI, 14.2–19.0 dB) in the umbo type, and 10.1 ± 5.8 dB (95% CI, 6.2–14.0 dB) in the tympanic cavity type. Conclusions The outcomes of endoscopic cartilage myringoplasty for chronic dry perforation repair differed according to lesion location in the remnant TM and tympanic cavity. However, these findings should be interpreted with caution because of the small sample size for each subtype and the substantial subgroup differences.