Clin Exp Otorhinolaryngol.  2018 Sep;11(3):186-191. 10.21053/ceo.2017.01753.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

• Park SY
• Lee HJ
• Shim MJ
• Kim DK
• Suh BD
• Park SN

• KMID: 2429008
• DOI: http://doi.org/10.21053/ceo.2017.01753

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.

Keyword

Tympanic Membrane Perforation; Temporal Fascia; Malleus; Onlay Tympanoplasty; Underlay Tympanoplasty

MeSH Terms

Follow-Up Studies
Hearing
Hearing Loss
Humans
Male
Malleus
Numismatics
Postoperative Complications
Retrospective Studies
Tertiary Care Centers
Transplants
Tympanic Membrane
Tympanic Membrane Perforation
Tympanoplasty*

Figure

• 

  Fig. 1. Surgical technique of the swing-door overlay tympanoplasty. (A) A posterior tympanomeatal flap is elevated down to the annulus with the fibrous annulus preserved at its bony sulcus. (B) The flap is cut in a vertical direction at the 9-o'clock position, and divided into superior and inferior flaps. The drum remnant is dissected off the malleus handle and removed almost entirely. (C) Superiorly and inferiorly based swing-door flaps are rotated anteriorly. Laterally based anterior meatal flap is elevated to expose the anterior annulus. (D) The dried temporalis fascia is trimmed to the right size. An S-shaped slit is made at the anterosuperior edge. (E) The fascia is placed over the fibrous annulus and medial to the malleus handle in a sandwich-like fashion. All canal flaps are replaced over the fascia graft. (F) The anterior tympanomeatal angle is packed with several pieces of antibiotic-impregnated gauze strips, securing the fascia and flap to the annulus and canal wall.

• 

  Fig. 2. Representative endoscopic findings of three tympanic membranes before (A-C) and after (D-F) the swing-door overlay tympanoplasty.

• 

  Fig. 3. (A) Pre- and postoperative mean air conduction (AC) thresholds at four frequencies in patients undergoing the swing-door overlay tympanoplasty. (B) Pre- and postoperative mean air-bone gaps (ABGs). HL, hearing level. *P<0.001, vs. preoperative value, paired t-test (n=306). Error bars indicate standard error of mean.

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  Fig. 4. Pre- and postoperative distribution of patients in the air-bone gap (ABG) bins with significant difference (n=306; P<0.001, chi-square test).

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