2018 年 152 巻 p. 22-23
Myringoplasty is one of the basic procedures in otologic surgery, and is widely performed to repair tympanic membrane perforations. We studied the treatment outcomes of myringoplasty at our hospital.
A retrospective chart review was conducted for 61 patients (30 males and 31 females, average age, 48.8 years (range, 5–87 years); 69 ears) who had undergone myringoplasty from April 2009 to March 2014. The perforation was caused by chronic otitis media in 56 ears, trauma in 8 ears, and iatrogenic factors in 5 ears. The perforation size was grade I in 38 ears, grade II in 25 ears, grade III in 5 ears, and grade IV in 1 ear. The graft material was subcutaneous tissue in 58 ears, temporal fascia in 10 ears, and tragal cartilage in 1 ear. The operative procedure was simple underlay myringoplasty in 61 ears, modified underlay myringoplasty in 3 ears, and inlay myringoplasty in 5 ears. The postoperative follow-up period ranged from 6 to 59 months, with an average of 21.8 months.
Overall, the perforation recurred in 12 ears, and the success rate of perforation closure was 82.6%. The cause of recurrent perforation was unfitting grafts in 3 ears, bacterial infection in 5 ears, and local ischemia in 4 ears. The overall success rate in terms of hearing improvement was 95.7%, according to the criteria proposed by the Otological Society of Japan (postoperative hearing level ≤30 dB, hearing gain ≥15 dB, and/or postoperative air-bone gap ≤15 dB). Of the 61 ears in which simple underlay myringoplasty had been performed, the success rates of perforation closure and hearing improvement were 83.6% (10 ears developed recurrent perforation) and 95.1%, respectively.
We need to address effective measures for prevention and salvage of recurrent perforation in order to improve the success rate of perforation closure.
