Abstract
Background: Various surgical techniques have been developed for the treatment of tympanic membrane perforation. One of the most common procedures is simple underlay myringoplasty with fibrin glue (SUM) developed by Dr. Yuasa. Compared to conventional tympanoplasty, SUM is less invasive. The drawbacks of SUM are medialization and dislocation of the underlying connective tissue. These two complications can lead to re-perforation, of which the incidence has been previously reported to be about 20％. The hearing improvement rate of SUM has been reported to be around 80％. We have developed a modified SUM, namely “multi-layered connective tissue underlay myringoplasty（MCUM）”. This new, technique does not require fibrin glue derived from homologous human blood. Also, our preliminary study showed it has even higher success rates because properly placed the multiple-layered connective tissue does not cause dislocation.
Method: In the present study, we retrospectively examined 61 patients' 68 ears operated by MCUM between January 2015 to December 2015 who had more than a one-year follow-up period.
Results: The tympanic membrane perforation closure rate and hearing improvement rate was 96％ and 94％, respectively. These success rates were equivalent to or higher than that of the previously reported conventional methods such as SUM. Moreover, this study also revealed that even large perforations could be successfully closed. The follow-up CT scans and audiometry revealed the volume of underlaid connective tissue has been reduced and eventually absorbed, and did not cause any harmful effect to the tympanic cavity aeration and hearing outcomes.
Conclusion: We have developed MCUM and this new technique brings high perforation closure rate and hearing improvement rate. MCUM can be applied to large sized perforation without using fibrin glue.
