Evaluation of Surgical and Audiological Outcomes of Push-Through Myringoplasty and Underlay Cartilage Tympanoplasty in Repairing Anterior Tympanic Membrane Perforations.

Introduction: Endoscopic push-through myringoplasty (PTM) that could be performed by the endoscopic transcanal approach is a minimally invasive procedure in repairing anterior quadrant perforations of the tympanic membrane. Push-through myringoplasty does not require any skin incision rather than graft harvesting and also does not require tympanomeatal flap elevation.

Objective: The purpose of the current study was to compare the surgical and audiological outcomes of PTM and conventional retroauricular underlay cartilage tympanoplasty (UCT) in the treatment of patients with anterior tympanic membrane (TM) perforation.

Methods: This clinical trial was conducted on total of 71 subjects with anterior TM perforation who underwent PTM (n = 32) and UCT (n = 39). Graft uptake rates, audiological outcomes, duration of surgery (DoS), and complications were analyzed and compared between groups.

Results: Graft uptake rates of the PTM and UCT group were 90.6% and 89.7%, respectively (P = 0.512). According to pure tone audiometry measurements at postoperative month 6, the air-bone gap (ABG) values remarkably improved in both PTM and UCT groups without any significant difference (P = 0.654). The average DoS was shorter in the PTM (29.7 ± 5.7 minutes) group relative to the UCT (48.7 ± 11.3 minutes) group, and the difference was extremely significant (P < 0.0001).

Conclusions: Push-through myringoplasty yielding shorter DoS and fewer postoperative complication and morbidity may serve as an efficient alternative to conventional microscopic UCT in treatment of anterior TM perforations, with comparable graft uptake rates and audiological outcomes.