Overlay versus underlay myringoplasty: A comparative study

Aims and Objectives: The objective of this study is to compare the outcome of overlay versus underlay myringoplasty procedure in the management of chronic inactive mucosal otitis media in terms of graft uptake, hearing improvement and complications. Materials and Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, S.M.G.S Hospital, Government Medical College, Jammu from June 1, 2012 to September 31, 2013 and clinical records of 77 patients who underwent myringoplasty by either overlay or underlay technique in this period were analyzed. A total of 72 patients with dry central tympanic membrane perforations of various sizes were included in this study. These patients were divided into two groups. In Group A, 37 patients were included in which tympanic membrane was repaired by using overlay technique of myringoplasty, whereas Group B comprised of 35 patients who underwent underlay myringoplasty. The results of two techniques were compared in terms of graft success rate that is, full uptake or failure to take up, medialization or lateralization of graft within 6 months of operation and improvement in hearing at the end of 6 months of follow-up. Results: In terms of graft uptake and postoperative AB gap improvement, Group B (underlay group) was slightly better with 91.43% uptake rate and mean postoperative AB gap of 11.11 dB than Group A (overlay group), which had 89.18% uptake rate and 11.72 dB as mean postoperative AB gap, though the difference was not statistically significant. There was only 1 case of graft medialization in Group B, while 3 cases had lateralization of graft in Group A. Conclusion: Both techniques of myringoplasty achieve satisfactory results, with the underlay technique being slightly better than the overlay technique. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation.