How do inlay, underlay, and overlay tympanoplasty compare in the treatment of tympanic membrane perforation (TMP)?

Updated: Dec 14, 2020
  • Author: Robert A Saadi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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A study by Haksever et al found that inlay butterfly transcanal cartilage tympanoplasty compared favorably with conventional underlay tympanoplasty in patients with dry, perforated chronic otitis media. The investigators examined results from 72 patients, 29 of whom underwent the inlay butterfly cartilage procedure and 43 of whom were treated with conventional underlay surgery. The tympanic-membrane closure rate and audiologic results were similar for the two techniques, but the average duration of surgery for inlay tympanoplasty was about half of that for the other operation (29.9 minutes vs 58.9 minutes, respectively). [29]

Similar results were reported in a study by Kim et al, in which 56 patients underwent inlay butterfly cartilage tympanoplasty, and another 56 individuals were treated with conventional underlay tympanoplasty. Surgical and functional success were comparable between the two procedures, but the duration of the inlay surgery was again about half of that for the underlay technique. Moreover, the visual analogue ̶ scale score for perioperative pain was lower for the inlay operation than it was for the underlay surgery (1.5 vs 4.9, respectively). [30]

A literature review by Jumaily et al found that tympanic membrane perforation closure rates for inlay butterfly transcanal cartilage tympanoplasty ranged from 71-100%. In a separate cohort, of pediatric and adult patients, the investigators reported complete closure in 21 of 32 perforations (66%) repaired with the procedure, with the mean air-bone gap dropping from 13.4 dB to 6.9 dB. [31]

A study by Ryan and Briggs found the overall success rate of overlay graft tympanoplasty to be 96.6%. For type 1 procedures, the success rate was 98.75%, while, when combined with intact canal wall mastoidectomy or modified radical mastoidectomy, the success rates for overlay tympanoplasty were 93.8% and 95%, respectively. [32]

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