Comparison of Grafting Success Rate and Hearing Outcomes between Primary and Revision Tympanoplasties

Document Type: Original


1 Otorhinolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

3 Department of Otorhinolaryngology Head and Neck Surgery, University Malaya Medical Center, University of Malaya, Kuala Lumpur, Malaysia.


There are a few studies that compare the outcomes between primary and revision tympanoplasties. The purpose of the present study was to compare the results of type I tympanoplasty (i.e., synonymous to myringoplasty) and revision myringoplasty based on the closure of tympanic membrane perforation and hearing improvement.
Materials and Methods:
Thisprospective single-blind study was carried out on a total of 240 patients with tympanic membrane perforation at a tertiary referral center.Thesubjects underwent primary or revision myringoplasty. Grafting success rate and hearing results were measured and the comparison between the primary and revision groups was drawn.
Grafting success rate was reported as 96.6% (112 out of 116 cases) for myringoplasty, while in revision myringoplasty the success rate of 78.2% (97 out of 124 patients) was achieved (P=0.001). Speech reception threshold was 23.1±9.2 dB and 24.9±13.1 dB in the primary and revision groups, respectively (P>0.05). However, the percentage of air-bone gap on audiometry≤20 dB were 83.8% and 76% in the primary and revision groups, respectively (P=0.26).
The findings of the present study have shown that although grafting success was reported significantly better in myringoplasty (tympanoplasty type 1), compared to that in revision myringoplasty, it did not reveal any superiority over revision tympanoplasty regarding the hearing outcomes. No consensus was achieved due to a great number of controversies in the literature.


Main Subjects

1. Fagan P, Patel N. A hole in the drum. An overview of tympanic membrane perforations. Australian family physician 2002;31(8):707.

2. Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM. Otitis media. The Lancet 2004;363(9407):465-73.

3. Olszewska E, Wagner M, Bernal-Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H, et al. Etiopathogenesis of cholesteatoma. European Archives of Oto-Rhino-Laryngology 2004; 261(1): 6-24.

4. Nadol JB. Revision mastoidectomy. Otolaryngologic Clinics of North America 2006; 39(4): 723-40.

5. Hou YY, Huang HL, Shi HY. Prevalence and hospital resource utilization in tympanoplasty and revision tympanoplasty: a population-based comparative study. Otology & Neurotology 2012; 33(3):400-5.

6. Vartiainen E, Nuutinen J. Success and pitfalls in myringoplasty: follow-up study of 404 cases. The American Journal of Otology 1993;14(3):301-5.

7. Hardman J, Muzaffar J, Nankivell P, Coulson C. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis. Otology & Neurotology 2015; 36(5): 796-804.

8. Faramarzi M, Dehbozorgi MM, Heydari ST. Is Cholesteatoma a Risk Factor for Graft Success Rate in Chronic Otitis Media Surgery? Iranian journal of otorhinolaryngology. 2015;27(83):417.

9. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngology-Head and Neck Surgery 2008;139(3):386-90.

10. Tos MI, Lau T. Revision tympanoplasty. The Journal of Laryngology & Otology 1986; 100(10): 1097-105.

11. Vartiainen E. Findings in revision myringoplasty. Ear, Nose, & Throat Journal 1993; 72(3): 201-4.

12. Nadol JB, Staecker H, Gliklich RE. Outcomes assessment for chronic otitis media: the Chronic Ear Survey. The Laryngoscope 2000;110(S94):32-5.

13. Andersen SA, Aabenhus K, Glad H, Sørensen MS. Graft take-rates after tympanoplasty: results from a prospective ear surgery database. Otology & Neurotology 2014;35(10):e292-7.

14. Fukuchi I, Cerchiari DP, Garcia E, Rezende CE, Rapoport PB. Tympanoplasty: surgical results and a comparison of the factors that may interfere in their success. Revista Brasileira de Otorrinolaringologia 2006;72(2):267-71.

15. Aggarwal R, Saeed SR, Green KJ. Myringoplasty. The Journal of Laryngology and Otology 2006;120(6):429-32.

16. Westerberg J, Harder H, Magnuson B, Hydén D. Ten-year myringoplasty series: does the cause of perforation affect the success rate? The Journal of Laryngology and Otology 2011; 125(2): 126-32.

17. Balaguer RG, Morales MS, Tamarit JC, Agostini GP, Murica VP, Dalmau JG. [Myringoplasties. A retrospective analysis of our surgical outcomes]. Acta Otorrinolaringologica Espanola 2011; 62(3): 213-9.

18. Urbieta I, Guijarro G. Myringoplasty: our results. Acta otorrinolaringologica espanola 2002; 53(7): 457-60.

19. Maroto DP, Gutiérrez JJ, Jiménez MC, Morente JC, Rodríguez VP, Benítez-Parejo N. Functional results in myringoplasties. Acta otorrinolaringolica 2010; 61(2):94-9.

20. Morant AV, Marco JA, Mallea IC, Orts MA, Cano BC, Contreras AC. Myringoplasty using formaldehyde formed fascia (Perkins' foot) in 188 cases: anatomical and functional results at 5 years. Acta otorrinolaringologica espanola 1993; 44(6): 425-30.

21. Jurado FJ, Gil JL, Secall MT, Vadillo ED, Palau EM, Novoa MD, et al. Myringoplasty: auditory follow-up and study of prognostic factors. Acta otorrinolaringologica espanola 2009; 60(3): 169-75.

22. Pesce TL, Grañon CS, Rivas EM, Marco IC. Primary myringoplasties. Results after a 2 year follow-up period. Acta otorrinolaringologica 2009; 60(2):79-83.

23. Frade CG, Castro CV, Cabanas ER, Elhendi W, Vaamonde PL, Labella TC. Prognostic factors influencing anatomic and functional outcome in myringoplasty. Acta otorrinolaringologica espanola 2002;53(10):729-35.

24. Shrestha S, Sinha BK. Hearing results after myringoplasty. Kathmandu university medical journal 2006;4(4):455-9.

25. Umapathy N, Dekker PJ. Myringoplasty: is it worth performing in children? Archives of Otolaryngology-Head & Neck Surgery 2003; 129(10): 1053-5.

26. Yuasa Y, Yuasa R. Postoperative results of simple underlay myringoplasty in better hearing ears. Acta oto-laryngologica 2008;128(2):139-43.

27. Altuna X, Navarro JJ, Martínez Z, Lobato R, Algaba J. Island cartilage myringoplasty. Anatomical and functional results in 122 cases. Acta otorrinolaringologica 2010;61(2):100-5.

28. Bhat NA, De R. Retrospective analysis of surgical outcome, symptom changes, and hearing improvement following myringoplasty. Journal of Otolaryngology-Head & Neck Surgery. 2000; 29(4): 229.

29. Emir H, Ceylan K, Kizilkaya Z, Gocmen H, Uzunkulaoglu H, Samim E. Success is a matter of experience: type 1 tympanoplasty : influencing factors on type 1 tympanoplasty. European Archives of Oto-Rhino-Laryngology 2007; 264(6): 595-9.

30. Veldman JE, Braunius WW. Revision surgery for chronic otitis media: a learning experience. Report on 389 cases with a long-term follow-up. Annals of Otology, Rhinology & Laryngology 1998; 107(6):486-91.

31. Webb BD, Chang CJ. Efficacy of tympanoplasty without mastoidectomy for chronic suppurative otitis media. Archives of Otolaryngology-Head & Neck Surgery 2008; 134(11): 1155-8.

32. Dornhoffer JL. Hearing results with cartilage tympanoplasty. The Laryngoscope 1997; 107(8): 1094-9.

33. Djalilian HR. Revision tympanoplasty using scar tissue graft. Otology & Neurotology. 2006; 27(2):131-5.

34. Lin YC, Wang WH, Weng HH, Lin YC. Predictors of surgical and hearing long-term results for inlay cartilage tympanoplasty. Archives of Otolaryngology Head & Neck Surgery. 2011; 137(3): 215-9.

35. Dornhoffer J. Cartilage tympanoplasty: indications, techniques, and outcomes in a 1,000-patient series. The Laryngoscope 2003; 113(11): 1844-56.

36. Gerber MJ, Mason JC, Lambert PR. Hearing results after primary cartilage tympanoplasty. The Laryngoscope 2000; 110(12): 1994-9.

37. Gamra OB, Mbarek C, Khammassi K, Methlouthi N, Ouni H, Hariga I, et al. Cartilage graft in type I tympanoplasty: audiological and otological outcome. European Archives of Oto-Rhino-Laryngology 2008;265(7):739-42.

38. Adkins WY, White B. Type I tympanoplasty: influencing factors. The Laryngoscope 1984; 94(7): 916-8.

39. Duckert LG, Müller J, Makielski KH, Helms J. Composite autograft "shield" reconstruction of remnant tympanic membranes. The American journal of otology 1995;16(1):21-6.

40. Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. The Laryngoscope 1993;103(12):1352-6.

41. Lesinskas E, Stankeviciute V. Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media. Auris Nasus Larynx. 2011;38(2):196-202.

42. Kaylie DM, Gardner EK, Jackson CG. Revision chronic ear surgery. Otolaryngology Head and Neck Surg 2006;134(3):443-50.

43. Landsberg R, Fishman G, DeRowe A, Berco E, Berger G. Fat graft myringoplasty: results of a long-term follow-up. Journal of Otolaryngology 2006; 35(1):44-7.

44. Deddens AE, Muntz HR, Lusk RP. Adipose myringoplasty in children.The Laryngoscope 1993; 103(2):216-9.