Success of butterfly myringoplasty in myringosclerosis
Reviewed by Praneta Kulloo

Butterfly inlay myringoplasty is a simple surgical technique used in the repair of tympanic membrane perforation. The authors evaluated the effects of myringosclerosis on the success of surgery by reviewing demographic data, perforation size and hearing outcomes of patients undergoing endoscopic inlay butterfly myringoplasty due to chronic otitis media. Seventy-five patients were recruited and divided into three groups, as follows: Group I – 24 patients without a myringosclerotic focus in the neighbourhood of tympanic membrane perforation; Group II – 23 patients with <50% myringosclerotic focus in the neighbourhood of tympanic membrane perforation; and Group III – 28 patients with >50% myringosclerotic focus in the neighbourhood of tympanic membrane perforation. All patients underwent endoscopic inlay butterfly myringoplasty without removal of the sclerotic plaque. There was no statistical difference between the preoperative, postoperative parameters and reduction in air-bone gap across the three groups. The improvement in hearing denoted by the comparison of air-bone gaps between pre and postoperative measurements was statistically significant (p<0.05). The grafting success rate was 100% in Group I, 96.4% in Group II, and 95.6% in Group III. The authors concluded that butterfly inlay myringoplasty is a reliable surgical method offering high grafting success rate and high rate of hearing gain in patients regardless of the presence or absence of myringosclerosis. However, they recognised that their study has a small number of patients, and they did not evaluate the ratio of myringosclerotic plaque to the remaining tympanic membrane which may impact on graft success and hearing gain. Although the study has limited power, I feel that otologists could consider butterfly inlay tympanoplasty when deciding their tympanoplasty approach for small perforations, irrespective of the presence of myringosclerosis, particularly when morbidity of standard tympanoplasty with tympanomeatal flap elevation might be higher.

Does myringosclerosis affect the success of butterfly myringoplasty?
Akyigit A, Karlidag T, Eroglu O, et al.
AURIS NASUS LARYNX
2023;50(6):854-8.