Difficulties that arise in closing anterior perforations in the tympanic membrane are due to a narrow isthmus of the external auditory canal and an anterior wall bulge which obscures the most anterior part of the tympanic membrane. The conventional microscopic method may require anterior canalplasty in addition to making periauricular incisions and raising a tympanomeatal flap. In this presentation, the authors describe two endoscopic methods, namely butterfly-inlay and push-through cartilage graft techniques for small anterior perforations. The series comprises 71 cases put into the two surgical groups: 34 patients undergoing butterfly-inlay cartilage myringoplasty and 31 undergoing push-through myringoplasty by endoscopic method. The former does not require a medial stabilisation buffer which is necessary in the latter for medial support from within the tympanic cavity. This results in fullness of the middle ear that can persevere perceptibly and functionally for quite some time. The study showed comparable success rates and air-bone closure in the two groups. The butterfly-inlay technique took less time to do. Cases with anterior canal wall bulge did not take any longer than those without. Advantages of endoscopic technique over the conventional microscopic method are better visualisation and avoidance of periauricular incisions, though the former takes a learning curve to operate single handed and bleeding control may be difficult. The article provides useful incentive for those developing oto-endoscopic techniques.
Two reliable endoscopic myringoplasty techniques for anterior tympanic membrane perforations
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