CC BY-NC-ND 4.0 · Laryngorhinootologie 2018; 97(S 02): S152
DOI: 10.1055/s-0038-1640236
Otologie: Otology
Georg Thieme Verlag KG Stuttgart · New York

Tympanoplasty using the antero-superior-pull-through technique for anterior and subtotal defects of the tympanic membrane – Initial results of a prospective study

A Anagiotos
1  ENT Clinic, Nicosia General Hospital, Zypern, Nikosia, Zypern
AO Gostian
2  Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Erlangen
› Author Affiliations
Further Information

Publication History

Publication Date:
18 April 2018 (online)



Tympanic membrane reconstruction in cases of anterior and subtotal tympanic membrane defects is a challenge to the ear surgeon. In our hands, the so-called antero-superior pull-through technique (ASPT) with perichondrium and possibly cartilage has been proven a reliable method. However, in the literature there are very few results of this technique. Therefore, the aim of this prospective study was to evaluate the results of the ASPT technique in anterior and subtotal tympanic membrane defects.


In the ASPT technique, the annulus fibrosus is almost completely detached, leaving the anterior tympanomeatal angle intact. The anterior part of the tympanic membrane is additionally made accessible via a wide antero-superior tympanotomy. The graft can then be positioned anterior-superior in underlay technique and stabilized on the bony ear canal. To date, 30 consecutive ears with chronic otitis media (Ø 35 years (6 – 77), 20% revision procedures) have been included. Outcomes of the study included eardrum defect closure and the audiologic outcome after type I tympanoplasty.


All patients had an intact tympanic membrane on average 8 weeks postoperatively. Two patients (6.7%) developed myringitis, which healed without consequences. Audiologically a stable bone conduction threshold (p > 0.05) and a significant improvement of the middle ear component by Ø 10 dB (0.5 – 4 kHz) (p < 0.001) were achieved.


The antero-superior pull-through technique provides an alternative method for occluding the technically challenging anterior and subtotal tympanic membrane defects with promising results in the first postoperative period. These results must now be confirmed in long-term studies.