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Typ I Tympanoplasty – Techniques-Comparison
18 April 2018 (online)
Onlay or underlay technique, the goal of the restoration of the eardrum is the same. The underlay technique is nowadays more popular.
Material and methods:
Sixty patients between 5 and 78 years of age, mean 38 years, were operated in our ENT-clinic by three skilled surgeons between 2015 – 2016. The preoperative data, surgery techniques and postoperative results were retrospectively analysed.
Twenty-five patients received a tympanoplasty with enaural approach in onlay technique. All of them had subtotal defects, reaching the anterior part of the limbus.
Thirty-five patients received an underlay-technique. Twenty-nine were operated through an enaural approach, six with a retroauricular incision. All of them received a chain control and enaural atticotomy, in four cases a cholesteatoma was removed. The ABG preoperative in the onlay-technique group was 21,20 dB and in the overlay-technique groupe15,93 dB. Postoperatively there was no significant difference in the modification from the 2 group. Both groups are similar in type and frequency of complications: residual or re-perforation, sensorineural hearing loss, dizziness and tinnitus. The wound healing was 6.5 days longer (median) in the overlay technique group.
The underlay-technique remains the method of choice. The onlay-technique is elaborate, time consuming and needs much experience. It can be used for subtotal perforations situated near the anterior rim. The extended ear canal drilling, danger of blunting or cholesteatoma formation are disadvantages of the onlay-technique that occur but can be minimized in skilled hands.