Research Article

Success Rate of Revision Myringoplasty Using Temporalis Fascia Graft


Background and Aim: To evaluate the success rate of revision myringoplasty using temporalis fascia graft and to assess the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome such as size and site of perforation, whether the patient is smoking or not and condition of contralateral ear.
Methods: Thirty patients were included in this prospective study, who underwent revision myringoplasty for chronic otitis media without cholesteatoma in the period between 2017-2019 in the Department of Ear, Nose, and Throat-Head and Neck Surgery in Almowasat University Hospital. Data of all patients: perforation size and site, middle ear status, surgical approach, graft material, pre and postoperative morphological and functional results were assessed. The temporal fascia was used for the reconstruction of TM. The interrelation between multiple preoperative parameters and postoperative morphological (closure of the perforation) and functional (hearing level) outcomes were assessed.
Results: Successful closure rate of the TM perforation was 86.66% and failure rate was 13.34% in revision myringoplasty. The improvement of the air bone gap between 10-20 dB was 76.66% while the air bone gap between 20-30 dB was unchanged 23.33%.
Conclusion: Revision myringoplasty can offer reasonably good chances for postoperative graft healing and hearing improvement with a high success rate. This gives the patient a good benefit in protecting the ear from developing complications that may have poor structural changes in the middle ear (ossicular necrosis and tympanosclerosis) which in turn leads to hearing loss.

[1] Kazikdas KC, Onal K, Boyraz I, Karabulut E. Palisade cartilage tympanoplasty for management of subtotal perforations: a comparison with the temporalis fascia technique. Eur Arch Otorhinolaryngol. 2007;264(9):985-9. [DOI:10.1007/s00405-007-0291-3]
[2] Ozbek C, Ciftçi O, Tuna EEU, Yazkan O, Ozdem C. A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results. Otol Neurotol. 2008;29(5):679-83. [DOI:10.1097/MAO.0b013e31817dad57]
[3] Sheehy JL, Anderson RG. Myringoplasty. A review of 472 cases. Ann Otol Rhinol Laryngol 1980;89:331–4. Ann Otol Rhinol Laryngol. 1980;89(4 Pt 1):331-4. [DOI:10.1177/000348948008900407]
[4] Boone RT, Gardner EK, Dornhoffer JL. Success of cartilage grafting in revision tympanoplasty without mastoidectomy. Otol Neurotol. 2004;25(5):678-81. [DOI:10.1097/00129492-200409000-00006]
[5] Dornhoffer J. Cartilage tympanoplasty: Indications, techniques, and outcomes in A 1,000-patient series. Laryngoscope. 2003;113(11):1844-56. [DOI:10.1097/00005537-200311000-00002]
[6] Angeli SI, Kulak JL, Guzmán J. Lateral tympanoplasty for total or near-total perforation: prognostic factors. Laryngoscope. 2006;116(9):1594-9. [DOI:10.1097/01.mlg.0000232495.77308.46]
[7] Djalilian HR. Revision tympanoplasty using scar tissue graft. Otol Neurotol. 2006;27(2):131-5. [DOI:10.1097/01.mao.0000190462.50755.f2]
[8] Chang CYJ, Gray LC. Pressed scar tissue for tympanic membrane grafting in revision tympanoplasty. Otolaryngol Head Neck Surg. 2005;132(1):30-6. [DOI:10.1016/j.otohns.2004.09.086]
[9] Neumann A, Jahnke K. [Reconstruction of the tympanic membrane applying cartilage: indications, techniques and results]. HNO. 2005;53(6):573-84; quiz 585-6. German. [DOI:10.1007/s00106-005-1280-8]
[10] Berger G, Ophir D, Berco E, Sadé J. Revision myringoplasty. J Laryngol Otol. 1997;111(6):517-20. [DOI:10.1017/s0022215100137818]
[11] Halik JJ, Smyth GD. Long-term results of tympanic membrane repair. Otolaryngol Head Neck Surg. 1988;98(2):162-9. [DOI:10.1177/019459988809800211]
[12] Altuna X, Navarro JJ, Martínez Z, Lobato R, Algaba J. [Island cartilage myringoplasty. Anatomical and functional results in 122 cases]. Acta Otorrinolaringol Esp. 2010;61(2):100-5. Spanish. [DOI:10.1016/j.otorri.2009.09.002]
[13] Booth JB. Myringoplasty. The lessons of failure. J Laryngol Otol. 1974;88(12):1223-36. [DOI:10.1017/s0022215100079950]
[14] Indorewala S. Dimensional stability of the free fascia grafts: an animal experiment. Laryngoscope. 2002;112(4):727-30. [DOI:10.1097/00005537-200204000-00024]
[15] Buckingham RA. Fascia and perichondrium atrophy in tympanoplasty and recurrent middle ear atelectasis. Ann Otol Rhinol Laryngol. 1992;101(9):755-8. [DOI:10.1177/000348949210100907]
[16] Utech H. Uber diagnostische und therapeutische Moglichkeiten der Tympanotomie bei Schalleitungstorungen. Z Laryn Rhinol. 1959;38:212-21.
[17] Heermann J. Autograft Tragal and Conchal Palisade Cartilage and Perichondrium in Tympanomastoid Reconstruction. Ear Nose Throat J. 1992;71(8):344-9. [DOI:10.1177/014556139207100803]
[18] Amedee RG, Mann WJ, Riechelmann H. Cartilage palisade tympanoplasty. Am J Otol. 1989;10(6):447-50. [DOI:10.1097/00129492-198911000-00006]
[19] Kotecha B, Fowler S, Topham J. Myringoplasty: a prospective audit study. Clin Otolaryngol Allied Sci. 1999;24(2):126-9. [DOI:10.1046/j.1365-2273.1999.00227.x]
[20] Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of otological, surgical and patientrelated factors in determining success in myringoplasty. Clin Otolaryngol. 2005;30(2):115-20. [DOI:10.1111/j.1365-2273.2004.00947.x]
[21] Sevil E, Doblan A. Significance of the middle ear risk index in predicting tympanoplasty success in the elderly. Eur Arch Otorhinolaryngol. 2021;278(10):3689-95. [DOI:10.1007/s00405-020-06430-9]
[22] Sismanis A, Dodson K, Kyrodimos E. Cartilage “shield” grafts in revision tympanoplasty. Otol Neurotol. 2008;29(3):330-3. [DOI:10.1097/mao.0b013e318161aae1]
[23] Caylan R, Titiz A, Falcioni M, de donatto G, Russo A, Taibah A, et al. Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg. 1998;118(5):709-13. [DOI:10.1177/019459989811800529]
[24] Ophir D, Porat M, Marshak G. Myringoplasty in the pediatric population. Arch Otolaryngol Head Neck Surg. 1987;113(12):1288-90. [DOI:10.1001/archotol.1987.01860120034003]
[25] Moore GF. Candidate’s thesis: Revision tympanoplasty utilizing fossa triangularis cartilage. Laryngoscope. 2002;112(9):1543-54. [DOI:10.1097/00005537-200209000-00003]
[26] Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD. Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope. 2006;116(10):1813-6. [DOI:10.1097/01.mlg.0000231742.11048.ed]
[27] Westerberg J, Harder H, Magnuson B, Westerberg L, Hydén D. Ten-year myringoplasty series: does the cause of perforation affect the success rate? J Laryngol Otol. 2011;125(2):126-32. [DOI:10.1017/S0022215110002069]
[28] Wasson JD, Papadimitriou CE, Pau H. Myringoplasty: impact of perforation size on closure and audiological improvement. J Laryngol Otol. 2009;123(9):973-7. [DOI:10.1017/S0022215109004368]
IssueVol 31 No 4 (2022) QRcode
SectionResearch Article(s)
Revision myringoplasty temporalis fascia tympanic membrane perforation

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Alhiraki IA. Success Rate of Revision Myringoplasty Using Temporalis Fascia Graft. Aud Vestib Res. 2022;31(4):289-294.