ENT - September 2020 - 522

Clinical Study

Simultaneous Bilateral Same-Day
Endoscopic Myringoplasty Using
Tragal Cartilage From One Ear

Ear, Nose & Throat Journal
2020, Vol. 99(8) 522-527
ª The Author(s) 2019
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DOI: 10.1177/0145561319854065
journals.sagepub.com/home/ear

Baklaci Deniz, MD1, Kuzucu Ihsan, MD2, Guler Ismail, MD3,
Kum Rauf Oguzhan, MD3, and Ozcan Muge, MD3

Abstract
The aim of this study is to investigate the outcomes of bilateral same-day endoscopic myringoplasty using tragal cartilage from one
ear in patients with bilateral chronic otitis media. In this retrospective study, medical records of 62 (84 ears) patients aged
between 18 and 65 years who underwent endoscopic myringoplasty at our center between January 2015 and December 2017
were evaluated. Patients were classified into 2 groups according to surgical procedure they received: unilateral myringoplasty
(group 1) and bilateral same-day myringoplasty (group 2). The comparisons were made between groups in terms of anatomical
graft success and functional outcomes. There were 40 patients in the unilateral group (group 1) and 22 patients in the bilateral
same-day group (group 2). The graft success rates were 92.5% and 93.2% for groups 1 and 2, respectively (P ¼ .904). The mean
preoperative air-bone gaps (ABGs) were 21.1 + 7.1 and 20.5 + 6.7 dB, respectively, whereas the mean postoperative ABGs
were 8.1 + 2.7 dB and 7.9 + 3.0 dB, respectively. The difference between pre- and postoperative ABGs for the entire group was
statistically significant (P < .001). Mean hearing gain was 12.5 + 11.0 dB and 15.6 + 10.1 dB in groups 1 and 2, respectively,
(P ¼ .183). Postoperative ABG was 10 dB in 33 (82.5%) and 36 (81.8%) ears in groups 1 and 2, respectively. The functional
success rates were similar in both groups (P ¼ .582). The average lengths of operation time were 61.6 + 12.5 minutes and 110.1
+ 25.2 minutes for groups 1 and 2, respectively. Bilateral same-day endoscopic myringoplasty using tragal cartilage from one ear
seems to be a safe and satisfactory procedure with a good satisfactory success rate.
Keywords
myringoplasty, endoscopic, bilateral, same-day, chronic otitis media

Introduction
Myringoplasty, a common and well-established method for
the repair of tympanic membrane (TM) perforations, is conventionally performed under the guidance of a surgical microscope via retroauricular, endaural, and transcanal approaches.
Recently, the endoscopic transcanal approach has been preferred predominantly because it does not necessitate incision
or canaloplasty, is less invasive than the microscopic
approach, does not require transplantation of hair to the ear
region, and reduces postoperative bleeding and pain.1 Huang
et al2 reported that the endoscopic technique for tympanoplasty offered cosmetically improved outcomes and decreased
operative time and exposure to anesthetic agents and associated complications.
Traditionally, each TM was obtained for grafting sequentially in 2 different settings, considerably increasing the cost,
time, and patient discomfort.3 The concept of bilateral sameday myringoplasty is debatable. Among otologic surgeons
globally, the traditional approach to a patient with bilateral
TM perforations is 2-staged, leading to a significant increase
in cost and time along with greater patient discomfort to the

patient.3 This has primarily been attributed to the theoretical
risk of iatrogenic sensorineural hearing loss (ISNHL), which is
approximately 1.2% to 4.5%.4-6 However, it is essential to note
the risk of ISNHL, which is encountered primarily in patients
with cholesteatoma, congenital malformation, or granulation
tissue or in cases where ossiculoplasty has been performed.
Tos et al6 reported no incidence of ISNHL in a series of 439
patients undergoing myringoplasty. Another argument against
performing bilateral myringoplasty is the idea that bilateral ear

1

Department of Otolaryngology, Kahramankazan State Hospital, Ankara,
Turkey
2
Faculty of Medicine, Department of Otolaryngology, Hospital of Aksaray
University, Aksaray, Turkey
3
Department of Otolaryngology, Numune Training and Research Hospital,
Ankara, Turkey
Received: March 15, 2019; revised: May 7, 2019; accepted: May 10, 2019
Corresponding Author:
Baklaci Deniz, MD, Department of Otolaryngology, Kahramankazan State
Hospital, 931st Avenue 945 Street No: 5/3, Ilker, Ankara, Turkey.
Email: doktorent@gmail.com
https://www.sagepub.com/journals-permissions https://www.doi.org/10.1177/0145561319854065 http://journals.sagepub.com/home/ear
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