Comparison between overlay and underlay primary myringoplasty: retrospective analysis on anatomical and functional results in 497 adult patients

BACKGROUND AND AIM: Retro-auricular approach using an autologous graft is the predominant surgical method for myringoplasty (MPL). Endaural and transcanal or endoscopic approaches are also used. There is no definitive consensus on the best MPL surgical technique. Aim of this study is to compare the two most used technique, over and underlay MPL, to evaluate the difference in anatomical and functional outcomes. METHODS: We made a retrospective analysis of 497 adult patients who underwent underlay or overlay primary MPL, between 2010 and 2018, and evaluated the difference in anatomical and functional outcomes. RESULTS: Successful functional results, evaluated after 18 months from surgery, were obtained in 380 patients (76,4%); in the underlay MPL, a successful result was obtained in 85%, in the overlay technique in the 68%. we observed anatomical failure in 13.4% patients; In detail 9,8% underwent MPL underlay and 17,2% MPL overlay. CONCLUSIONS: Our results indicate that underlay technique involves fewer complications. We believe that this remains the technique to prefer, except in subtotal or wide anterior perforations that could be better managed with the overlay technique. (www.actabiomedica.it)