Hearing Evaluation After Myringoplasty in Underlay Technique

Abstract

Background: Chronic suppurative otitis media (CSOM), particularly the inactive mucosal variety, remains a significant cause of hearing impairment in Bangladesh. Myringoplasty is a commonly performed surgical procedure to restore  the integrity of the tympanic membrane and improve hearing. This study aimed to evaluate hearing outcomes  following myringoplasty using the underlay technique.
Objective: To evaluate hearing improvement and factors influencing outcomes following underlay myringoplasty in CSOM patients.
Materials and Methods: This cross-sectional study was conducted at Ad-din Women’s Medical College and Hospital,  Dhaka, over a 24 month period from January 2023 to December 2024. Forty patients aged 15–45 years with central perforation of the tympanic membrane due to inactive mucosal CSOM were selected based on strict inclusion and exclusion criteria. All patients underwent myringoplasty using the underlay technique with autologous temporalis fascia. Hearing improvement was assessed through pure tone audiometry, measuring air conduction thresholds and air-bone gap preoperatively and at the 5th and 9th postoperative weeks.
Results: The overall graft take rate was 92.5%. Hearing gain (defined as an improvement in air conduction threshold) was observed in 70% of patients. The mean preoperative air conduction threshold and air bone gap were 37.27 ± 8.96 dB and 26.01 ± 2.27 dB, respectively, which improved to 27.41 ± 5.67 dB and 17.56 ± 1.70 dB postoperatively. Greater hearing  gain was noted in patients with small perforations and posterior sites, whereas subtotal perforations had comparatively less gain. No statistically significant association was found between hearing improvement and age, sex, or habitat.
Conclusion: Myringoplasty using the underlay technique is effective in achieving a high rate of graft uptake and significant hearing improvement. Factors such as size and site of perforation influence the audiological outcomes. These findings can guide surgical decision-making and patient counseling in managing CSOM.

The Journal of Ad-din Women's Medical College; Vol. 13 (2), July 2025; p 3-8