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The two classical techniques that have been developed are the "underlay" and the "overlay" procedures. The surgical technique is better is still matter of debate. overlay), site of perforation and type of graft utilized. Several factors may affect surgical outcome such as the surgical approach (endaural, postaural) and technique (underlay vs. The principal indications are recurrent otorrhea, the desire to swim without having to waterproof the ear and to improve conductive hearing loss. Introduced by Berthold 2, myringoplasty was further developed by Wullstein 3 and Zollner 4. Up to 80% of these perforations heal spontaneously 1 for the remaining, surgical repair, known as myringoplasty, is usually proposed.
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Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. Concludendo nella nostra casistica, mediante le miringoplastiche underlay e overlay abbiamo ottenuto un'alta percentuale di successo sia come guarigione che come guadagno uditivo, quest'ultimo più accentuato nel gruppo underlay. Il guadagno uditivo è stato significativo in entrambi i gruppi sebbene maggiore nel gruppo di pazienti trattati con tecnica underlay. Abbiamo registrato 5 insuccessi nel primo gruppo e 3 nel secondo. Nella nostra casistica 63 pazienti sono stati sottoposti a miringoplastica con tecnica overlay e 52 con tecnica underlay. La tecnica underlay è stata impiegata, invece, per il trattamento delle perforazioni più piccole e per quelle dei quadranti posteriori. La miringoplastica overlay è stata preferibilmente effettuata per le perforazioni subtotali, per quelle che interessano i quadranti anteriori e nelle revisioni. Abbiamo valutato la guarigione e i risultati funzionali di 115 pazienti sottoposti a miringoplastica per otite media cronica e perforazione post-traumatica della membrana timpanica. Le due principali tecniche di miringoplastica sono l'underlay e l'overlay, che differiscono per i rapporti che l'innesto contrae con l'anulus e i residui della membrana del timpano. The air bone gap improved significantly in both groups with a better hearing gain in the underlay group. In the former group, five cases were anatomically unsuccessful, whereas in the second group there were three failures. Of 115 cases, 63 underwent an overlay myringoplasty and 52 underlay myringoplasty. We reserve an underlay technique for smaller perforations and for those limited to the posterior part of the tympanic membrane. We prefer an overlay technique in subtotal perforations, in those involving the anterior and antero-inferior parts of the ear drum with respect to the handle of the malleus and in revision surgery. 115 patients who underwent myringoplasty for tympanic membrane perforation secondary to chronic otitis media and/or trauma were included, and hearing function was evaluated. In myringoplasty, the two most common techniques for positioning the graft relative to the remnant of both the tympanic membrane and the annulus are the "overlay" and the "underlay" techniques.
OVERPLAY FOR THE UNDERLAY SERIES
In this series of patients, the underlay or overlay positioning of a graft achieves successful outcome for both repair of perforation and hearing function, with better hearing gain in the underlay group.