Official publication of Rawalpindi Medical University
Successful Myringoplasty - Do The Site & Size Of TM Perforation Matter?

Supplementary Files


How to Cite

Manzoor A, Hameed MK, Ali I, Khalil N, Umara A, Naveed S. Successful Myringoplasty - Do The Site & Size Of TM Perforation Matter?. JRMC [Internet]. 2023 Jun. 24 [cited 2024 Mar. 2];27(2). Available from:


Objective: To determine the success rate of myringoplasty based on the site and size of tympanic membrane perforation.

Study Design: Cross sectional, Descriptive

Study Settings: ENT Department Fauji Foundation Hospital, Rawalpindi

Study Duration: 30 July 2019 to 29 December 2021.

Material and Methods: After approval of Hospital Ethical Committee, a sample size of 100 patients was calculated by using WHO sample size calculator. Patients were selected through Non probability convenient sampling. Informed consent was obtained from all the patients. All the patients were operated upon through post auricular approach using underlay technique and temporalis fascia was used as a graft in all the cases. Success of myringoplasty was assessed one month after surgery. Myringoplasty was considered successful upon complete closure of the defect as assessed under surgical microscope. Data analysis was done for frequencies and percentages using SPSS version 24.

Results: There were 52% males and 48% females. Mean age of patients was 35.5 years and they ranged between 17 to 48 years. Overall myringoplasty was successful in 71% patients. Regarding the size of perforation, it was successful in 100% pinhead size perforations, in 86.7% small sized, 89.5% medium sized, 42% large and 6.7% subtotal sized perforations. Regarding site of the perforations, myringoplasty was successful in 96% anterior, 100% posterior, 40% inferior, 40% middle and 8% subtotal/ large perforations.

Conclusion: Myringoplasty is an effective surgery for sealing Tympanic Membrane perforations resulting in better quality of life. Success rate of myringoplasty has a definite association with size and site of perforation. The smaller the perforation, the higher would be the success rate. Similarly, anterior and posterior perforations heal better as compared to inferior and mid position perforations.

Key words: Myringoplasty, Size and site of Tympanic membrane perforation, Tympanic membrane, Chronic Suppurative Otitis Media.


Emmett SD, Kokesh J, Kaylie D. Chronic Ear Disease. Med Clin North Am. 2018 Nov;102(6):1063-1079. doi: 10.1016/j.mcna.2018.06.008. Epub 2018 Sep 20. PMID: 30342609.

Mittal R, Lisi CV, Gerring R et al. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015; 64 (10):1103-1116. doi: 10.1099/jmm.0.000155.

Le TT, Vo DMN, Duong TM, Nguyen N. Endoscopic transcanal myringoplasty with anterior tab flap underlay technique: An analysis of 35 cases. Ann Med Surg (Lond). 2022 Jul 11; 80:104135. doi: 10.1016/j.amsu.2022.104135. PMID: 35846857; PMCID: PMC9283794.

Golz A, Goldenberg D, Netzer A et al. Paper patching for chronic tympanic membrane perforations. Otolaryngol Head Neck Surg, 2003; 128 (4): 565-570. doi: 10.1016/S0194-59980300124-4

Sharma C, Singh J, Kakkar V et al. Fat graft myringoplasty in small central perforations. Indian J Otol 2014; 20: 211-215. doi:10.4103/0971-7749.146942

Han JS, Han JJ, Park JM et al. The long-term stability of Fat-Graft Myringoplasty in the closure of tympanic membrane perforations and hearing restoration. ORL, 2021; 83: 85-92. DOI: 10.1159/000512084

Din I, Khan AR, Shafiullah et al. Outcome of Myringoplasty of graft success rate in patients with Chronic Otitis Media. J Med Sci, 2015; 23 (4): 209-212.

Yorgancılar E, Yildirim M, Gun R, Bakir S, Tekin R, Gocmez C et al. Complications of chronic suppurative otitis media: a retrospective review. Eur Arch Otorhinolaryngol. 2013; 270 (1): 69-76. doi: 10.1007/s00405-012-1924-8.

Lou Z. Endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal to repair marginal perforations. Journal of Otolaryngology - Head and Neck Surgery, 2020; 49: 13.

Acharya R, Tulachan B, Acharya A. Myringoplast graft uptake: Short and Long term outcome. J Univ Coll of Med Sci, 2022; 10 (1): 24-27. DOI:

Karunaratne D, Violaris N. Myringoplasty Outcomes from a 5-years single surgeon’s experience and important surgical technical aspects. J Audiol Otol 2021; 25 (4): 224-229.

Dangol K, Shrivastav RP. Study of various prognostic factors affecting successful myringoplasty in a tertiary care centre. Int Arch Otorhinolaryngol 2017; 21: 250-254. doi: 10.1055/s-0036-1593818

Monfared A, Bergeron CM, Ortiz J, Lee H, Kamine K, Dray T, et al. Bivalve cartilage inlay myringoplasty: an office based procedure for closing small to medium sized tympanic membrane perforations. Otolaryngol Head Neck Surg. 2008; 139 (5): 630-634. doi: 10.1016/j.otohns.2008.08.007.

Lee P, Kelly G, Mills RP. Myringoplasty: does the size of the perforation matter? Clin Otolaryngol Allied Sci. 2002; 27(3): 331–334. doi: 10.1046/j.1365-2273.2002.00590.x.

Garcia RB, Suarez-Varela MMM, Conjeros JMT, Porras GA, Puchades VM, Galofre JD. Myringoplasties. A retrospective analysis of our surgical outcomes. Acta Otorrinolaringol Esp. 2011; 62 (3): 213–219.

Biswas SS, Hossain MA, Alam MM, Atiq MT, Al-Amin Z. Hearing evaluation after myringoplasty. Bangladesh J Otorhinolaryngol. 2010; 16 (1): 23–28. https:// 10.3329/bjo.v16i1.5777

Awan Z, Bashir H, Hussain A. Myringoplasty: a comparative study of different graft materials and various surgical techniques. Ann Pak Inst Med Sci. 2008; 4 (4): 209–211.

Singh SP, Nagi RS, Singh J. To study the effect of site and size of tympanic membrane perforation on graft uptake rates and hearing improvement in type I tympanoplasty using sliced conchal cartilage reinforced with temporalis muscle fascia and temporalis muscle fascia alone. Indian J Otol 2019; 25: 121-126. doi: 10.410 /indianjotol.INDIANJOTOL_94_18

Mondal SK, Biswas AK, Huq MM et al. Hearing gain after myringoplasty in relation to the size of tympanic membrane perforation. Bangladesh J Otorhinolaryngol, 2020; 25 (1): 54 – 59.

Kim HC, Park KS, Yang HC, Jang CH. Surgical results and factors affecting outcome in patients with fat-graft myringoplasty. Ear Nose Throat J. 2021 Dec 9:1455613211063243. doi: 10.1177/01455613211063243. Epub ahead of print. PMID: 34881650.

Wu PW, Wang WH, Huang CC, Lee TJ, Huang CC. Comparison of short and long term hearing outcomes of successful inlay cartilage tympanoplasty between small and large eardrum perforations. Clin Exp Otorhinolaryngol. 2015; 8 (4): 359-363. doi: 10.3342/ceo.2015.8.4.359

Westerberg J, Harder H, Magnuson B, Westerberg L, Hyden D. Ten year myringoplasty series: Does the cause of perforation affect the success rate? JLO 2011; 125 (2): 126-132. doi: 10.1017/S0022215110002069.

Carr SD, Strachan DR, Raine CH, Factors affecting myringoplasty success. J Laryngol Otol. 2015; 129 (1): 23-26. doi: 10.1017/S0022215114003156.

Pothala H, Shukla SC, Khan W, Ramalingam R, Ramalingam KK. A prospective comparative study between dry and wet tympanoplasty. Ann Otol Neurotol ISO, 2018; 1: 83-88. DOI

Das A, Sen B, Ghosh D, Sengupta A. Myringoplsty: Impact of size of perforation on the success rate. Indian J Otolaryngol Head Neck Surg, 2015; 67 (2): 185-189. doi 10.1007/s12070-014-0810-7

Gersdorff M, Garin P, Decat M, Juantegui M. Myringoplasty: long-term results in adults and children. Am J Otol. 2010; 16 (4): 532-535. PMID: 8588656

Darouassi Y, Aljalil A, Ennouali A et al. Prognostic factors of myringoplasty: a study of 140 cases series and review of the literature. The Pan African Medical Journal. 2019; 33: 323. doi:10.11604/pamj.2019.33.323.18060

Karakus MF, Karakurt SE, Cloak M, Dere HH. The effect of perforation size and site on graft success and hearing in Cartilage Tympanoplasty with mastoidectomy. Middle Black Sea Journal of Health Sciences, 2020; 6 (3): 364-368. DOI: 10.19127/mbsjohs.801416

Tseng CC, Lai MT, WuCC, Yuan SP, Ding YF. Endoscopic Transcanal Myringoplasty for Anterior Perforations of the Tympanic Membrane. JAMA Otolaryngol Head Neck Surg. 2016; 142 (11):1088-1093. doi: 10.1001/ jamaoto.2016.2114.

Singh GB, Sidhu TS, Sharma A, Singh N. Tympanoplasty type 1 in children: an evaluative study. Int J Pediatr Otorhinolaryngol. 2005; 69 (8):1071–1076. doi: 10.1016/j.ijporl.2005.02.016.

Lima JC, Marone SA, Martucci O, Goncalez F, da Silva Neto JJ, Ramos AC. Evaluation of the organic and functional results of tympanoplasties through a retro-auricular approach at a medical residency unit. Braz J Otorhinolaryngol. 2011; 77 (2): 229–236. doi: 10.1590/s1808-86942011000200013

Saleh EM, Salem MAM, Nemr SHA. Impact of site and size of pars tensa tympanic membrane perforation on the success rate of myringoplasty. Egypt J Otolaryngol, 2019; 35: 339-346. doi: 10.4103/ejo.ejo_69_18.

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright (c) 2023 Mirza Khizar Hameed Mirza Khizar Hameed, Dr Areesha Manzoor, Dr Irshad Ali, Dr Nudrat Khalil, Dr Seema Naveed, Dr. Ansa Umara