Success and pitfalls in myringoplasty: follow-up study of 404 cases.

Results of 404 primary myringoplasty operations were critically analyzed. Patients who underwent tympanic membrane repair as the only procedure were included. In all cases, temporal muscle fascia was used as graft material. Mean follow-up period was 5.5 years. Overall success rate was found to be 88 percent. Welding injuries did not heal as well as other traumatic perforations or perforations caused by otitis media. Age of the patient, size or site of perforation, or surgical technique (underlay or overlay) did not affect success rate. Twenty-five percent of the failures were considered to be attributable to eustachian tube insufficiency. One percent (5 cases) failed as a result of chronic mastoiditis overlooked by the surgeon. Postoperative cholesteatoma developed in three ears (0.7%). Postoperative air-bone gap within 10 dB was achieved in 61 percent and within 20 dB in 87 percent of patients. In 11 of the audiologic failures, the cause of persistent conductive hearing loss was found to be fixation or erosion of the ossicles overlooked by the surgeon. The most decisive factor influencing results appeared to be the surgeon's experience.