Underlay or overlay myringoplasty in children: which approach is better?

BACKGROUND: Bilateral tympanic membrane perforation may cause a loss of hearing resulting in impaired social interactions and academic performance, delayed language and cognitive development, and lower learning abilities in children. the overlay and the underlay techniques are the two standard methods for perforation repair, with much debate between which of the two is better, especially from the functional point of view. We compared the perforation closure rates and hearing improvement after surgery with the overlay and the underlay techniques to determine which of the two is preferable for tympanic membrane perforation repair in children. METHODS: This retrospective study involved 149 patients who had undergone myringoplasty. Pure tone audiometry was conducted before and after surgery and functional results were defined considering the air bone gap. RESULTS: The overall perforation closure rate was 91.9% in underlay and 90% in overlay technique and the air-bone gap <10 dB was respectively 60.6% and 38%. CONCLUSIONS: In conclusion, myringoplasty may be safe even in younger children and both techniques can achieve high rates of anatomical success. The optimal results after the underlay technique suggest that it should be more widely used and that it should be the first option when considering repair of tympanic membrane perforation.