gms | German Medical Science

Background: Simple underlay myringoplasty (SUM) with fibrin glue was developed by Dr. Yuasa in 1989. Over the last 15 years, this transcanal technique has become widely adopted in Japan because of its simplicity and high success rate.

Objective: To introduce SUM to European otolaryngologists.

Subjects: 423 ears with perforated ear drum underwent SUM at Sendai Ear Surgicenter from 2000 to 2004. They aged from 4 to 87 years (mean: 46.0 years). The surgical indications were for cases without cholesteatoma, with hearing gain in a paper patch test, and with no shadow in the tympanic cavity on CT.

Technique: A transcanal approach is used. The margin of the perforation is freshened with a fine pick under local anesthesia. A graft of connective tissue is obtained from the retroauricular region, and is inserted through the perforation. The stretched graft is gently lifted to make contact with the edge of the perforation, and a few drops of fibrin glue are applied to the contact area. There is no packing in the external canal (see Figs. 1 and 2 in Katsura H, Sakagami M, et al, Otol Neurotol 26: 842-845, 2005). If the perforation persists, then re-closure is attempted in the office by using the patient’s frozen material.

Results: Overall rate of closure was 341/423 (80.6%), and that after re-closure was finally 404/423 (95.5%). In 82 ears with failure of closure, the initial size of perforation was small in 46 ears, middle in 26 ears, large in 9 ears, and multiple in 1 ear.

Conclusions: SUM had advantages of simplicity of technique, a high rate of closure of the perforation and very low incidence of complications. SUM was also applied to bilateral same day surgery for bilateral chronic otitis media and surgery on an only hearing ear.