Failures in myringoplasty.

We analyzed those failures occurring in 417 myringoplasties. Forty-four drum re-perforations were found (10.6%), half of which occurred immediately after operation. Causes of these early failures included necrosis in the middle of the graft without infection (10 ears) and blunting of the anterior margins of the graft (7 ears). Infection was the most common cause of re-perforations in the later failures. Re-perforations also occurred more frequently when larger perforations were closed in contrast to repair of small ones. We found that other pre-operative factors ("dry" or "wet" ear, site of the perforation) or grafting technique ("underlay" or "overlay") did not affect the graft take-rate. Adhesive eardrums were found in 23 ears (5.5%). These were more common when ears were infected pre-operatively, when middle ear mucosa was removed during the primary operation, or when squamous epithelium was present on the tympanic mucosa. Lateralization of the grafted eardrum was found in two cases (0.5%), both of which had been operated on using the sandwich technique.