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<p>Double-layer myringoplasty, combining cartilage and perichondrium, may enhance graft stability over single-layer repair, but concerns about hearing and operative burden remain. We analyzed four randomized trials (309 adults with large/subtotal perforations) from major databases up to May 2025. Risk ratios (RR) and mean differences (MD) were pooled; GRADE assessed evidence certainty. Double-layer repair improved graft success (RR 1.09, 95% CI 1.03–1.15) and reduced residual/recurrent perforations without affecting postoperative air–bone gap (MD − 0.44 dB) or bone-conduction thresholds (MD − 0.27 dB). Operative times were similar, though heterogeneous. Graft misplacements occurred only in single-layer arms. Evidence certainty was high for anatomical outcomes, moderate to low for hearing and time measures. Double layer myringoplasty offers superior anatomical results without compromising hearing or operative efficiency. It is a preferred option for challenging perforations, pending confirmation in larger, long-term trials.</p>

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Double-Layer vs. Single-Layer Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Control Trials with Grade Assessment

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Mohamed Saad Rakab,
  • Ibraheem Altamimi,
  • Ibrahim M. Alabdulkarim,
  • Abdulmajeed Fahad N. AlOtaibi,
  • Abdullah Obaid Almutairi,
  • Lojain Abdulsalam Alkhaldi,
  • Abdulrahman Alzmmam,
  • Noura Almarri,
  • Mohammed Adel Albalawi,
  • Haidar Bonajmah,
  • Bandar M. Alkhamsi

摘要

Double-layer myringoplasty, combining cartilage and perichondrium, may enhance graft stability over single-layer repair, but concerns about hearing and operative burden remain. We analyzed four randomized trials (309 adults with large/subtotal perforations) from major databases up to May 2025. Risk ratios (RR) and mean differences (MD) were pooled; GRADE assessed evidence certainty. Double-layer repair improved graft success (RR 1.09, 95% CI 1.03–1.15) and reduced residual/recurrent perforations without affecting postoperative air–bone gap (MD − 0.44 dB) or bone-conduction thresholds (MD − 0.27 dB). Operative times were similar, though heterogeneous. Graft misplacements occurred only in single-layer arms. Evidence certainty was high for anatomical outcomes, moderate to low for hearing and time measures. Double layer myringoplasty offers superior anatomical results without compromising hearing or operative efficiency. It is a preferred option for challenging perforations, pending confirmation in larger, long-term trials.