An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 7 , ISSUE 3 ( September-December, 2015 ) > List of Articles


Staining in Tympanoplasty: Is Methylene Blue Rational?

SPS Yadav, Bhushan Kathuria, Himani Dhingra, Joginder Gulia, Sharad Hernot

Keywords : Methylene blue,Myringoplasty,Temporalis fascia,Underlay

Citation Information : Yadav S, Kathuria B, Dhingra H, Gulia J, Hernot S. Staining in Tympanoplasty: Is Methylene Blue Rational?. Int J Otorhinolaryngol Clin 2015; 7 (3):125-131.

DOI: 10.5005/jp-journals-10003-1208

Published Online: 01-04-2016

Copyright Statement:  Copyright © 2015; The Author(s).



Is there any advantages of using methylene blue in myringoplasty? To compare the results of methylene blue stained temporalis fascia graft with unstained temporalis fascia graft in underlay myringoplasty.

Materials and methods

In this prospective study, 120 patients of either sex in age group of 15 to 50 years with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited. Patients were initially managed medically to make the ear dry and after that they were operated upon. Sixty patients underwent underlay myringoplasty using methylene blue stained temporalis fascia graft and 60 patients underwent underlay myringoplasty using unstained temporalis fascia graft. Follow-up period was at least 6 months.


Graft uptake and hearing improvement was comparable in both groups. Although there was 10% higher graft uptake using methylene blue stained temporalis fascia (95%) as compared to unstained temporalis fascia graft (85%), however the difference was not statistically significant (p = 0.5). But there was statistically significant difference in gain in hearing threshold (gain in air-bone gap) in the myringoplasty using methylene blue stained temporalis fascia graft (18 dB ± 7.156) as compared to myringoplasty using unstained temporalis fascia graft (13.7 dB ± 5.70814) (p = 0.04).


Methylene blue use in myringoplasty allows improved identification of the graft, can be very helpful for trainee residents and reduce the time of a graft placement. Also, methylene blue as an antioxidant and antimicrobial properties, prevents degradation and lysis of fascia graft, improves the overall success rate of graft uptake with no adverse effects.

How to cite this article

Kathuria B, Dhingra H, Gulia J, Kakkar V, Yadav SPS, Hernot S, Bishnoi S. Staining in Tympanoplasty: Is Methylene Blue Rational? Int J Otorhinolaryngol Clin 2015;7(3):125-131.

PDF Share
  1. Tympanic reconstruction: fifteen year report on tympanoplasty—Part II. J Laryngol Otol 1976 Aug;90(8):713–741.
  2. Retrospective analysis of surgical outcome, symptoms changes and hearing improvement following myringoplasty. J Otolaryngol 2000 Aug;29(4):229–232.
  3. An endoscopic method of tympanic membrane fluorescein angiography. Ann Otol Rhinol Laryngol 1986 Sep-Oct;99(5 Pt 1):439–443.
  4. Sandwich graft tympanoplasty: experience, results and complications. Laryngoscope 1989 Feb;99(2):213–217.
  5. Use of William's microclips in various aspects of tymanoplastic surgery. Laryngoscope 1981 Dec;91(12):2106–2125.
  6. Loop overaly tympanoplasty for anterior or subtotal perforations. Auris Nasus Larynx 2010 Apr;37(2):162–166.
  7. Mediolateral graft tympanoplasty for anterior or subtotal tympanic membrane perforation. Otolaryngol Head Neck Surg 2005 Apr;132(4):532–536.
  8. Over-underlay tympanoplasty. Laryngoscope 2002 May;112(5):802–807.
  9. Myringoplasty. Clin Otolaryngol Allied Sci 1976;1(1):53–65.
  10. Intraoperative marking of overlay graft: a simple technique to pass a malleus through a hole. Mediterr J Otol 2008;4:217–220.
  11. Intraoperative staining of tympanoplasty grafts: a technique to facilitate graft placement. Otolaryngol Head Neck Surg 2008 May;138(5):682–683.
  12. Intravital staining with methylene blue in tympanoplasty. Eur Arch Otorhinolaryngol 2010 Sep;267(9):1351–1354.
  13. Methylene blue stained temporalis fascia graft tympanoplasty. Laryngoscope 1983 Feb;93(2):241.
  14. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen 2006 Nov-Dec;14(6):680–692.
  15. Methylene blue stain guiding layered excision in Mohs‘ micrographic surgery. Ophthalmic Surg 1991 Apr;22(4):233–236.
  16. Modified methylene blue injection improves lymph node harvest in rectal cancer. ANZ J Surg 2014 Oct 21 (Epub ahead of print).
  17. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Breast J 2001 May-Jun;7(3):181–183.
  18. Methylene blue for diagnosis of displaced atrial lines. Anaesth Intensive Care 2006 Apr;34(2):280–281.
  19. Methylene blue for rapid identification of parathyroids. Br Med J 1971 Sep 18;3(5776):680–681.
  20. Utility and safety of methylene blue demarcation of preauricular sinuses and brachial sinuses and fistulae in children. J Otolaryngol Head Neck Surg 2009 Apr;38(2):302–310.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.