Comparison of Endoscopic Tympanoplasty with Microscopic Tympanoplasty

Background: Minimally invasive surgery has recently been developed along with endoscopic techniques. Endoscopic Ear Surgery is becoming popular with its anatomic and physiologic concepts. Tympanoplasty is one of the commonest operations performed for the middle ear. While using the endoscope we can place the graft accurately while avoiding unnecessary post or endaural incision and soft tissue dissections which are mandatory during tympanoplasty using a microscope. Our study was aimed to compare the outcomes of endoscopic and microscopic tympanoplasty in terms of graft uptake, hearing outcome and postoperative pain. Methods: This is a retrospective comparative study of 63 patients who underwent type 1 tympanoplasty at Holy Family Hospital ENT Department from March 2017 to March 2020. The subjects were classified into 2 groups; Endoscopic tympanoplasty (ET, n=30), Microscopic Tympanoplasty (MT, n=33). Type 1 Tympanoplasty, was the procedure done on patients of both the groups. Demographic data, perforation size of the tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated. Results : The perforation size of the tympanic membrane in the Endoscopic group and the microscopic group was nearly the same (p=.877). Pre and post-operative air-bone gaps including air and bone conduction thresholds were not significantly different between the two groups. The graft success rate in the endoscopic and Microscopic group was 93.3% and 63.3% respectively; the values were significantly different(p=0.0046). Immediate and 6 hours postoperative pain was similar in both the groups, however pain on ist postoperative day was significantly lower in the endoscopic group. Conclusion: We can do minimal invasive tympanoplasty with the help of endoscopes with better graft success rate, less preoperative time, and less postoperative pain.

Download Full-text

Is Allergic Rhinitis a Factor That Affects Success of Tympanoplasty?

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.48 ◽

2016 ◽

Vol 59 (1) ◽

pp. 10-13

Author(s):

Elif Ersoy Callioglu ◽

A. Sami Bercin ◽

Hayati Kale ◽

Togay Muderris ◽

Sule Demirci ◽

...

Keyword(s):

Allergic Rhinitis ◽

Success Rate ◽

Middle Ear ◽

Success Rates ◽

Type 1 Tympanoplasty ◽

Significant Difference ◽

Patient Groups ◽

The Difference ◽

Graft Success

Objective: The aim of the present study was to investigate the effect of allergic rhinitis on the success of the operation in chronic otitis surgery by using score for allergic rhinitis (SFAR). Materials and Methods: In the present study; 121 patients, who underwent type 1 tympanoplasty were examined retrospectively. SFAR of all patients were recorded. The graft success rates of 26 patients with allergic rhinitis (AR) and 95 patients with no allergic rhinitis group (NAR) were compared. Results: While the graft success rate in NAR group was 89.5%, this rate was 80.8% in the AR group. However, the difference between groups was not statistically significant (p = 0.311). Conclusion: These findings suggest that allergic rhinitis decreases the graft success rate of the pathologies occurring in eustachian tube, middle ear and mastoid although statistically significant difference wasn’t found. Prospective studies with larger patient groups are required in order to evaluate this pathology.

Download Full-text

Boomerang-Shaped vs. Shield-Shaped Chondroperichondrial Cartilage Grafts for Type 1 Tympanoplasty in Children: A Study of 121 Patients

Ear Nose & Throat Journal ◽

10.1177/0145561317096010-1121 ◽

2017 ◽

Vol 96 (10-11) ◽

pp. 419-432 ◽

Cited By ~ 2

Author(s):

Can Özbay ◽

Fatih Kemal Soy ◽

Erkan Kulduk ◽

Riza Dundar ◽

Ahmet Yükkaldiran ◽

...

Keyword(s):

Tympanic Membrane ◽

Graft Material ◽

Success Rates ◽

Cartilage Grafts ◽

Type 1 Tympanoplasty ◽

Grafting Technique ◽

Study Population ◽

Graft Success ◽

The Impact

Many techniques and graft materials have been used for the reconstruction of the tympanic membrane. We conducted a retrospective study to compare anatomic and functional outcomes of type 1 tympanoplasty that we performed with boomerang-shaped chondroperichondrial cartilage grafts (BSGs) and shield-shaped chondroperichondrial cartilage grafts (SSGs) in pediatric patients. Our study population was made up 121 patients—61 boys and 60 girls, aged 7 to 16 years (mean: 12.4)—who had undergone a type 1 tympanoplasty. Patients were divided into two groups according to the grafting technique used; there were 59 patients in the BSG group and 62 patients in the SSG group. Ear examinations were performed at postoperative months 3, 6, 12, and 24, and pure-tone average (PTA) for air-conduction threshold values and air-bone gaps (ABGs) were evaluated at 0.5, 1.0, 2.0, and 4.0 kHz at the same visits. We also investigated the impact of the graft material on functional graft success and intergroup differences (if any) in surgical success. Mean postoperative follow-up periods were 30.5 and 30.2 months in the BSG and SSG groups, respectively. We found that the success rates for tympanic membrane reconstruction were not significantly different in the two groups (91.5 and 88.7%). Postoperatively, the mean PTA and ABG values in both groups at 3, 6, 12, and 24 months were significantly lower than the preoperative values (p < 0.05). There were no significant differences in mean PTA values between the two groups at 3, 6, 12, and 24 months. However, the extent of the decrease in PTA values in the BSG group at 3 months was significantly greater than that of the SSG group (p < 0.05). There were no significant differences in mean ABG values between the two groups at 3, 6, and 12 months, but at 24 months, the value was significantly higher in the BSG group (p < 0.05). Finally, the extent of the decrease in ABG in the BSG group at both 3 and 6 months was significantly greater than that of the SSG group (p < 0.05). We conclude that the BSG procedure is a reliable and safe method of performing pediatric tympanoplasty.

Download Full-text

A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211573 ◽

2021 ◽

Vol 7 (5) ◽

pp. 809

Author(s):

Inderdeep Singh ◽

Basavaraj S. Patil ◽

Mohammad Z. Akhtar

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Acute Otitis Media ◽

Tympanic Membrane Perforation ◽

Surgical Closure ◽

Type 1 Tympanoplasty ◽

Microscopic Surgery ◽

Membrane Perforation ◽

Conventional Type

Background: The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO2)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.Methods: This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO2 (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO2 laser myringoplasty was compared with conventional type 1 tympanoplasty. Results: Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.Conclusions: A closure rate of 80% (24/30) was achieved with a CO2-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size <3 mm, where the CO2 facility is available before they undergo formal conventional microscopic surgery.

Download Full-text

Interlay technique type 1 tympanoplasty, an alternative for closing large central tympanic membrane perforation

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v50i1.356 ◽

2020 ◽

Vol 50 (1) ◽

pp. 84

Author(s):

Anton Budhi Darmawan

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Otitis Media ◽

Tympanic Membrane Perforation ◽

Google Scholar ◽

High Success Rate ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Membrane Perforation

Background: Type 1 tympanoplasty or myringoplasty is the most frequently performed procedure in the field of otology. Type 1 tympanoplasty is a surgical procedure to repair and only involves the restoration of the perforated tympanic membrane. There are three most accepted methods often used universally, namely underlay, overlay, and interlay. The interlay method is a relatively new method developed in 1992 for closing tympanic membrane perforation. This method has a high success rate of 96%. Objective: To report the success of type 1 tympanoplasty with an interlay method to close large central tympanic membrane perforations at Margono Soekarjo District Hospital. Case Report: Reporting 3 cases of chronic tubotympanic suppurative otitis media with large central tympanic membrane perforation which were repaired by type 1 tympanoplasty using interlay method. Clinical Question: Does interlay method type 1 tympanoplasty performed on large central tympanic membrane perforation provide better result compared with other methods of type 1 tympanoplasty? Review Method: Studying the evidence-based literatures on type 1 tympanoplasty interlay methods through Cochrane, Pubmed, and Google Scholar databases. Based on the inclusion and exclusion criteria, three journals were relevant with the reported cases. Result: All three journals stated that interlay method type 1 tympanoplasty had high success rate in terms of closing the tympanic membrane perforation and diminishing air-bone gap. Conclusion: Type 1 Tympanoplasty interlay method could be used as an alternative for the closure of a large central tympanic membrane perforation.Keywords: Chronic Tubotympanic Suppurative Otitis Media, large central tympanic membrane perforation, interlay tympanoplasty ABSTRAK Latar belakang: Timpanoplasti tipe 1 atau miringoplasti merupakan prosedur di bidang otologi yang paling sering dilakukan. Timpanoplasti tipe 1 merupakan metode pembedahan yang bertujuan untuk memperbaiki, dan terbatas hanya di membran timpani. Terdapat tiga metode yang paling diterima dan sering digunakan secara universal, yaitu underlay, overlay, dan interlay. Metode interlay merupakan metode penambalan perforasi membran timpani yang relatif baru, dikembangkan pada tahun 1992. Metode ini mempunyai keberhasilan yang tinggi yaitu mencapai 96%. Tujuan: Melaporkan keberhasilan timpanoplasti tipe 1 dengan metode interlay untuk penutupan perforasi membran timpani sentral besar di RSUD Margono Soekarjo. Laporan kasus: Dilaporkan 3 kasus otitis media supuratif kronik tipe tubotimpani dengan perforasi sentral besar, yang dilakukan timpanoplasti tipe 1 dengan metode interlay. Pertanyaan klinis: Apakah metode interlay timpanoplasti tipe 1 yang dilakukan pada perforasi membran timpani yang besar, dapat memberikan hasil yang lebih baik daripada metode lain timpanoplasti tipe 1? Telaah literatur: Telaah berbasis bukti mengenai timpanoplasti tipe 1 metode interlay melalui database Cochrane, Pubmed, dan Google Scholar. Berdasarkan kriteria inklusi dan ekslusi didapatkan tiga jurnal yang relevan dengan kasus yang dilaporkan. Hasil: Ketiga jurnal tersebut menyatakan bahwa timpanoplasti tipe 1 metode interlay mempunyai angka keberhasilan yang tinggi dalam hal penutupan perforasi membran timpani maupun mengurangi air-bone gap. Kesimpulan: Timpanoplasti tipe 1 metode interlay dapat digunakan sebagai alternatif untuk penutupan perforasi membran timpani sentral yang besar

Download Full-text

Comparison of Post-operative Outcomes of Endoscopic and Microscopic Type 1 Tympanoplasty-A Retrospective

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2020.v28i1.174 ◽

2020 ◽

Vol 28 (1) ◽

pp. 51-54

Author(s):

Gurumani S ◽

Valli R ◽

Deepthy Das

Keyword(s):

Retrospective Study ◽

Middle Ear ◽

Endoscopic Surgery ◽

Good Alternative ◽

Type 1 Tympanoplasty ◽

Microscopic Surgery ◽

Operative Outcomes ◽

Microscopic Tympanoplasty ◽

Endoscopic Tympanoplasty

Introduction With increasing popularity of Endoscopic middle ear surgeries, a better understanding of the features salient to endoscopic and microscopic tympanoplasty has gained importance. This study aims to compare the results of both. Materials and Methods It is a retrospective study based on MRD data collected from January 2017 to July 2018 on 40 patients with dry central perforation. 20 patients underwent endoscopic tympanoplasty and other 20 underwent microscopic tympanoplasty. Results of the surgery were compared at the end of 3 months which was based on the outcomes of surgery by means of graft uptake, comparison of pre-op and post-op audiogram readings . Results Eighteen cases (90%) of endoscopic surgery had mild CHL while in microscopic surgery 7 cases (35%) had moderate CHL. Average pre–op ABG was 29.05 dB in microscopic and 22.8dB in endoscopic surgery. Average post-op ABG 12.65dB and 18.4 for endoscopic and microscopic surgery. There was significant improvement in hearing gain in both the surgeries (p<0.001). Graft uptake was found to be have similar outcome. Conclusion Endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty but needs more training as compared to conventional method.

Download Full-text

Comparison of endoscopic tympanoplasty to microscopic tympanoplasty in anterior tympanic membrane perforation

Laparoscopic Endoscopic and Robotic Surgery ◽

10.1016/j.lers.2020.06.001 ◽

2020 ◽

Vol 3 (3) ◽

pp. 70-73

Author(s):

Jingna Zhang ◽

Sunhong Hu

Keyword(s):

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Microscopic Tympanoplasty ◽

Endoscopic Tympanoplasty

Download Full-text

A Comparative Study of Endoscopic versus Microscopic Cartilage Type I Tympanoplasty

International Archives of Otorhinolaryngology ◽

10.1055/s-0039-1693139 ◽

2019 ◽

Vol 24 (01) ◽

pp. e80-e85 ◽

Cited By ~ 3

Author(s):

Dipesh Shakya ◽

Arun KC ◽

Ajit Nepal

Keyword(s):

Comparative Study ◽

Success Rate ◽

Demographic Data ◽

Operation Time ◽

Type I ◽

Success Rates ◽

Type I Tympanoplasty ◽

Graft Success ◽

Retrospective Comparative Study ◽

Endoscopic Tympanoplasty

Abstract Introduction The use of endoscope is rapidly increasing in otological and neuro-otological surgery in the last 2 decades. Middle ear surgeries, including tympanoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Superior visualization and transcanal access to diseases normally managed with a transmastoid approach are touted as advantages with the endoscope. Objectives The present study aimed to compare the outcomes of endoscopic and microscopic cartilage tympanoplasty (Type I) Methods This was a retrospective comparative study of 70 patients (25 males and 45 females) who underwent type I tympanoplasty between March 2015 and April 2016. The subjects were classified into 2 groups: endoscopic tympanoplasty (ET, n = 35), and microscopic tympanoplasty (MT, n = 35). Tragal cartilage was used as a graft and technique used was cartilage shield tympanoplasty in both groups. Demographic data, perforation size of the tympanic membrane at the preoperative state, operation time, hearing outcome, and graft success rate were evaluated. Results The epidemiological profiles, the preoperative hearing status, and the perforation size were similar in both groups. The mean operation time of the MT group (52.63 ± 8.68 minutes) was longer than that of the ET group (48.20 ± 10.37 minutes), but the difference was not statistically significant. The graft success rates 12 weeks postoperatively were 91.42% both in the ET and MT groups, that is, 32/35; and these values were not statistically significantly different. There was a statistically significant improvement in hearing within the groups, both pre- and postoperatively, but there was no difference between the groups. Conclusion Endoscopic tympanoplasty is a minimally invasive surgery with similar graft success rate, comparable hearing outcomes and shorter operative time period as compared to microscopic use.

Download Full-text

The effect of anterior tab flap technique on graft success rate in large tympanic membrane perforation

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-06222-1 ◽

2020 ◽

Author(s):

Mohammad Faramarzi ◽

Sepideh Atashi ◽

Mohsen Edalatkhah ◽

Sareh Roosta

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Flap Technique ◽

Membrane Perforation ◽

Graft Success

Download Full-text

Outcome of Type 1 tympanoplasty: An experience at Biratnagar eye hospital in Eastern Nepal

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i2.13357 ◽

2015 ◽

Vol 7 (2) ◽

pp. 55-60 ◽

Cited By ~ 1

Author(s):

Sanjeev Kumar Thakur ◽

Sanjay Kumar Singh ◽

Anwar Afaque ◽

Nisha Ghimire

Keyword(s):

Medical Sciences ◽

Hearing Improvement ◽

Hearing Outcome ◽

Type 1 Tympanoplasty ◽

Younger Age ◽

History Of ◽

The Mean ◽

The Difference ◽

Graft Success

Background: The history of tympanoplasty is well over a century. Type 1 tympanoplasty is an established procedure worldwide with a variation in the outcome.Aims and Objectives: To analyze the outcome of Type 1 tympanoplasty surgeries in terms of graft success and hearing improvement done at the Ear Department of Biratnagar eye hospital in eastern Nepal and discuss the various factors that might have influenced it.Materials and Methods: Retrospective analysis of records of the cases that underwent Type 1 tympanoplasty from August 2013 to January 2015 was done. The factors analysed were age, gender, the side of the affected ear and the perforation size. Appropriate Statistical test was applied and the results were discussed.Results: A total of 151 cases of type 1 Tympanoplasty were analysed were females had higher frequency than males, with higher incidence at younger age. The mean age of successful cases was 28.53. Females had a better success rate in terms of graft success compared to males. Moderate size perforations had the best outcome of graft success and least were of small size perforations. Of all cases analyzed, hearing improvement was observed in maximum cases.Conclusion: There was no significant influence of age or gender on the hearing outcome. The difference of hearing improvement according to size of perforation was also not significant.Asian Journal of Medical Sciences Vol.7(2) 2015 55-60

Download Full-text

Type 1 tympanoplasty: does the status of contralateral ear affect the outcome?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191738 ◽

2019 ◽

Vol 5 (3) ◽

pp. 722

Author(s):

Arindam Das ◽

Sandipta Mitra ◽

Debasish Ghosh ◽

Arunabha Sengupta

Keyword(s):

Success Rate ◽

Otitis Media ◽

Prospective Observational Study ◽

Tertiary Care ◽

Chronic Otitis Media ◽

Care Hospital ◽

Type 1 Tympanoplasty ◽

The Status ◽

Contralateral Ear

Background: The objective of the study was to investigate the effect of contralateral ear status on the success rate (anatomical closure) of type 1 tympanoplasty.Methods: The study is a prospective observational study comprising of 60 patients diagnosed with chronic otitis media, who underwent type 1 tympanoplasty during 2016-2018 in a tertiary care hospital. Results: In our study, contralateral ear was normal in 40 (66.7%) cases & diseased in 20 (33.3%) cases. Success rate of type 1 tympanoplasty in patients with normal contralateral ear was 90% (n=36) but success rate was only 60% (n=12) in diseased contralateral ear. This was statistically significant (p=0.006).Conclusions: Our study revealed that the status of the opposite ear is an individual prognostic factor for type 1 tympanoplasty. In other words, graft-healing rates are poorer in individuals whose opposite ears are atelectatic or perforated because of chronic otitis media.

Download Full-text