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

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.

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Comparison of Endoscopic Tympanoplasty with Microscopic Tympanoplasty

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i4.1481 ◽

2020 ◽

Vol 24 (4) ◽

pp. 400-405

Author(s):

Nausheen Qureshi ◽

Muhammad Musharaf Baig ◽

Misbah Parvez ◽

Sundas Masood ◽

Memoona Afzal

Keyword(s):

Postoperative Pain ◽

Success Rate ◽

Tympanic Membrane ◽

Bone Conduction ◽

Type 1 Tympanoplasty ◽

Graft Success ◽

Microscopic Tympanoplasty ◽

Endoscopic Tympanoplasty ◽

Endoscopic Group

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.

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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.

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Clinical study on type 1 tympanoplasty: anatomical and functional outcomes

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193675 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1197

Author(s):

A. Kusumanjali ◽

V. Krishna Chaitanya

Keyword(s):

Success Rate ◽

Middle Ear ◽

Pure Tone Audiometry ◽

Type I ◽

Middle Ear Mucosa ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Cortical Mastoidectomy ◽

Type I Tympanoplasty

Background: Tympanoplasty is operation to eradicate disease in middle ear and to reconstruct the hearing mechanism. Present study aims at assessment of success rate and hearing improvement following type I tympanoplasty.Methods: 50 patients with chronic suppurative otitis media, tubotympanic type attending department of ENT are taken up for study screened with clinical history and examination. Type I tympanoplasty performed in all patients. Simple mastoidectomy with type I tympanoplasty performed in 8 patients. Patients are followed after surgery on 7th, 14th days and end of 3 months. Anatomical outcome is assessed in terms of graft uptake. Pure tone audiometry was performed at 3 months and air bone gap is considered to assess outcome. Results: Out of 50 cases, 43 cases (86%) showed good success rate by means of graft uptake. Remaining 5 cases showed residual perforation and 3 cases medialization of graft. In 42 patients type1 tympanoplasty is performed, success rate was 80.95% and in cases with where type1 tympanoplasty with cortical Mastoidectomy was done and the success rate was 100%. In the present study mean pre op AB gap was 27.65 dB and mean post op AB gap was 19.07 dB. The difference between the two, i.e., AB gap closure was 8.52 dB which is statistically significant.Conclusions: Type-1 tympanoplasty using temporalis fascia with underlay technique have good surgical success rate with excellent improvement of hearing. Cortical mastoidectomy can be planned depending on the status of the middle ear mucosa.

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Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i2.56355 ◽

2021 ◽

Vol 27 (2) ◽

pp. 104-110

Author(s):

Md Mainul Islam ◽

Kanu Lal Saha ◽

Harun Ar Rashid Talukder ◽

Md Khalid Mahmud ◽

Riashat Azim Majumder ◽

...

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Uptake Rate ◽

Cartilage Graft ◽

Temporalis Fascia ◽

Hearing Gain ◽

Type 1 Tympanoplasty ◽

Fascia Graft ◽

Cartilage Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge and perforation. It is the commonest ear problem in adult and children. Most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. Inactive mucosal variety of COM presents with the perforation in tympanic membrane with non-inflamed middle ear mucosa. The treatment of inactive mucosal variety of COM is Type 1tympanoplasty. It can be done by conventional temporalis fascia or cartilage graft. Both have some merits and demerits. Objective: To compare the the outcomes between reinforcement cartilage graft and temporalis fascia graft in type -1 tympanoplasty. Methods: 86 (43 patients in each group) patients with COM (inactive mucosal) who were admitted in the department of Otolaryngology – Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2018 to June 2019, and had fulfilled the inclusion and exclusion criteria were selected for the study. History, examinations, investigations were done. All patients underwent type 1 tympanoplasty. Prior to surgery relevant investigations were done and informed written consent was taken from all patients. In Group-A reinforcement cartilage tympanoplasty cases and in Group-B temporalis fascia tympanoplasty cases were placed. Post-operative graft uptake rate and hearing gain were compared in two groups Results: The surgical outcomes between reinforcement cartilage tympanoplasty in comparison with temporalis fascia tympanoplasty showed no significant difference of graft uptake rate and hearing gain. Conclusion: Cartilage tympanoplasty has been practised for reconstruction of perforated tympanic membrane in COM since long with variable results. Graft uptake rate in cartilage reinforcement is comparatively better than temporalis fascia graft. So, reinforcement cartilage graft can be adopted as an alternative to temporalis fascia graft in type- I tympanoplasty. Bangladesh J Otorhinolaryngol 2021; 27(2): 104-110

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Diagnostic accuracy of intra-operative assessment of de-epithelisation of the malleus by the surgeon in type 1 tympanoplasty compared to histopathological examination

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000987 ◽

2019 ◽

Vol 133 (06) ◽

pp. 462-465 ◽

Cited By ~ 1

Author(s):

A P Azeez ◽

V Letha

Keyword(s):

Diagnostic Accuracy ◽

Middle Ear ◽

Microscopic Examination ◽

Histopathological Examination ◽

Type 1 Tympanoplasty ◽

Limited Experience ◽

Operative Assessment

AbstractObjectiveThis study was undertaken to determine the accuracy of the surgeon's assessment in detecting epithelial remnants over the malleus after de-epithelisation in tympanoplasty.MethodsIntra-operatively, the umbo was assessed for epithelial remnants with the microscope. The umbo was then resected and sent for histopathological examination to detect epithelial remnants.ResultsOut of 42 cases, microscopic examination findings for epithelium were positive in 16 cases and negative in 26 cases. Histopathology findings were positive in 13 cases. The surgeons’ assessment was accurate only in two cases.ConclusionResidents, with their limited experience, are more likely to leave residual epithelium. When the chance of residual epithelium over the umbo is significant, the surgeon has two choices: to place the graft medial to the umbo or to resect the umbo. It is our opinion that the malleus exteriorisation should be incorporated into tympanoplasty training, with the aim of preventing epithelial entrapment in the middle ear.

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COMPARISON OF THE EFFICACY OF ENDOSCOPIC TYMPANOPLASTY WITH MICROSCOPIC TYMPANOPLASTY

10.36106/gjra/7001902 ◽

2021 ◽

pp. 52-55

Author(s):

Anjana Tigga ◽

Shruti Dhingra

Keyword(s):

Hospital Stay ◽

Middle Ear ◽

Past Century ◽

Endoscopic Ear Surgery ◽

Ear Surgery ◽

Camera System ◽

Health Care Centre ◽

Minimally Invasive Surgical ◽

Microscopic Tympanoplasty ◽

Endoscopic Tympanoplasty

Introduction: Otological surgery has progressed rapidly over the past century. With the recent introduction of the 3-chip camera system and high denition video systems, endoscopes now provide ultra high resolution images of the middle ear that were never seen previously. We conducted this study to compare the efcacy of endoscopictympanoplasty over microscopic tympanoplasty in terms of preoperative ease of surgery including visualisation of ossicles and eustanchian tube and intraoperative bleeding, graft uptake, hearing improvement, post-operative pain score, post-auricular hypoesthesia, duration of hospital stay etc. Methods: The present study is prospective observational study, conducted in a Tertiary Health Care Centre. Results: Endoscopic tympanoplasty has many advantages over microscopic tympanoplasty and can be a better alternative or adjuct to microscopic tympanoplasty. Conclusion: Endoscopic ear surgery provides a better magnication, wide eld view, and the ability to look around corners. Further more transcanal endoscopic ear surgery (TESS) approaches transform external auditory canal into a minimally invasive surgical portal to access middle ear disease. The ease of surgery improves with time and has a gradual learning curve. The graft uptake rate is comparable with both approaches. The overall satisfaction score in terms of reduced pain and hypoesthesia with decreased hospital stay is higher in endoscopic approach.

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Variations of the Technique in Endoscopic Tympanoplasty

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2021.00493 ◽

2021 ◽

Vol 64 (8) ◽

pp. 604-606

Author(s):

Jeong Heon Kim ◽

Jong Woo Chung

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Surgical Procedure ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Pros And Cons ◽

Microscopic Tympanoplasty ◽

Endoscopic Tympanoplasty

Endoscopic tympanoplasty is a surgical procedure for patients with tympanic membrane perforation with minimal middle ear or mastoid inflammation. Recent findings revealed that endoscopic tympanoplasty harvests equivalent or even superior results over microscopic tympanoplasty. However, a number of disadvantages are related to endoscpoic tympanoplasty, one of which is the single-handed procedure that may lead to recurrent perforation. We hereby illustrate a number of techniques involved in endoscopic tympanoplasty along with their pros and cons.

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A study on endoscopic type 1 tympanoplasty in tubotympanic chronic suppurative otitis media

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194930 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1580

Author(s):

Kiran A. Deshmukh ◽

Vinayak Kurle

Keyword(s):

Hospital Stay ◽

Otitis Media ◽

Middle Ear ◽

Operating Time ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Type 1 Tympanoplasty ◽

Duration Of Surgery ◽

The Mean

Background: Chronic suppurative otitis media (CSOM) attributes to 71.6% of hearing impairment in which most of them only have central perforation without any ossicular erosion or middle ear pathology. Tympanoplasty has evolved to provide and reconstruct better hearing mechanism, avoid complications as well as recurrence. Traditionally over the decades, tympanoplasty has been done using an operating microscope. Middle ear endoscopy was first introduced by Mer and colleagues in 1967, since then middle ear surgeries which were traditionally done using the microscope can be done using the endoscope also.Methods: This prospective study was conducted at Basaweshwar Teaching and General Hospital, Kalaburagi between March 2016 to November 2017. Endoscopic type 1 tympanoplasty was performed in all the cases using temporalis fascia.Results: There were 30 patients between 15-65 years with average being 29.6 years in which 17 were females and 13 were males. Pre and post-operative PTA at 1, 3 and 6 months were analyzed. The mean duration of surgery was 50.13 mins. The mean duration of hospital stay was 2.23 days. The mean duration of wound healing was 12.23 days. The average pre-operative PTA was 32.47±4.79 dBHL and postoperative PTA at 1, 3 and 6 months was18.3±3.22 dbHL, 16.5±2.2 dbHL and 16.35±2.22 dBHL. The graft uptake at end of 6 months was 100%.Conclusions: We here by conclude that endoscope can be a better alternative for microscope in type 1 tympanoplasty as it provides a wide panoramic view, less operating time and hospital stay with minimal visible scar post operatively.

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Treatment choice for repair of sound-conducting apparatus with isolated ossicular anomalies

Russian otorhinolaryngology ◽

10.18692/1810-4800-2021-1-8-17 ◽

2021 ◽

Vol 20 (1) ◽

pp. 8-17

Author(s):

I. A. Anikin ◽

Keyword(s):

Middle Ear ◽

Anesthetic Management ◽

Functional Results ◽

Successful Development ◽

Surgical Interventions ◽

Type 1 Tympanoplasty ◽

Auditory Ossicles ◽

Sound Conduction ◽

Technical Solutions

Over the last decades, attention to the study of the possibilities of pediatric otorhinolaryngology has increased. The constantly evolving technologies in reconstructive surgery and advances in the field of anesthetic management have made it possible to carry out the necessary surgical interventions at the earliest possible time. Even such traditionally complex areas like treatment of isolated middle ear abnormalities receive more and more opportunities for successful development. In order to achieve maximal results of hearing in isolated ossicular abnormalities, various approaches to their reconstruction are used. In our work, we aimed to find out which of the two most topical technical solutions is optimal in terms of functional results’ achievement. To do this, we analyzed two independent groups of patients in whom different approaches to the repair of the sound conduction was applied. On the basis of the study, it can be argued that attempts to preserve a deformed, but movable chain of the auditory ossicles, that is, performing type 1 tympanoplasty with an intact stapes with anomalies in the development of auditory ossicles did not prove their feasibility. Performing surgery using a simpler technique, namely with the removal of deformed ossicles and the use of partial titanium prostheses, allows you to achieve the best anatomical and functional results.

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A comparative study between endoscopic and microscopic type 1 tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20220009 ◽

2022 ◽

Author(s):

Shaik Abdul Subhan Faruq ◽

Divya Bhadri Sri ◽

Srinivasa Rao Uppala

Keyword(s):

Pure Tone Audiometry ◽

Minimal Invasive ◽

Microscopic Surgery ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean ◽

Group 2 ◽

Endoscopic Tympanoplasty ◽

Group 1

Background: The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.Methods: This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.Results: Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.Conclusions: By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.

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