Variations of the Technique in 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.

Shifting from postauricular to transcanal microscopic tympanoplasty may have similar frequency-specific improvements with better air-bone-gap closure at low frequencies and a minimal learning-curve effect

The shift from postauricular to transcanal microscopic tympanoplasty brings potential advantages of minimal morbidity, less postoperative pain, patient comfort, and surgical ease and speed, but also uncertainties of unfamiliar grafting material, an inadequate operation view, and an uncertain learning curve. These challenges might affect the successful repair rate and the frequency-specific hearing outcome, which is important for hearing perception. Rare studies reported frequency-specific hearing outcome with the learning curve for shifting from postauricular to transcanal microscopic tympanoplasty. Here, from Jul. 2013 to Nov. 2018, we compared patients in a shift from postauricular approach (35 ears) to transcanal approach (35 ears) of microscopic type-1 tympanoplasty. The results show that both of postauricular and transcanal microscopic tympanoplasties reduced the mean air-bone gap, 0.5k Hz gap, and 1k Hz gap after the surgery. The further analyses on gap change as a function of frequency (0.5, 1, 2, and 4k Hz) show that both of postauricular and transcanal tympanoplasties improved postoperative air-bone gap among the levels of frequency. The post hoc comparisons display a common gap reduction difference between 0.5k and 4k Hz. The successful repair rate did not differ between the 2 groups. There was no correlation between the postoperative mean gap change and the surgery date, suggesting a minimal learning-curve effect. The results of similar frequency-specific improvements and a minimal learning-curve effect may help to ease the concerns of those uncertainties before the shift.

COMPARISON OF THE EFFICACY OF ENDOSCOPIC TYMPANOPLASTY WITH MICROSCOPIC 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.

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.

Correlation between microscopic and endoscopic approach to tympanoplasty: a comparative study

<p><strong>Background:</strong> The objective of the study was to evaluate the role of endoscopes in the management of dry central perforations of the tympanic membrane, compare the visualization of middle ear anatomy, time taken for the procedure and each step of the surgery and preoperative and postoperative hearing results/improvement.</p><p><strong>Methods: </strong>Fifty patients of chronic suppurative otitis media without cholesteatoma who came to ENT OPD at MGM medical college and hospital Aurangabad were included. They were divided into 2 groups with 25 patients each. Group A underwent microscopic approach to tympanoplasty and group b underwent endoscopic approach to tympanoplasty. Patients were assessed pre and postoperatively after 7 days, 14 days, 1 month, 3 months and 6 months with postoperative audiometry in the third month. <strong></strong></p><p><strong>Results: </strong>There was an improvement in the post-operative audiometry air bone gap (ABG) in both the groups. The operative time for group A was comparatively lesser than group B. Residual perforation were detected in one patient in group A at postoperative months 3 and 6, and for group B at postoperative month 3 and in two patients at postoperative month 6.<strong></strong></p><p><strong>Conclusions: </strong>A shorter operative duration is an advantage of microscopic tympanoplasty technique. One handed technique is one of the disadvantages of endoscope. The endoscopic approach gave better results in terms of easy visualization of the entire tympanic membrane and ossicular system. Tympanoplasty using endoscope was found to be an effective method for management of dry central perforations of the tympanic membrane.<strong></strong></p>

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.