A comparative study between endoscopic and microscopic type 1 tympanoplasty

<p><strong>Background:</strong> The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.</p><p><strong>Methods:</strong> 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.</p><p><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> 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.</p><p> </p>

COMPARISON BETWEEN TRAGAL CARTILAGE WITH PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT BY UNDERLAY ENDOSCOPIC TYMPANOPLASTY

Objective: To compare the results of tragal cartilage with perichondrium versus temporalis fascia graft in endoscopic tympanoplasty using underlay technique. Study Design: Comparative prospective study. Place and Duration of Study: Study conducted in Tertiary Care Hospital, Karachi, from Jul 2018 to Feb 2020. Methodology: Overall, 34 patients having permanent unilateral tympanic membrane perforations were included in this study, in whom underlay endoscopic tympanoplasty was performed. Group A patients underwent temporalis fascia graft while group B received a tragal cartilage with perichondrium graft. The success rate between groups was compared in respect of reduction in postoperative air-bone gap and healing of perforation. Results: The success rate of graft was 88% (30/34) in group A and 94% (32/34) in group B after 6 months follow-up, the difference was not found to be statistically significant (p=0.368). Hearing improvement in the form of closure of air bone gap in group A was from 24.52 ± 1.73 dB (decibel) to 13.56 ± 5.67s dB and in group B it was from 19.76 ± 3.47dB to 11.94 ± 3.9dB, the difference was not significant statistically (p=0.333). Conclusion: Keeping in view the results of our study, we conclude that both tragal cartilage with perichondrium and temporalis fascia graft are considered equally successful in endoscopic tympanoplasty.

Underlay Versus Modified Circumferential Subannular Graft Technique in Endoscopic Tympanoplasty

Background and Objectives To describe and evaluate modified circumferential subannular tympanoplasty (MCST) via endoscopic approach, we compared the results of MCST to those of the underlay technique and the results of previous studies.Subjects and Method A retrospective comparative study was conducted of 31 patients who underwent endoscopic transcanal tympanoplasty. Patients were classified into the MCST group (n=11) and the underlay group (n=20) according to the graft technique. Demographic data, size and location of the perforation, pre- and postoperative hearing, operating time, complication rate, and graft success rate were analyzed in each group.Results No significant differences between the two groups were observed in the demographic data or the locations of the perforations. The sizes of the perforations were 31.4±14.3% and 25.0±18.1%, respectively. The average operating times were 68.6±16.5 min and 64.9±9.3 min, respectively, and canaloplasty was not required in any patient. The postoperative hearing improvement and air-bone gap were not significantly different. No postoperative complications were observed in either group.Conclusion MCST is a feasible and effective technique for endoscopic transcanal tympanoplasty. The postoperative results and operating times of MCST were comparable to those of other graft techniques. MCST showed more stable results in anterior perforation than in underlay graft.

Features of combined endoscopic tympanoplasty in children with chronic otitis media with cholesteatoma

Topicality: Chronic purulent otitis media is a disease that is often encountered in everyday practice by otolaryngologists. To date, the full rehabilitation of the middle ear in pediatric practice has caused much debate about the method of surgery and remains a difficult surgical task. Aim: to develop a more effective combined method of endoscopic microsurgery in children with chronic otitis media with cholesteatoma. Materials and methods: examined 52 children aged from 2 to 12 years, operated on a closed variant of tympanoplasty for cholesteatoma otitis. Patients were divided into 2 groups: 1st group (comparison), which used the standard technique of closed variant of surgery with retroauricular incision using an operating microscope (33 patients); and the 2nd group (main), where the combined surgery with retroauricular incision with the using of a microscope and endoscope and endoaural drainage of the antrum was performed in 19 patients. Results: We conducted an analysis of different types of tympanoplasty in a closed variant of tympanoplasty in children with cholesteatoma otitis and endoaural drainage of the antrum or without it. In the main group, the number of secondary engraftment of the neotympanic membrane decreased 3.4 times, residual perforations – 2.9 times, residual cholesteatoma – 2.9 times, the number of repeated operations – 3.5 times relative to the comparison group. Conclusion: At the combined surgery of cholesteatoma otitis with endoscopic support at patients of the main group the percent of residual cholesteatoma is lower. The endoaural drainage of the antrum provides additional ventilation and drainage of the reconstructed cavities of a middle ear in the early postoperative period, increases the number of primary engraftment of the neotympanic membrane and reduces the percentage of residual perforations.

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.