Comparison of endoscopic underlay and over‐under tympanoplasty techniques for type I tympanoplasty

To detach or not to detach the umbo in type I tympanoplasty: functional results

PURPOSE

To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over-under tympanoplasty type I (TTI).

METHODS

The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over-under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air-bone gap (ABG), pre- and postoperatively.

RESULTS

Both underlay and over-under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over-under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery.

CONCLUSIONS

Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over-under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights.

Comparison of perichondrium-cartilage button technique and traditional over-underlay technique for repairing large perforations

OBJECTIVE

This study was performed to compare the operation time, graft outcomes and complications between the endoscopic cartilage-perichondrium button technique and over-under technique for repairing large perforations.

METHODS

A total of 52 chronic large perforations were randomly allocated to receive treatment using the endoscopic cartilage-perichondrium button technique (n = 26) or over-under technique (n = 26). The graft outcomes, mean operation time and post-operative complications were compared between the two groups at 12 months.

RESULTS

The study population consisted of 52 patients with unilateral chronic large perforations. All patients completed 12 months of follow up. The mean operation time was 32.3 ± 4.2 minutes in the button technique group and 51.6 ± 2.8 minutes in the over-underlay technique group (p < 0.01). The graft success rate at 12 months was 92.3 per cent (24 out of 26) in the button technique group and 96.2 per cent (25 out of 26) in the over-underlay group (p = 0.552).

CONCLUSION

The endoscopic cartilage-perichondrium button technique had similar graft success rates and hearing outcomes for large chronic perforations to the over-under technique, but significantly shortened the mean operation time.

Comparison of the Extended Perichondrium-Cartilage Butterfly Inlay Technique and Over-Underlay Technique for Repairing Subtotal Perforation: A 2-Year Follow-up Study

OBJECTIVE

To compare graft outcomes and postoperative complications between the extended perichondrium-cartilage butterfly inlay (PCBI) technique and the perichondrium-cartilage over-underlay (PCOU) technique for repairing subtotal perforations over a 2-year follow-up period.

METHODS AND MATERIALS

Patients with subtotal perforations were prospectively randomized to either the extended PCBI (n = 52) or PCOU (n = 51) group. Evaluation metrics included operation time, graft success rate, hearing gain, and complications at 24 months postoperatively.

RESULTS

The study included 103 patients with 103 ears. Follow-up loss occurred in 11 of 52 patients (21.2%) in the PCBI group and 13 of 51 patients (25.5%) in the PCOU group (P = .773). The final analysis included 41 of 52 patients (78.9%) in the PCBI group and 38 of 51 patients (74.5%) in the PCOU group. The average operation time was significantly shorter in the PCBI group (31.2 ± 1.9 min) compared to the PCOU group (52.8 ± 6.3 min, P < .001). At 24 months postoperatively, the graft success rate was 82.9% (34 patients) in the PCBI group and 92.1% (35 patients) in the PCOU group (P = .374). No significant group difference was noted in mean air-bone gap (ABG) gain (P = .759). High-resolution computed tomography (HRCT) demonstrated well-pneumatized mastoids and middle ears in both groups. Altered taste was reported in no PCBI group patients and 23.7% (9 patients) of the PCOU group patients (P < .05). Graft cholesteatoma was found in 4.9% (two patients) in the PCBI group and 7.9% (three patients) in the PCOU group (P = .930).

CONCLUSION

The endoscopic extended PCBI technique is safe and effective for repairing subtotal perforation. It avoids raising a tympanomeatal flap and demonstrates high long-term graft success with minimal complications.

Comparison of temporalis fascia and cartilage graft over-under myringoplasty for repairing large perforations

OBJECTIVE

The objective of this study was to compare the operation time, graft success, audiometric outcomes and complications of over-under technique using a temporalis fascia (TMF) and cartilage grafts for the repair of large perforations.

STUDY DESIGN

Randomized controlled trial.

MATERIALS AND METHODS

80 large perforations >2 quadrants of eardrum were prospectively randomized to undergo TMF over-under technique group (TFON, n = 40) or cartilage-perichondrium over-under technique group (CPON, n = 40). The graft success rate, audiometric outcomes, and complications were compared among two groups at 12 months.

RESULTS

The mean operation time was 56.8 ± 4.2 (range:52-71) min in the TFON group and 37.9 ± 2.8 (range: 31-47) min in the CPON group (P < 0.001). The lost follow-up rate was 3 (7.5 %) patients in the TFON group and 2 (5.0 %) patient in the CPON group (P = 0.644). Finally, 37 patients in the TFON group and 38 patients in the CPON group were included in this study. The graft infection rate was 2 (5.4 %) patients in the TFON group and 2 (5.3 %) patient in the CPON group (P = 0.626), all the graft infection resulted in the residual perforation. The remaining residual perforation was 2 (5.4 %) patients in the TFON group and 1 (2.6 %) patient in the CPON group; the re-perforation was 3 (8.1 %) patients in the TFON group and 0 (0.0 %) patient in the CPON group. The graft success rate was 81.1 % (30/37) patients in the TFON group and 92.1 % (35/38) patient in the CPON group. The mean preoperative and 12-month postoperative ABGs were significantly different in any group (P < 0.01). However, there were no significant difference among two groups regardless of pre-or post-ABGs or ABG closure. No lateralization of the graft or blunting was noted in any group. Four (10.8 %)patients developed atelectasis and one (2.7 %) developed the EAC scarring in the TFON group. Graft cholesteatomas was found in 2 (5.4 %) patients in the TFON group and in 5 (13.2 %) patients in the CPON group (P = 0.449). Three (8.1 %) patients had temporary hypogeusia in the TFON group.

CONCLUSION

Although temporalis fascia graft over-under technique obtained similar graft success rates and hearing outcomes for large chronic perforations to the cartilage-perichondrium over-under technique, temporalis fascia graft technique prolonged the operation time and increased the re-perforation and graft atelectasis. Nevertheless, the graft cholesteatomas were comparable among two techniques.

Local Anesthesia-Based Modified Cartilage "Inlay" Graft Myringoplasty for Repairing Large Perforation

OBJECTIVE

The objective of this study was to evaluate the graft success rate and hearing outcome of modified cartilage inlay graft technique for repairing large perforations under local anesthesia.

STUDY DESIGN

Prospective case series.

METHODS AND MATERIALS

We performed a prospective study in 31 patients with large perforations who underwent endoscopic local anesthesia-based modified cartilage inlay graft technique with no raising of the squamous epithelium and no rimming of the perforation margins. The graft outcomes and complications were evaluated at 6 and 24 months postoperatively.

RESULTS

Thirty-one patients (31 ears) were included in this study. The mean operation time was 42.3 ± 2.6 (ranged 36-51) minutes. The visual analog scale pain scores at intraoperative and 2 and 48 hours postoperatively were, respectively, 2.6 ± 0.6, 1.4 ± 0.2, and 0.6 ± 0.1. The graft success rate was 100.0% (31/31) at 6 months after surgery. However, only 25 (80.6%, 25/31) patients completed a 2-year follow-up and performed a temporal bone CT examination; re-perforation was seen in 2 patients, the graft success rate was 92.0% (23/25). CT revealed the well-developed pneumatization of the mastoids and middle ear in all the patients. Nevertheless, 1 (1/25, 8.0%) patient developed a graft epithelial inclusion cyst, which was removed by endoscope in the outpatient setting. The mean preoperative air bone gap (ABG) was 23.1 ± 4.3 dB, while the mean postoperative ABG after 6 months was 14.9 ± 2.6 dB; the difference between these values was significant (P < .05; Wilcoxon's signed-rank test), and the functional success rate was 93.5% (29/31).

CONCLUSION

Endoscopic modified cartilage "inlay" graft technique with no raising the squamous epithelium and no rimming the perforation is a minimally invasive technique with a short operative time and satisfying success rate for closure of large perforations under local anesthesia.

Predictors of Functional Outcomes and Recovery Time Following Tympanoplasty

Objectives: To identify the predictors of tympanoplasty success including graft success, hearing outcomes, and recovery time. Methods: Patients who underwent a tympanoplasty between January 2019 and July 2022 were enrolled. Hearing outcomes were measured by air-bone gap from pure tone. Demographic data of the patient, surgical parameters, and Ossiculoplasty Outcome Parameter Staging (OOPS) were reviewed and evaluated to predict the success of tympanoplasty using univariate and multivariate logistic or Cox regression analyzes. Results: Of 138 patients, 151 procedures were studied. At the 6-month follow-up visit, the overall graft success was 90.7% and the overall hearing success was 40.4%. There was a correlation between the OOPS index and postoperative hearing success (Spearman r = 0.322). Blood loss > 10 ml and OOPS ≥ 4 were independent predictors of hearing failure. Blocked aditus ad antrum and blood loss > 10 ml were independent predictors of prolonged recovery time. Conclusions: The OOPS index exhibits a strong predictive influence on hearing outcomes after tympanoplasty. A predictive model that combines the amount of blood loss and blockage of aditus ad antrum can serve as a useful tool in predicting postoperative recovery time.

Endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforations with 3 years of follow-up

OBJECTIVE

The objective of this study was to evaluate graft outcomes and complications of endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforation with 3 years of follow-up.

MATERIAL AND METHODS

Adult patients with chronic kidney-shaped perforation underwent endoscopic perichondrium-cartilage H type technique. The graft outcomes and complications were evaluated at 36 months after surgery.

RESULTS

The total of 51 ears were included in this study. The mean operation time was 31.5 ± 4.1 min. Residual perforation was seen in 2 patients, the graft success rate was 96.1 % (49/51) at postoperative 12 months. Granular myringitis was noted in 8.2 % (4/49) patients in 49 patients with graft success. The mean preoperative ABG was 23.6 ± 3.7 dB, while the mean postoperative ABG postoperatively 12 months was 12.9 ± 5.2 dB (P < 0.05), the functional success rate was 94.1 % (48/51). At postoperative 36 months, only 32 (62.7 %, 32/51) patients were followed up, while 19 (37.3 %, 19/51) patients lost followup. Of the 32 patients with followup of 36 months, the mean follow-up time was 38.2 ± 7.1 (37-46) months, re-perforation was seen in one. All 32 patients performed the postoperative CT examination at last followup, CT revealed the well pneumatization of mastoids and middle ear.

CONCLUSIONS

Endoscopic cartilage-perichondrium H type technique is an alternative method for repairing chronic kidney-shaped perforations, with a highly successful, short operation time, minimally invasive procedure, and no cholesteatoma.