Cartilaginous myringoplasty: the endoscopic transcanal procedure

Outcomes of perichondrium graft covering the epithelium of the tympanic membrane for large-sized perforations: A 3-5-year follow-up study

OBJECTIVE

The objective of this study was to evaluate the graft outcomes and iatrogenic cholesteatomas for 3 years following cartilage-perichondrium over-underlay technique with perichondrial graft covering the epithelium for large-sized tympanic membrane (TM) perforations.

MATERIALS AND METHODS

This prospective case series enrolled patients with large-sized perforation who underwent endoscopic cartilage-perichondrium over-underlay technique. The graft success rate, hearing outcomes, and development of iatrogenic middle ear cholesteatomas and graft cholesteatomas were assessed at 3 years postoperatively.

RESULTS

This study included 62 ears of 62 patients. The mean follow-up duration was 47.3 ± 10.8 (38-64) months. Neovascularization was observed in the lateral perichondrium graft in 55 (88.7 %) patients, which inosculated into the TM remnant at 4-5 weeks. However, graft neovascularization was not observed in the four patients with excessive perichondrium graft that migrated into the external auditory canal and the three patients with middle ear infections. The graft failure rate was 6.5 % at 6 months, 11.3 % at 12 months, 6.5 % at 24 months, and the overall graft success rate was 91.8 % at the last follow-up. Granular myringitis developed in 11.3 % (7/62) of the patients. High-resolution computed tomography revealed well-pneumatized mastoids and middle ear at the final follow-up. However, graft cholesteatomas were observed in 3 (4.8 %) patients at 7-24 months postoperatively.

CONCLUSIONS

The cartilage-perichondrium over-underlay technique with perichondrial graft covering TM epithelium is safe and effective for the repair of large perforations, with good short- and long-term graft outcomes, minimal risk of graft cholesteatoma development, and no risk of iatrogenic middle ear cholesteatomas.

Endoscopic Versus Microscopic Tympanoplasty: A Systematic Review and Metanalysis

OBJECTIVE

Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics.

DATA SOURCES

We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.

REVIEW METHODS

Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.

RESULTS

Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I2  = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I2  = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I2  = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I2  = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I2  = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I2  = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I2  = 43.95%), when compared to the postauricular microscopic approach.

CONCLUSION

Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.

LEVEL OF EVIDENCE

NA Laryngoscope, 2024.

Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction

Background

Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition.

Materials and Methods

This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups.

Results

Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37 min in the Endoscopic group and 91.92 ± 15.35 min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group.

Conclusion

Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04184-4.

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.

Quality-of-life outcomes with endoscopic and microscopic type I tympanoplasty-a prospective cohort study

PURPOSE

Endoscopic type I tympanoplasty was originally introduced in the 1990s and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation and is defined as microscopic type I tympanoplasty. The aim of this study is the comparison of quality-of-life (QoL) outcomes with endoscopic to that with microscopic type I tympanoplasty.

METHODS

All patients, or in the case of children with the aid of a parent, were asked to complete a novel QoL questionnaire drafted by our study group. The analysis was performed with descriptive statistics-mean, SD and relative frequency-and with a mixed model (generalized least squares fit). A two-sided p value of < 0.05 was regarded as statistically significant.

RESULTS

A total of 83 patients completed the questionnaire, 38 in the endoscopic group and 45 in the microscopic group. Every question represented a different. A statistically significant result was found in favor of the endoscopic approach regarding average hospitalization rate (p = 0.003) and cosmetic outcomes (p = 0.015). No statistically significant difference was otherwise observed between the groups.

CONCLUSIONS

Based on our prospective cohort study, the QoL outcomes of endoscopic type I tympanoplasty in terms of postoperative pain, headache, nausea, vomiting, dizziness, taste disorder and hearing were comparable to the microscopic type I tympanoplasty. In regard to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the average hospitalization rate proved to be statistically significantly lower than in the microscopic group.

Comparison of Endoscopic Modified and Typical Myringoplasty: A Randomized Controlled Trial

OBJECTIVE

Here, we aimed to compare the operation time, postoperative pain score, graft healing, graft success rate, cholesteatoma incidence, audiometric outcomes, and complications between endoscopic modified myringoplasty (EMM) and endoscopic typical myringoplasty (ETM).

METHODS

Patients with unilateral chronic tympanic membrane (TM) perforations undergoing myringoplasty were prospectively randomized to undergo EMM (n = 44) or ETM (n = 45). The operation time, postoperative pain score, graft healing, graft success rate, cholesteatoma incidence, audiometric outcomes, and complications were compared between these groups.

RESULTS

In total, 89 patients with unilateral chronic perforations were included (EMM group, 44; ETM group, 45). There were significant differences between the EMM and ETM groups in mean pain scores on the day after surgery (1.32 ± 0.56 vs. 2.58 ± 1.16, p < 0.001) and in the mean operation time (18.18 ± 2.43 vs. 51.53 ± 8.28 min, p < 0.001). There were no significant differences in graft success rates (93.18% vs. 88.89%, p = 0.735), pre- or postoperative air conduction pure-tone averages or air bone gaps (ABGs), or changes in ABGs between the groups. However, the difference in graft healing was significant at postoperative week 2 (33/44 vs. 24/45, p = 0.033) but was nonsignificant at postoperative week 4 and month 6. Computed tomography revealed the middle ear and mastoid to be well pneumatized at 12 months in all patients.

CONCLUSION

While 12-month graft and audiometric outcomes were comparable between EMM and ETM techniques, patients who underwent EMM had less postoperative pain, shorter operative times, faster healing, and a lower incidence of complications.

LEVEL OF EVIDENCE

1 Laryngoscope, 133:2779-2785, 2023.

Recurrent tympanic perforation after myringoplasty: a narrative literature review and personal experience

The aim of the work is to review the current literature concerning recidivism of tympanic perforation after myringoplasty and to give some tips to improve the chance of success and manage the possible scenario of failure. An analysis of the existing literature is presented and, based on it and on our experience, an algorithm of management of tympanic perforation recidivism is proposed.

Endoscopic Transcanal Myringoplasty–Smart Myringoplasty for Nex Gen ENT Surgeons: Our Experience

Otolaryngology is one of the branch where endoscopes is being widely used nowadays to perform different surgeries. Ear surgeries are of special interest among the ENT surgeons. It has several advantages compared to the microscopes. 60 patients underwent endoscopic transcanal myringoplasty by the postgraduate residents under direct supervision of same consultants, using temporalis facia graft. The overall success rate in terms of graft uptake was 86.67% and the AB gap closure of < 10 dB in 63.3% of cases and 10-20 dB in 33.3%. Endoscopic myringoplasty was found to be equally effective, less morbid and very cost effective than the microscopic myringoplasty. This was applicable irrespective of the size of the perforation and condition of the middle ear (dry/wet) in our centre.

Endoscopic Ear Surgery: Our Experience

Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology.

The Feasibility and Treatment Results of Transcanal Endoscopic Myringoplasty

OBJECTIVE

We reported on transcanal endoscopic myringoplasty in 25 cases preliminarily in 2014. Now our number of transcanal endoscopic myringoplasty reached to 209 ears and allowed us to adequately investigate the visibility, necessity of canalplasty, treatment results, and multivariate analysis.

STUDY DESIGN

A prospective case series.

SETTING

Tertiary referral center.

PATIENTS

Transcanal endoscopic myringoplasty was performed on 209 ears in 201 patients between 2011 and 2019 and followed up over 1 year.

METHODS

Preoperative endoscopic and microscopic views for the same patient were compared. We examined success rates at 1 year after surgery according to operation type, perforation size, operation side, gender, cause of perforation, and age, and also examined hearing results. Logistic regression analysis was performed to investigate the basic demographic and clinical characteristics of the patients associated with perforation closure.

RESULTS

The anterior edge of the preoperative perforation was not visible under microscopy in 14.4% of patients. In contrast, endoscopic views revealed the entire tympanic membrane in one field. However, canalplasty was required in 2.4% of tympanic procedures due to difficulty of manipulation. The overall closure rate for perforations was 90.4%. Logistic regression analysis revealed that age > 11 was the only significant factor associated with perforation closure. The average reduction in air-bone gap was 12.1 dB.

CONCLUSION

The endoscopic myringoplasty produced better visualization, the same or better closure rates, and the same or lower complication rates as compared with traditional microscopic techniques.

Endoscopic inlay cartilage and perichondrium myringoplasty for repairing large perforations in teenagers

OBJECTIVE

This study compared the long-term graft success rates and hearing outcomes of overlay-underlay and underly cartilage myringoplasty for repairing large perforations in Teenagers.

STUDY DESIGN

prospective, randomized study.

SETTING

Tertiary referral center.

METHODS

Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups:intervention group (n = 39) and control group (n = 41). The graft success rate, hearing improvement, and complications were compared between the two groups.

RESULTS

A total of 80 patients were included in this study. The graft success rate was 100% in the intervention group and 95.1% in the control group at postoperative 3 months, the difference wasn't significant (P = 0.496). Also, the graft success rate was not significantly different between the two groups at 12 months postoperatively (100.0% vs 87.8%, p = 0.073). However, the difference of graft success rate was significant between the two groups at 24 months postoperatively (97.4% vs 75.6%, p = 0.012). CT examination revealed well-pneumatized middle ears 24 months after surgery in both group. However, epithelial pearls near the umbo were seen at 31 months postoperatively in one patient in the observation group.

CONCLUSIONS

Compared to the endoscopic cartilage with perichondrium composite graft underlay technique, endoscopic perichondrial graft overlay and cartilage underlay had a better long-term graft success rate and lower rate of long-term re-perforation in teenagers. However, the graft technique had no effect on hearing outcome.

Comparison of Medial Underlay and Lateral Underlay Endoscopic Type I Tympanoplasty for Anterior Perforations of the Tympanic Membrane

OBJECTIVES

To compare the outcomes of medial and lateral underlay endoscopic type I tympanoplasty for anterior tympanic membrane (TM) perforations.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary care academic referral center.

PATIENTS

Patients who were diagnosed with either chronic otitis media with dry and stable anterior TM perforations or traumatic anterior TM perforations and underwent endoscopic type I tympanoplasty between 2017 and 2019.

INTERVENTIONS

Medial or lateral underlay type I endoscopic tympanoplasty.

MAIN OUTCOME MEASURES

Patient demographics, size, and location of TM perforation, graft success rate, and hearing outcome.

RESULTS

Of the 170 patients, 68 and 102 patients underwent the medial and lateral underlay techniques, respectively. Patient demographics were not significantly different between groups, except the middle ear mucosa status. Graft success rates were significantly different between groups regardless of the perforation size (85.3 and 95.1%, p < 0.001). The lateral underlay group had a significantly better outcome (p < 0.001) when anterior superior quadrant TM perforation was included than the medial underlay group (p = 0.552). Hearing outcomes did not significantly differ between groups, but a significant audiological improvement was observed in both groups (p < 0.05).

CONCLUSION

Lateral underlay type I endoscopic tympanoplasty can be challenging as it requires dissection of the malleus. However, the lateral underlay group had a high graft success rate without sensorineural hearing loss in the repair of anterior TM perforations. Thus, lateral underlay type I endoscopic tympanoplasty should be considered for repairing anterior TM perforations, especially when the anterior superior quadrant is involved.

FGF2 and EGF for the Regeneration of Tympanic Membrane: A Systematic Review

Objective

A systematic review was conducted to compare the effectiveness and safety of fibroblast growth factor-2 (FGF2) and epidermal growth factor (EGF) for regeneration of the tympanic membrane (TM).

Methods

The PubMed database was searched for relevant studies. Experimental and clinical studies reporting acute and chronic TM perforations in relation to two healing outcomes (success rate and closure time) and complications were selected.

Results

A total of 47 studies were included. Five experimental studies showed closure rates of 55%-100% with FGF2 compared with 10%-62.5% in controls for acute perforations. Five experimental studies showed closure rates of 30.3%-100% with EGF and 3.6%-41% in controls for chronic perforations. Two experimental studies showed closure rates of 31.6% or 85.7% with FGF2 and 15.8% or 100% with EGF. Nine clinical studies of acute large perforations showed closure rates of 91.4%-100% with FGF2 or EGF. Two clinical studies showed similar closure rates between groups treated with FGF2 and EGF. Seven clinical studies showed closure rates of 88.9%-100% within 3 months and 58%-66% within 12 months using FGF2 in repair of chronic perforations, but only one study showed a significantly higher closure rate in the saline group compared with the FGF2 group (71.4% vs. 57.5%, respectively, P = 0.547). In addition, three experimental studies showed no ototoxicity associated with FGF2 or EGF. No middle ear cholesteatoma or epithelial pearls were reported, except in one experimental study and one clinical study, respectively.

Conclusions

FGF2 and EGF showed good effects and reliable safety for the regeneration of TM. In addition, EGF was better for the regeneration of acute perforations, while FGF2 combined with biological scaffolds was superior to EGF for chronic perforations, but was associated with high rates of reperforation over time. Further studies are required to determine whether EGF or FGF2 is better for TM regeneration.

The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty

OBJECTIVE

To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia.

STUDY DESIGN

Retrospective patient review and posttreatment questionnaire survey.

SETTING

Tertiary referral center.

PATIENTS

Sixty adult patients with chronic dry tympanic membrane perforation.

INTERVENTIONS

Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used.

MAIN OUTCOME MEASURES

Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey.

RESULTS

Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method.

CONCLUSION

This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.

Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media

OBJECTIVES

This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty.

METHODS

This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups.

RESULTS

The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group.

CONCLUSION

Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.

Can Tissue Engineering Bring Hope to the Development of Human Tympanic Membrane?

The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMPs) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anesthetic risks, and high failure of graft patency. The tissue engineering strategy, which includes the applications of a three-dimensional (3D) scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches, which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, we provide an overview of the in vitro and preclinical studies of emerging products over the past 5 years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.

Endoscopic tympanoplasty type I for tympanic perforations: analysis of prognostic factors

PURPOSE

To assess the anatomical and functional outcomes of endoscopic transcanal tympanoplasty type I for tympanic membrane perforations.

METHODS

Eight hundred thirty-five patients who underwent tympanoplasty between January 2011 and January 2019 were selected. Patients with tympanic membrane perforation treated with a transcanal endoscopic tympanoplasty type 1 and a follow-up period longer than 6 months have been retrospectively reviewed. The presence of cholesteatoma or ossicular chain dysfunctions were considered exclusion criteria. Eighty-one patients were included in the present study population. The main outcome was the rate of overall graft success. Secondary outcomes included hearing results. Prognostic factors related to both the abovementioned outcomes were assessed.

RESULTS

Overall, 66 patients (81.5%) had a successful graft at the last follow-up evaluation. Mean follow-up was 22.1 (range 6-104) months. The anterior quadrants were entailed by the perforation in 62 (76.5%) cases. The overall success rate with cartilage (or cartilage and perichondrium) was 91.2% (p < 0.01). The median preoperative and postoperative ABG were 18.7 (13.4-25.6) and 7.5 (2.5-12.5), respectively, revealing a significant median improvement of 11.2 (p < 0.001). The type of graft and the postoperative tympanic membrane status were significantly associated with the audiologic outcome with p = 0.01 and p = 0.02, respectively.

CONCLUSIONS

Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results. Tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results. Anterior eardrum perforations can be successfully and safely managed with transcanal endoscopic approach avoiding postauricular approach and canalplasty.

In reply to the letter to the editor regarding "Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study"

This is a reply letter to the manuscript "The size and diameter of pieces of cartilage are not fixed for the palisade technique and one-piece technique", regarding the elevation of a tympanomeatal flap and keratin pearl formation in "Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study" ( https://doi.org/10.1007/s00405-020-05947-3 ).

Comparison of clinical outcome between endoscopic and postauricular incision microscopic type-1 tympanoplasty

BACKGROUND

Microscopic type-1 tympanoplasty (T1T) is a classical method for the treatment of chronic otitis media. However, it has its limitations. The development of otoendoscopy provided a new method for T1T.

OBJECTIVE

To investigate the difference between endoscopic T1T and microscopic T1T.

MATERIAL AND METHODS

Seventy-four patients who underwent T1T were evaluated retrospectively. About 52 cases underwent endoscopic T1T, and 22 cases accepted microscopic T1T. Parameters including operative duration, incision size, graft site, duration of postoperative hospitalization, visual analog scale (VAS) score, complications, hearing improvement, and expenses were compared.

RESULTS

Operative duration of endoscopic T1T (47.0 ± 8.2 min) was shorter than microscopic T1T (58.0 ± 9.3 min) (p < .05). The VAS score under endoscopic T1T (1.5 ± 0.2) was lower than microscopic T1T (5.6 ± 0.4) (p < .05). There was no complication during endoscopic T1T, but damage to the chorda tympani nerve (one case) was noted for microscopic T1T. There was no difference in hearing improvement between endoscopic (15.0 ± 1.5 dB) and microscopic T1T (16.0 ± 1.1 dB). Duration of postoperative hospitalization and expenses were lower for endoscopic T1T.

CONCLUSIONS AND SIGNIFICANCE

Endoscopic T1T is a minimally invasive surgery with similar graft success rate, comparable hearing improvement, fast recovery, low cost, and high patient satisfaction compared to microscopic T1T.

Endoscopic Myringoplasty and Type I Tympanoplasty

Herein we provide a broad overview of the literature as it applies to endoscopic myringoplasty and type I tympanoplasty. Advantages and disadvantages of the endoscopic approach are reviewed for both the adult and pediatric populations and are compared with conventional microscopic techniques.

Myringoplasty With an Ultrathin Cartilage-Perichondrium Complex Graft Versus Temporalis Fascia Graft: A Propensity Score-Matched Analysis

OBJECTIVE

To compare endoscopic myringoplasty using the cartilage-perichondrium complex as a graft (test group) with temporalis fascia microscopic myringoplasty (control group).

STUDY DESIGN

A retrospective cohort study.

SETTING

Department of Otorhinolaryngology in a tertiary Chinese hospital.

METHODS

Data were collected on patients between 2017 and 2019. To balance the baseline characteristics between groups, we performed a propensity score-matched analysis, and 44 patients were included in each group. Hearing improvement and eardrum closure rates were compared, and risk factors affecting them were analyzed.

RESULTS

In the control and test groups, 90.90% and 86.36% of patients had a mean air-bone gap ≤20 dB after the surgery, respectively (P = .843). The air conduction (AC) threshold gain at each frequency was similar in the 2 groups (P > .05). The closure rates were 95.45% and 93.18%, respectively (P = .645). The air-bone gap improved significantly after surgery, F(1, 61) = 6.729, P = .012. Age, group, middle ear mucosal status, and location of the perforation did not affect the change in air-bone gap or the drum closure rate (P > .05). However, there was an interaction between the change in air-bone gap and the size of the perforation, F(1, 61) = 11.067, P = 0001.

CONCLUSION

Endoscopic myringoplasty using a cartilage-perichondrium complex graft is comparable with traditional surgery. Age, location of the perforation, and middle ear mucosal status did not significantly affect the change in air-bone gap or the drum closure rate. A perforation size ≥50% was always associated with a better air-bone gap improvement.

Endoscopic single versus double flap tympanoplasty: a randomized clinical trial

OBJECTIVE

This study aims to compare the results of endoscopic over-underlay tympanoplasty, single flap technique, with endoscopic over-underlay tympanoplasty combined with an anterior tab, double flap technique, in repair of the challenging total and subtotal tympanic membrane perforations with inadequate anterior remnant. This is to determine whether highly adequate visualization at the anterior meatal angle area offered by endoscopy can eliminate the need for anterior tab reinforcement.

SUBJECTS AND METHODS

A prospective randomized single-blinded study involving 104 patients with total or subtotal tympanic membrane perforations was conducted. Patients were randomized into two groups: 52 with endoscopic single flap tympanoplasty, first group, and 52 with endoscopic double flap tympanoplasty, second group, between August 2017 and February 2019. The main outcome is graft take rate. Secondary outcomes include hearing results, pain score assessment, operative time and postoperative complications.

RESULTS

Graft take rates were 94% and 98% for the first and second groups, respectively (P value = 0.307). Significant improvement was achieved in total air-bone gap from 21.45 ± 5.37 and 23.1 ± 4.47 preoperatively to 6.4 ± 5.46 and 6.15 ± 3.57 postoperatively for the first and second groups, respectively. Pain scores were not significantly different between the two groups. Mean operative time was significantly longer in the second group (P value = 0.010). There was no reported lateralization or anterior blunting in both groups.

CONCLUSION

In repair of total and subtotal tympanic membrane perforations with inadequate anterior remnant, endoscopic enrollment provides excellent visualization and good manipulation at the anterior meatal angle area with favorable results, eliminating the need for adding an anterior tab and alleviating the burden of longer operative time.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov (NCT03922295) "retrospectively registered" at 18/4/2019.

Does microscopic experience influence learning curve in endoscopic ear surgery? A multicentric study

OBJECTIVE

The aim of the present study was to illustrate the learning curve of endoscopic type-1 tympanoplasty comparing experts in microscopic otology versus neophyte surgeons.

METHODS

Eight ear surgeons, from tertiary referral centers, who had performed at least 30 endoscopic type 1 tympanoplasties were included in the study. Demographic data and medical records regarding the first 30 endoscopic type-1 tympanoplasties were retrospectively collected by each surgeon. A 14-questions survey focused on subjective aspects of the learning curve was administered. Surgeons were divided in two groups: one with previous experience in microscopic ear surgery (group 1) and one with no previous experience in ear surgery (group 2). The learning curve of endoscopic type 1 tympanoplasty was compared between the groups.

RESULTS

Mean surgical time was 89.2 min in group 1 vs. 79.5 min in group 2 (p < 0.01). When divided in 5 surgeries-steps, the only significant difference was appreciated in the first 5 surgeries with a longer mean time in group 1 vs. group 2 (+28.4 min; p < 0.05).

CONCLUSIONS

Surgeon's previous experience may influence the EES learning curve. Our results show that the first 5 surgical procedures are more challenging for surgeons experienced in microscopic surgery, subsequently the curve progression improves sharply and appears reversing the initial trend by the end of the 30 surgeries.

Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report

PURPOSE

Middle ear surgery may benefit from robot-based assistance to hold micro-instruments or an endoscope. However, the surgical gesture performed by one hand may perturb surgeons accustomed to two-handed surgery. A robot-based holder may combine the benefits from endoscopic exposure and a two-handed technique. Furthermore, tremor suppression and accurate tool control might help the surgeon during critical surgical steps. The goal of this work was to study the safety of an otological robot-based assistant under clinical conditions in a limited series of patients.

METHODS

The RobOtol system has been used as an endoscope or a micro instrument holder for this series. Eleven cases were operated on with the robot as an endoscope holder for chronic otitis. Twenty-one cases were operated on with the robot as a micro-instrument holder for otosclerosis (9 cases), transtympanic tube placement (2 cases), or cochlear implantation (10 cases).

RESULTS

No complications related to the robot manipulation occurred during surgery nor in postoperative. In the chronic otitis group, all perforations were sealed and 3-month postoperative pure-tone average air-bone gap (PTA ABG) was 15 ± 2.6 dB. In the otosclerosis group, 1-month post-op PTA ABG was 10 ± 1 dB. For cochlear implantation cases, a scala tympani insertion, a vestibular scala translocation occurred and a full scala vestibuli insertion was observed in 7, 2 and 1 case, respectively.

CONCLUSION

The RobOtol system has reached the clinical stage. It could be used safely and with accurate control as an endoscope holder or a micro instrument holder in 32 cases.

The Effect of External Auditory Canal Packing Duration on Healing After Endoscopic Cartilage Myringoplasty

INTRODUCTION

The external auditory canal (EAC) packing is widely used in otosurgery and is considered to promote hemostasis and to support tympanic membrane grafts. However, few studies have investigated the effects of packing removal time on healing.

OBJECTIVE

We investigated the effect of EAC packing duration on healing after endoscopic cartilage myringoplasty in patients with chronic tympanic membrane perforations (TMPs).

MATERIALS AND METHODS

Patients with chronic TMPs who underwent endoscopic "push-through" cartilage myringoplasty were divided into early and late groups based on the length of time before EAC packing was removed. The graft success rate, eardrum appearance, and hearing gain were assessed 3 months after surgery.

RESULTS

The study included 137 patients. Three months after surgery, the graft success rate was 83.5% (66/79) in the early group and 94.8% (55/58) in the late group (P = .042). The graft was displaced in 8 (10.1%) patients in the early group and in 1 (1.7%) patient in the late group (P = .050). No epithelialization was found on the surface of the grafts in the early group, whereas epithelialization was nearly complete 4 weeks after surgery in the late group.

CONCLUSIONS

Delaying removal of the EAC packing after endoscopic cartilage myringoplasty may promote tympanic membrane better healing and cartilage graft epithelialization and improve the appearance of the eardrum.

Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study

PURPOSE

The endoscopic approach to tympanoplasty is gaining popularity, but its adoption for the palisade tympanoplasty technique is unstudied. The aim of the present study was to evaluate the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations.

METHODS

Retrospective study of 42 adult patients who underwent endoscopic tympanoplasty for a subtotal perforation in a university tertiary referral center from January 2018 to June 2019. Patients underwent transcanal tympanoplasty either with cartilage palisade grafts or with one-piece composite cartilage-perichondrium grafts. Both techniques were compared for graft take rate and audiometric results.

RESULTS

Twenty palisade and 22 single-piece tympanoplasties were analyzed. No statistically significant differences between groups were found in terms of tympanic membrane closure (85% vs. 86.3%, p = 0.5) or hearing improvement.

CONCLUSION

The results of the present study suggest that similar results can be obtained with palisade cartilage grafts compared to the one-piece composite cartilage-perichondrium technique for endoscopic tympanic membrane closure. Further studies with long-term results will be needed to confirm these findings.

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4 ± 5.24 dB. The mean ABG was 9.2 ± 2.13 dB 1 month postoperatively and 8.5 ± 2.26 dB 6 months postoperatively (p < .005).Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn't require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.

Transcanal Endoscopic Type 1 Cartilage Tympanoplasty in Children

Objective

Transcanal endoscopic type 1 tympanoplasty is a minimally invasive procedure that enables better visualization of deep and narrow spaces compared to conventional microscopic methods. In our study, we aimed to evaluate air-bone gap difference, graft success, and hearing gain according to the perforation size and location in pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty.

Methods

Fifty pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty for chronic otitis media were included in the study. Tragal cartilage grafts were used in all patients. Air conduction pure tone audiometry hearing results (500, 1000, 2000, and 4000 Hz), mean air-bone gap levels, operating times, postoperative gap closure, and graft success rates were evaluated.

Results

Mean operating time was 43.34±8.56 minutes. Overall graft success was 94% (47/50). Mean hearing levels at all frequencies (500, 1000, 2000, and 4000 Hz) were found to have significantly improved after the operation (p<0.001). Mean preoperative air conduction pure tone threshold and mean air-bone gap had statistically significantly improved by the 6th postoperative month (p<0.001).

Conclusion

Transcanal endoscopic type 1 cartilage tympanoplasty was found to be a minimally traumatic, easy and safe method with a low complication rate. In pediatric patients, this method allows for high rates of anatomic and functional recovery with optimal surgery time regardless of the location and the size of the perforation.

Endoscopic type I tympanoplasty is as effective as microscopic type I tympanoplasty but less invasive-A meta-analysis

BACKGROUND

Endoscopic type I tympanoplasty was originally introduced in the 1990s, and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty.

OBJECTIVE OF REVIEW

The aim of this study was the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty.

TYPE OF REVIEW

We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

SEARCH STRATEGY

A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics-Web of Science, ClinicalTrials.gov, World Health Organization Library, and Scopus by inserting, 'myringoplasty OR (tympanoplasty AND perforation)' into the search query. We applied only a 'human' filter. We excluded non-English studies. Additional records were identified by checking the references of relevant studies.

EVALUATION METHOD

Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias and estimated the quality of evidence for each outcome.

RESULTS

Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82-1.77; I2  = 0.0%), the postoperative hearing results (WMD = -1.13; 95% CI: -2.72-0.45; I2  = 78.1%) and the operation time (WMD = -21.11; 95% CI: -42.60-0.38; I2  = 99.3%), were all comparable amongst the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR = 7.96; 95% CI: 4.30-14.76; I2  = 0.0%, P = 1.000) and features an increase in desirable cosmetic results (OR = 19.29; 95% CI: 11.37-32.73; I2  = 0.0%, P = 0.839), when compared with the microscopic approach.

CONCLUSIONS

Based on our meta-analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower.

Endoscopic transcanal versus conventional microscopic tympanoplasty in treatment of anterior tympanic membrane perforations

PURPOSE

To compare the surgical outcomes of endoscopic transcanal tympanoplasty (ETT) and conventional microscopic tympanoplasty (CMT) in repairing anterior tympanic membrane perforations (ATMPs).

METHODS

We retrospectively analyzed the graft success rate, hearing outcomes, operative time, hospitalization period and complications in patients who underwent ETT and CMT between October 2015 and July 2018. In addition, the authors investigated whether anterior canal wall protrusion (ACWP) affects the graft success rate and operative time.

RESULTS

The graft success rates for ETT and CMT were 93.7% (30 out of 32 patients) and 91.4% (32 out of 35 patients), respectively (p = 0.640). There was no significant relationship between ACWP and graft success rates in either the endoscopic (p = 0.685) and microscopic (p = 0.894) group. The mean operative time was significantly shorter in the ETT group (37.2 ± 3.1 min) than in the CMT group (52.9 ± 9.2 min) (p < 0.001). Regarding operative time, there was no statistically significant difference between patients with and without ACWP (38.3 versus 36.3 min, respectively (p = 0.124)) in the ETT group. However, the mean operative time of patients with ACWP in the CMT group was significantly longer than patients without ACWP [62.3 versus 48.8 min, respectively (p < 0.001)].

CONCLUSIONS

ETT offering fewer complication rates and shorter duration of surgery may serve as a reasonable alternative to CMT in repairing ATMPs, with comparable graft success rates.

Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty

Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures. Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty. Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success. Results: Mean follow up time was 20.69 ± 5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69 ± 2.83 dB HL in group 1 and 7.98 ± 3.08 dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups (p>.05). Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.

Comparison of temporal muscle fascia and tragal cartilage perichondrium in endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap

INTRODUCTION

Elevation of tympanomeatal flap is one of the basic steps of tympanoplasty. A satisfactory level of anatomic and functional success can be achieved by using different grafts with limited tympanomeatal flap elevation.

OBJECTIVES

We aimed to compare the anatomic and functional success of tragal cartilage perichondrium and temporal muscle fascia in cases of endoscopic type 1 tympanoplasty performed with limited tympanomeatal flap elevation.

METHODS

In total, 81 cases (33 females, 48 males, mean age 22.1 ± 10.1 years, interval 18-49 years) which underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap were included the present study. All cases were divided into two groups as tragal cartilage perichondrium (group A) and temporal muscle fascia (group B). The comparison of the groups were made considering the pre- and postoperative air-bone gap and the tympanic membrane status.

RESULTS

There was no statistically significant difference between Group A and Group B in preoperative and in postoperative air-bone gap values (p = 0.608 and 0.529, respectively). In Group A and B, postoperative air-bone gap values demonstrated significant decrease compared to the preoperative values (p = 0.0001). Group A and group B did not demonstrate significant differences between postoperative improvements of air-bone gap values (p = 0.687). Graft retention success was 92.6% in group A while it was 90.0% in group B. There was no statistically significant difference between the groups in terms of graft retention success (p = 0.166).

CONCLUSION

In accordance with the results of this study, we believe that both tragal cartilage perichondrium and temporal muscle fascia, and also in limited tympanomeatal flap elevation in endoscopic tympanoplasty are all eligible for result in safe and successful surgery.

Total Endoscopic Transcanal Cartilage Myringoplasty: A Prospective Study

Introduction  Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope.

Objectives  The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results.

Methods  This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months.

Results  During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% ( n  = 123) of the patients 6 months after the intervention.

Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively.

Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant ( p  < 0.001).

Conclusion  The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

Endoscopic Type 1 Tympanoplasty in Chronic Otitis Media: Comparative Study with a Postauricular Microscopic Approach

OBJECTIVE

To compare surgical outcomes after tympanoplasty without ossiculoplasty for chronic otitis media between transcanal endoscopic ear surgery (TEES) and postauricular microscopic ear surgery (PAMES).

STUDY DESIGN

Case-control study.

SETTING

Tertiary care university hospital.

SUBJECTS AND METHODS

Consecutive patients (N = 122) who had undergone tympanoplasty without ossiculoplasty for chronic otitis media were enrolled in this retrospective study and divided into 2 groups: TEES (n = 47) and PAMES (n = 75). Middle ear condition was graded with the middle ear risk index. Hearing, repair of tympanic membrane perforation, and surgical time were assessed.

RESULTS

The surgical success rate for hearing (air-bone gap ≤20 dB) was 95.7% in the TEES group and 84.0% in the PAMES group. Lower middle ear risk resulted in similar mean (95% CI) closure of air-bone gaps (TEES: 9.6, 6.5-12.6; PAMES: 8.0, 6.4-9.7; P = .333), whereas higher middle ear risk demonstrated significantly larger closure of air-bone gaps for the TEES group (10.1, 3.3-16.9) than the PAMES group (-0.2, -4.5 to 4.2; P = .009). The surgical success rate for repair of tympanic membrane perforation and surgical time were equivalent between TEES and PAMES.

CONCLUSION

Under favorable conditions of the middle ear, TEES and PAMES resulted in similar hearing improvement by tympanoplasty without ossiculoplasty. However, under adverse conditions of the middle ear, TEES was a more beneficial approach for hearing improvement than PAMES.

Outcomes of Adopting Endoscopic Tympanoplasty in an Academic Teaching Hospital

Objectives:

To compare the outcomes of endoscopic versus microscopic tympanoplasty during the initial period of a surgeon adopting the new endoscopic technique and teaching the surgical approach to residents assisting in surgery.

Methods:

Retrospective medical chart review of 60 consecutive operations for repair of isolated tympanic membrane perforations from 2011 to 2016 performed by a single surgeon assisted by residents in an academic teaching hospital. The outcomes of 20 ears repaired microscopically before the senior author adopted endoscopic ear surgery (Group A) were compared with the outcomes of the first 20 ears that were attempted with endoscopic surgery (Group B) and the next 20 ears performed endoscopically (Group C). Sixty ear operations were performed on 52 patients as 8 patients had bilateral ear surgery.

Results:

The tympanic membrane closure rate was 80% for Group A, 80% for Group B, and 95% for Group C. Mean air-bone gap improvement was 12.8 dB in Group A, 8.3 dB in Group B, and 12.1 dB in Group C. Mean duration of surgery was 99.2 minutes in Group A, 91.3 minutes in Group B, and 90.5 minutes in Group C. In Group B, 20% of the ears (4/20) were converted to a microscopic approach; in Group C, none required conversion.

Conclusions:

Maintenance of good outcomes and similar results can be maintained during a surgeon’s transition to adopting endoscopic tympanoplasty and teaching it to residents.