Narrow band imaging endoscopy improves visualization of vessels of the perforated tympanic membrane

Digital image enhancement may improve sensitivity of cholesteatoma detection during endoscopic ear surgery

OBJECTIVES

This study investigates the possible benefits and limitations of the digital image enhancement systems provided by Storz Professional Image Enhancement System (SPIES) during endoscopic ear surgery (EES) for cholesteatoma. An increased detection of cholesteatoma residuals during the final steps of endoscopic surgery using DIE technology was hypothesized.

DESIGN

Cross-sectional study.

SETTING

Tertiary referral hospital.

METHODS

A total of 10 questionnaires of 18 intraoperative pictures with equal numbers of cholesteatoma and non-cholesteatoma images, each presented in three different image-enhancing modalities (Clara, Spectra A, Spectra B), were generated. Fifty-one experienced ear surgeons participated to the survey and were randomly assigned to a questionnaire and completed it at two time points. The experts were asked to rate for each picture whether cholesteatoma was present or not. The answers were compared with the histopathological reports.

RESULTS

Clara showed the highest accuracy in cholesteatoma detection, followed by Spectra A and lastly Spectra B. In contrast, Spectra B showed the highest sensitivity and Clara the highest specificity, while Spectra A was placed in the middle for both values. Using the Spectra B modality, most responses agreed across the two time points. Ear surgeons assessed the usefulness, as well as preference among image modalities for cholesteatoma surgery, in the following order: Clara, Spectra B, Spectra A.

CONCLUSION

Digital enhancement technologies are applicable to EES. After complete cholesteatoma removal, Spectra B showed the highest sensitivity in the detection of cholesteatoma residuals as compared with Clara and Spectra A. Thus, Spectra B may be recommended to avoid missing any cholesteatoma residuals during EES.

Double-Layered (Cartilage Island + Extra Perichondrium) Graft for Type 1 Tympanoplasty

OBJECTIVE

To compare the graft success rates and hearing results of single-layered (composite island) grafting (SLG) vs double-layered (composite plus second layer of perichondrium) grafting (DLG) for over-under type 1 tympanoplasty techniques.

STUDY DESIGN

Retrospective chart review.

SETTINGS

Tertiary center otorhinolaryngology clinic.

SUBJECTS AND METHODS

Medical charts of the patients who underwent type 1 tympanoplasty via the microscopic technique by a single surgeon between 2015 and 2019 were analyzed.

RESULTS

A total of 48 patients were included. The DLG (n = 26) group had higher graft take rates as compared to the SLG group (n = 22) for all patients (P = .038) and for moderate- to high-risk patients according to Middle Ear Risk Index (MERI) scores (P = .029) but not for patients with mild disease (P = .429) or myringosclerotic patients (P = .242). The DLG group exhibited higher air-bone gap closure (C-ABG) values as compared to the SLG group for all patients (P = .018). However, there was no noticeable difference in C-ABG values within the patients with successful grafting (P = .217). Only graft success status had a significant effect on C-ABG values when the multivariate linear regression was performed. (P = .016). Higher MERI scores and presence of myringosclerosis were related to the unsuccessful grafting (P < .01).

CONCLUSION

DLG tympanoplasty is encouraged, especially for patients with higher MERI scores, to increase the graft success rates. Better hearing outcomes of DLG tympanoplasty were related to the higher graft success status of this technique; DLG had no additional hearing effect for patients with successful grafting. Higher MERI scores and presence of myringosclerosis were related to graft failure.