1
|
Gkrinia E, Ntziovara AM, Brotis AG, Tzimkas-Dakis K, Saratziotis A, Korais C, Hajiioannou J. Endoscopic Versus Microscopic Tympanoplasty: A Systematic Review and Metanalysis. Laryngoscope 2024; 134:3466-3476. [PMID: 38415937 DOI: 10.1002/lary.31365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/29/2024]
Abstract
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, 134:3466-3476, 2024.
Collapse
Affiliation(s)
- Eleni Gkrinia
- ENT Department, University Hospital of Larissa, Larisa, Greece
| | | | | | | | | | - Christos Korais
- ENT Department, University Hospital of Larissa, Larisa, Greece
| | | |
Collapse
|
2
|
Wang TC, Shih TC, Chen CK, Hsieh VCR, Lin DJ, Tien HC, Chen KC, Tsai MH, Lin CD, Tsai CH. Endoscopic Versus Microscopic Type I Tympanoplasty: An Updated Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:675-693. [PMID: 38140741 DOI: 10.1002/ohn.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/17/2023] [Accepted: 10/22/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Our objective was to perform a systematic review and meta-analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty. STUDY DESIGN Randomized controlled trials, two-arm prospective studies, and retrospective studies were included. SETTING Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: "endoscopic," "microscopic," and "tympanoplasty." METHODS Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS). RESULTS Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures. CONCLUSION Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.
Collapse
Affiliation(s)
- Tang-Chuan Wang
- Department of Otolaryngology-Head and Neck Surgery, Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Master Program for Biomedical Engineering, College of Biomedical Engineering, China Medical University, Taichung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
| | - Tzu-Ching Shih
- Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Dan-Jae Lin
- Department of Department of Biomedical Engineering, College of Biomedical Engineering, China Medical University, Taichung, Taiwan
| | - Hui-Chi Tien
- Department of Otolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
| | - Kuang-Chao Chen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Hsui Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
3
|
Zhang Y, Lou Z. Inside-out raising mucosal-tympanomeatal flap approach for the repair of large marginal perforations. BMC Surg 2023; 23:378. [PMID: 38093229 PMCID: PMC10717025 DOI: 10.1186/s12893-023-02286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE This study evaluated the graft success rate and hearing outcomes of the inside-out raising mucosal-tympanomeatal flap technique for the repair of large marginal perforations. STUDY DESIGN Prospective case series. MATERIALS AND METHODS The study enrolled patients with large marginal perforations who underwent endoscopic cartilage myringoplasty with the inside-out raising mucosal-tympanomeatal flap technique. The graft success rate, hearing outcomes, and complications were evaluated at 12 months postoperatively. RESULTS In total, 48 patients with large marginal perforations were included. 81% of the population had large perforation, 14.6 had subtotal and total perforation was seen in 4.2%. The mean operation time was 38.6 ± 7.1 min. At 12 months postoperatively, the graft success rate was 89.6% (43/48). The mean air-bone gap was 25.6 ± 5.2 dB preoperatively and 16.5 ± 4.1 dB at 12 months postoperatively, with significant differences between these values (p = 0.001). The functional success rate was 85.4% (41/48). None of the patients experienced worsened sensorineural hearing loss or graft-related complications, such as graft lateralization, significant blunting, and graft medialization, during follow-up. CONCLUSIONS Endoscopic cartilage-perichondrium myringoplasty for the repair of large marginal perforations using the inside-out raising mucosal-tympanomeatal flap technique was associated with satisfactory graft outcomes and minimal complications.
Collapse
Affiliation(s)
- Yanting Zhang
- Department of operating theater, Yiwu central hospital, 699 jiangdong road, Yiwu city, Zhejiang provice, 322000, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu central hospital, 699 jiangdong road, Yiwu city, Zhejiang provice, 322000, China.
| |
Collapse
|
4
|
Gutierrez JA, Cabrera CI, Stout A, Mowry SE. Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:1453-1466. [PMID: 36951041 DOI: 10.1177/00034894231159000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. METHODS A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. RESULTS Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. CONCLUSION Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. LEVEL OF EVIDENCE 3B.
Collapse
Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amber Stout
- Medical Core Library, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reverse University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
5
|
Bianchini AJ, Berlitz VG, Mocelin AG, Ribeiro JF, Keruk JG, Hamerschmidt R. Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review. Int Arch Otorhinolaryngol 2023; 27:e528-e535. [PMID: 37564466 PMCID: PMC10411212 DOI: 10.1055/s-0042-1748808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 10/17/2022] Open
Abstract
Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this. Objectives The present systematic review attempted to compare endoscopic and microscopic surgery techniques and to discover whether there would be superiority in the results of any of them, based on data currently available in the literature. Data Synthesis The objectives of the present review were organized according to the PICO planning and strategy adapted for systematic reviews. The inclusion and exclusion criteria were established aiming to select only select primary data. The main medical databases were searched using an optimized search string with appropriate descriptors. The searched databases were MEDLINE, LILACS, SciELO, and EMBASE. A total of 99 studies were selected and 38 were fully assessed after the inclusion criteria were applied. All included articles were reviewed by all authors and their results were discussed and summarized. Conclusion The endoscopic technique was shown to be a safer technique comparable in effectiveness to the use of microscopy. In addition, it provides possible advantages such as shortening the surgical time and better postoperative pain outcomes.
Collapse
Affiliation(s)
- Ana Júlia Bianchini
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Vitória Gabriela Berlitz
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Aurenzo Gonçalves Mocelin
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Juliana Ferraz Ribeiro
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - João Gabriel Keruk
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Rogério Hamerschmidt
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| |
Collapse
|
6
|
Mitton TJ, Killeen DE, Momin ZK, Hunter JB, Isaacson B, Lee K, Kutz JW. Endoscopic Versus Microscopic Pediatric Tympanoplasty: Is There a Difference Between Closure Rates and Hearing Outcomes? Otol Neurotol 2022; 43:1205-1211. [PMID: 36166975 DOI: 10.1097/mao.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare closure rates and hearing outcomes of microscopic and endoscopic tympanoplasty in pediatric patients. STUDY DESIGN Retrospective chart review. SETTING Tertiary university medical center. PATIENTS Pediatric patients who underwent tympanoplasty surgery by a fellowship-trained neurotologist between 2010 and 2019 with a minimum of 2 months of follow-up, a tympanic membrane perforation, and no preoperative cholesteatoma. INTERVENTIONS Transcanal endoscopic tympanoplasty or microscopic tympanoplasty (MT) surgery. MAIN OUTCOME MEASURES The primary outcome is postoperative closure of the tympanic membrane perforation, assessed using otomicroscopy at the last follow-up appointment. Secondary outcomes include operative time and changes in the air-bone gap (ABG) and pure-tone average (PTA). RESULTS Two hundred eleven tympanoplasty operations were analyzed: 121 in the transcanal endoscopic ear surgery (TEES) group and 90 in the MT group. Tympanic membrane closure rates were no different between the two groups (TEES, 82.6%; MT, 88.9%; p = 0.24), and no significant association was found on multivariable analysis (TEES: odds ratio, 0.8; p = 0.61). Both groups showed improvements in the 4-month PTA and ABG and the 12-month PTA, but the 12-month ABG only improved in the TEES group ( p < 0.01). The TEES group had a shorter average operative time (109.8 versus 123.5 min; p = 0.03) and less need for a postauricular incision (2.5% versus 93.3%; p < 0.01). CONCLUSION In pediatric tympanoplasty, TEES gives similar membrane closure and hearing outcomes as the microscopic technique, with less operative time and less need for a postauricular incision.
Collapse
Affiliation(s)
- Tanner J Mitton
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zoha K Momin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kenneth Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joe Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
7
|
Mitton T, Kim J, Killeen DE, Hunter JB, Isaacson B, Kutz JW. Transcanal Endoscopic Versus Microscopic Tympanoplasty: Is There a Difference in Perforation Closure Rates? OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e016. [PMID: 38516628 PMCID: PMC10950148 DOI: 10.1097/ono.0000000000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/22/2022] [Indexed: 03/23/2024]
Abstract
Objective To compare closure rates of endoscopic and microscopic tympanoplasty (MT) as influenced by perforation size, perforation location, and graft position. Study Design Retrospective chart review. Setting Tertiary university medical center. Patients Adult patients who underwent tympanoplasty by a fellowship-trained neurotologist from January 2010 to December 2019, had at least 2 months of follow-up, and had a tympanic perforation with no cholesteatoma before surgery. Interventions Transcanal endoscopic tympanoplasty (ET) or MT. Main Outcome Measures The primary outcome is postoperative closure of the tympanic membrane perforation as assessed using otomicroscopy at the last follow-up appointment. Results Two-hundred and eleven patients-98 in the transcanal ET group and 113 in the MT group-were identified. Tympanic membrane closure rates were not significantly different between the ET and MT groups (79.6% and 84.1% respectively; P = 0.473), and further multivariable analysis revealed that closure rates for ET relative to MT had an insignificant odds ratio (0.56; P = 0.144). Similar analyses also found no significant difference between the 2 methods in subsets of perforation size (small, large, subtotal/total), perforation location (anterior, posterior, inferior), and graft position (underlay, overlay). Conclusions ET resulted in similar rates of postoperative closure rates compared with the microscopic technique.
Collapse
Affiliation(s)
- Tanner Mitton
- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jenny Kim
- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel E. Killeen
- Department of Otolaryngology – Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jacob B. Hunter
- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brandon Isaacson
- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joe Walter Kutz
- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
8
|
Li A, Liang Z, Chen H, Yang Y, Xu Y, Gao X, Chen J. Endoscopic closure of tympanic membrane anterior perforation using a strip-type chondroperichondrial graft. Medicine (Baltimore) 2022; 101:e30037. [PMID: 35984182 PMCID: PMC9387989 DOI: 10.1097/md.0000000000030037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Myringoplasty is a surgical procedure to reconstruct tympanic perforation. However, repair of anterior perforations is still challenging. To analyze the anatomical and hearing outcomes of myringoplasty with a new technique of chondroperichondrial graft via endoscopy, 23 adult patients were retrospectively analyzed. All patients had anterior perforations of tympanic membranes that were repaired with a composite strip-type cartilage-perichondrium graft through a total endoscopic transcanal approach. The anatomical graft success rate at postoperative 1 month was 86.96% (20/23) and reached 100% at the 6- and 12-month follow-up. Compared to the preoperative air conduction threshold (44.7 ± 13.56 dB) and air-bone gap (ABG) (22.35 ± 6.54 dB), the postoperative air conduction threshold and ABG decreased to 33.52 ± 10.88 dB and 12.52 ± 3.94 dB, respectively (P < .0001). Twenty-two (95.65%) patients had an ABG below 20 dB postoperatively. The mean ABG improvement in our cohort was 9.83 ± 5.00 dB. The functional graft success rate was 95.65% (22/23). The convenience, reliability, time, and labor savings accrued from the approach described here make it a good choice for repair of anterior perforation of tympanic membrane.
Collapse
Affiliation(s)
- Ao Li
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Zheng Liang
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Hong Chen
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Ye Yang
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Yuqin Xu
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Xia Gao
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
| | - Jie Chen
- Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Nanjing, China
- Research Institute of Otolaryngology, Nanjing, China
- *Correspondence: Jie Chen, PhD, Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), No. 321 Zhongshan Road, Nanjing 210008 (e-mail: )
| |
Collapse
|
9
|
Chen D, Duan M. The study of otoendoscopic tympanoplasty (type I). Acta Otolaryngol 2022; 142:575-578. [PMID: 35984434 DOI: 10.1080/00016489.2022.2104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND With the development of otoendoscopic surgery technology and the update of equipment, more and more otoendoscopic tympanoplasty are carried out. OBJECTIVES To investigate application of otoendoscopic tympanoplasty. METHODS Seventy-six patients with tympanic membrane perforation were randomly enrolled into otoendoscopic group (OP, n = 38) and microscope group (MP, n = 38). We compared two-group patients using operative time, intraoperative blood loss, healing of postoperative perforations, and degree of postoperative hearing improvement. RESULTS Average operation time was statistically significant shorter in the OP than the MP (p < .05); the intraoperative blood loss in the OP was significant less than MP (p < .05); after postoperative follow-up, the healing rate of tympanic membrane perforation was 92.11% in the OP compared to 89.47% in the MP. However, there was no statistically significant difference in the two groups (p > .05). There were no statistically significant differences between the preoperative and postoperative air and bone conduction thresholds in the two groups (p > .05). CONCLUSIONS Otoendoscopic tympanoplasty is a minimally invasive operation but with similar effects as compared to microscopic one. But the operation time and intraoperative blood loss in the OP were significantly better than those in the MP, thus it is a safe, effective and easy to be operated in clinical practice.
Collapse
Affiliation(s)
- Dengsheng Chen
- Department of Otolaryngology, People's Hospital of Xuancheng City, The Affiliated Xuancheng Hospital of Wannan Medical College, Xuancheng City, China
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
10
|
Zeng N, Liang M, Yan S, Zhang L, Li S, Yang Q. Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Medicine (Baltimore) 2022; 101:e29631. [PMID: 35866811 PMCID: PMC9302349 DOI: 10.1097/md.0000000000029631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/04/2023] Open
Abstract
To investigate the feasibility and efficacy of transcanal endoscopic treatment for congenital middle ear cholesteatoma in children. Eleven children diagnosed with congenital middle ear cholesteatoma, who underwent total ear endoscopic surgery under general anesthesia, were included from the Huazhong University of Science and Technology Union Shenzhen Hospital between January 2016 and December 2020. We retrospectively analyzed their operation process and surgical complications through the surgical video; moreover, we compared the pre- and postoperative hearing outcomes. One child underwent a planned second operation to reconstruct the ossicular chain. At 6 postoperative months, all 11 children underwent reexamination. There was no significant change and a significant decrease in the mean bone and air conduction hearing thresholds, respectively (P > .05 and P < .05); moreover, there was a significant reduction in the air-bone conduction difference (P < .05). Further, the air-bone conduction difference was reduced to >20 dB and >10 dB in 11 and 7 children, respectively. Follow-up of the children did not reveal sensorineural deafness, facial paralysis, and other serious complications; further, there were no cases of recurrence. Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children is feasible, minimally invasive, and functional.
Collapse
Affiliation(s)
- Nan Zeng
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Meng Liang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, People’s Republic of China
| | - Shang Yan
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Lue Zhang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Shuo Li
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| | - Qiong Yang
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital, Nanshan Hospital, Shenzhen, People’s Republic of China
| |
Collapse
|
11
|
Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain. Otol Neurotol 2021; 42:e1648-e1651. [PMID: 34172655 DOI: 10.1097/mao.0000000000003235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compares post-operative hearing outcomes and morbidity after pediatric total ossicular replacement prosthesis (TORP) ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus a post-auricular microscope-guided (PAM) approach. PATIENTS Forty-four children who underwent ossiculoplasty with titanium TORP after previous cholesteatoma surgery. INTERVENTION Ossiculoplasty using TEES or PAM approach. MAIN OUTCOME MEASURES Hearing outcome after ossiculoplasty was determined by post-operative air-bone gap (ABG) on audiogram nearest to 1 year after surgery. Post-operative morbidity was measured by total number of opiate doses the child received during hospital stay, along with the highest documented post-operative pain score. Comparisons were made with Mann-Whitney U test. RESULTS Hearing data were available for 41 patients: 21 had undergone TEES (median preoperative ABG 39 dB) and 20 had PAM surgery (median preoperative ABG 39 dB). Post-operatively at 1 year, ABG closed significantly in each group (TEES 21 dB, p = 0.003; PAM 23 dB, p = 0.01), and there was no difference between groups (p = 0.6). 57% who underwent TEES and 50% who underwent PAM surgery experienced serviceable hearing post-operatively, defined as air conduction pure-tone average (PTA) ≤ 30 dB HL. Visual analogue pain scores from 0 (no pain) to 10 (worst pain imaginable) were available for 13 who underwent TEES and 18 who underwent PAM surgery. In children undergoing TEES, only two reported pain above 0, with the highest pain score being 4. Children undergoing PAM surgery had a median pain score of 3 (median difference = 3, p < 0.001). Children undergoing TEES required fewer weight appropriate doses of opiate analgesic (median = 0) than children who underwent PAM surgery (median = 1) (median difference = 1, p = 0.003). Children undergoing TEES had a significantly shorter surgical time (median 135 min) than those who underwent PAM surgery (median 168 min) (median difference = 33 min, p = <0.006). CONCLUSION Hearing outcomes in TORP ossiculoplasty are similar in TEES and PAM surgery, and TEES may decrease post-operative pain.
Collapse
|
12
|
Interlay Myringoplasty With Anterior Subannular Grafting Technique for Anterior and Subtotal Perforations. Otol Neurotol 2021; 41:791-794. [PMID: 32282786 DOI: 10.1097/mao.0000000000002649] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the interlay myringoplasty with anterior subannular grafting technique and evaluate postoperative hearing and complications of this technique. STUDY DESIGN Retrospective chart review. PATIENTS We included 141 patients with anterior and subtotal tympanic membrane (TM) perforation. Patients who underwent concurrent ossicular chain reconstruction were included in graft success and complication rates evaluations, and were excluded from audiometric evaluation. INTERVENTIONS Only squamous layer of the TM continuous with posterior meatal skin is elevated except one of anterioinferior annulus. The inner tympanic remnant is released from the anterioinferior annulus and then the subannular mucosa is separated from the annulus to fashion a subannular pocket. The anterior edge of the graft is inserted into the pocket, and the rest of the graft is sandwiched between the two divided layers of the TM. MAIN OUTCOME MEASURES Graft success rate and hearing results were evaluated at 6 months postoperatively. Postoperative complications were also noted. RESULTS The technique was successfully performed in 132 (93.6%) cases. Graft success rate was 98.3% (111/113) and the mean improvement of the air-bone gap was 9.5 dB, which was statistically significant (p < 0.001). There was no anterior blunting or TM lateralization. The pearl formations were found in six (5.3%) patients. All of them were easily removed at follow-up examination. CONCLUSIONS The present study showed the interlay myringoplasty with anterior subannular grafting technique produces excellent results to repair anterior or subtotal TM perforations with few risk of anterior blunting and lateralization of the TM.
Collapse
|
13
|
Shakya D, KC A, Tamang N, Nepal A. Endoscopic versus microscopic type-I cartilage tympanoplasty for anterior perforation - a comparative study. Acta Otolaryngol 2021; 141:135-140. [PMID: 33118838 DOI: 10.1080/00016489.2020.1834616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic otitis media with anterior perforation is a challenging condition to treat with a microscope especially if the canal is narrow or has overhang. The endoscope provides the advantage of wide-angle view and transcanal access avoiding postauricular approach and canaloplasty. OBJECTIVE To compare the anatomical, functional outcomes, and surgical duration between endoscopic and microscopic type-I tympanoplasty performed for anterior perforation. MATERIALS AND METHODS A comparative study was conducted. The two groups, the microscopic (MT) and the endoscopic (ET) were created with 50 cases each and underwent type-I tympanoplasty. Results were evaluated at a minimum follow-up of 12 months. RESULTS The graft uptake rate in MT and ET was 81.8% and 91.3% respectively and was not statistically significant. The mean operative time for MT and ET was 68.68 ± 18.79 min and 61.24 ± 11.18 min respectively which was significant (p-.003). Endoscopic tympanoplasty significantly saved time. The difference in hearing outcomes was highly significant within the groups but not between the groups. CONCLUSION AND SIGNIFICANCE The endoscopic tympanoplasty offered superior visualization avoiding postauricular incision and canaloplasty, with morphological and functional outcomes comparable to microscopic tympanoplasty. It offers significantly faster completion of procedure and provides minimally invasive surgery.
Collapse
Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, Civil Service Hospital, Kathmandu, Nepal
| | - Arun KC
- Department of Otorhinolaryngology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Nirmala Tamang
- Department of Otorhinolaryngology, Civil Service Hospital, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, Patan Academy of Health Sciences, School of Medicine, Lagankhel, Nepal
| |
Collapse
|
14
|
Kim DJ, Lee HM, Choi SW, Oh SJ, Kong SK, Lee IW. Comparative study of endoscopic and microscopic tympanoplasty performed by a single experienced surgeon. Am J Otolaryngol 2021; 42:102788. [PMID: 33171411 DOI: 10.1016/j.amjoto.2020.102788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The use of endoscopes in otologic procedures has been increasing worldwide. This study aimed to compare the efficacy of microscopic tympanoplasty (MT) and endoscopic tympanoplasty (ET) for tympanic membrane and middle ear surgery. MATERIALS AND METHODS We retrospectively analyzed 81 patients who underwent MT (n = 44) and ET (n = 37) for chronic otitis media with tympanic membrane perforation performed by a single surgeon between January 2013 and September 2019. The hearing outcomes, graft success rate, complications, operation time and hospital stay, and cost-effectiveness were recorded and compared between groups. Hearing outcomes were determined by pure tone audiometry. Cost-effectiveness was determined by the operation cost and total cost. RESULTS There was no significant difference between the MT and ET groups regarding demographic characteristics, with the exception of the male:female ratio. There was no significant difference in the pre- and postoperative air conduction, bone conduction thresholds, and air-bone gap values between the two groups, but a significant audiologic improvement was observed in both groups (p < 0.05). In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms, there was no significant difference between groups (p > 0.05). The operation time and hospital stay were shorter in the ET group than in the MT group (p < 0.05). There were no significant differences in operation cost between the two groups (p > 0.05), but the total cost was significantly lower in the ET group than the MT group (p < 0.05). CONCLUSION ET is as safe and medically efficacious as conventional MT, shortens the operation time and hospital stay, and is cost-effective.
Collapse
Affiliation(s)
- Dong Jo Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun Min Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| |
Collapse
|
15
|
Ji L, Zhai S. Comparison of frequency-specific hearing outcomes after endoscopic and microscopic tympanoplasty. Acta Otolaryngol 2020; 140:990-994. [PMID: 32804588 DOI: 10.1080/00016489.2020.1804074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hearing results of endoscopic and microscopic tympanoplasty have been compared using the average pure tone threshold which could conceal subtle differences at a specific frequency. OBJECTIVES To compare frequency-specific hearing outcomes of endoscopic and microscopic tympanoplasty. MATERIAL AND METHODS The study included 42 patients who underwent endoscopic or microscopic type I tympanoplasty. The medical charts of these patients were reviewed retrospectively. We evaluated the pure tone audiometry at 250, 500, 1000, 2000 and 4000 Hz, including bone conduction (BC), air conduction (AC) and air-bone gap (ABG) before and after the surgery. The main outcome measures were frequency-specific pre- and post-operative hearing thresholds and the corresponding changes. We also assessed the graft success rate and surgical complications. RESULTS BC revealed a significant aggravation at 4000 Hz in microscopic tympanoplasty group, but no significant differences between the two groups at any frequencies. Both groups showed improvements in AC and ABG at all frequencies, without significant differences between the two groups at any single frequency. The maximum improvement of AC and ABG was found at 250 Hz. The graft success rate and operative complications were also similar. CONCLUSIONS AND SIGNIFICANCE The frequency-specific hearing outcomes of endoscopic and microscopic tympanoplasty are similar.
Collapse
Affiliation(s)
- Lingchao Ji
- Medical School of Chinese PLA, Beijing, China
| | - Suoqiang Zhai
- Medical School of Chinese PLA, Beijing, China
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
16
|
Endoscopic transcanal transpetrosal approach to the petroclival region: a cadaveric study with comparison to the Kawase approach. Neurosurg Rev 2020; 44:2171-2179. [PMID: 32936389 DOI: 10.1007/s10143-020-01389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
This study introduces expanded application of the endoscopic transcanal approach with anterior petrosectomy (ETAP) in reaching the petroclival region, which was compared through a quantitative analysis to the middle fossa transpetrosal-transtentorial approach (Kawase approach). Anatomical dissections were performed in five cadaveric heads. For each head, the ETAP was performed on one side with a detailed description of each step, while the Kawase approach was performed on the contralateral side. Quantitative measurements of the exposed area over the ventrolateral surface of the brainstem, and of the angles of attack to the posterior margin of the trigeminal nerve root entry zone (CN V-REZ) and porus acusticus internus (PAI) were obtained for statistical comparison. The ETAP provided significantly larger exposure over the ventrolateral surface of the pons (93.03 ± 21.87 mm2) than did the Kawase approach (34.57 ± 11.78 mm2). In contrast to the ETAP, the Kawase approach afforded greater angles of attack to the CN V-REZ and PAI in the vertical and horizontal planes. The ETAP is a feasible and minimally invasive procedure for accessing the petroclival region. In comparison to the Kawase approach, the ETAP allows for fully anterior petrosectomy and larger exposure over the ventrolateral surface of the brainstem without passing through the cranial nerves or requiring traction of the temporal lobe.
Collapse
|
17
|
Monteiro EMR, Beckmann S, Pedrosa MM, Siggemann T, Morato SMA, Anschuetz L. Learning curve for endoscopic tympanoplasty type I: comparison of endoscopic-native and microscopically-trained surgeons. Eur Arch Otorhinolaryngol 2020; 278:2247-2252. [PMID: 32852570 PMCID: PMC8165066 DOI: 10.1007/s00405-020-06293-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
Purpose Type I tympanoplasty is one of the first operations to be performed by ear surgeons in training and is increasingly performed using the endoscopic technique. The aim of the present study is to assess and compare the learning curve for type I tympanoplasties between a microscopically trained and endoscopic native ear surgeon. We hypothesize comparable learning curves between the two surgeons regardless of previous microscopic experience. Methods Retrospective analysis and comparison of the 25 first consecutive cases of type I tympanoplasty performed by a microscopically trained ear surgeon (MTES) and a native endoscopic ear surgeon (NEES). Results Mean duration of surgery in MTES and NEES groups was 54 ± 12.3 min and 55.6 ± 17.5 min, respectively. Both surgeons achieved a reduction of the surgery duration over time with statistically significant reduction from the first five cases to the last five cases in both groups. Graft intake rate was 92% after 3 months. Preoperative and postoperative PTA revealed a mean improvement of air bone gap (ABG) of 11.5 ± 7.1 dB HL in MTES group versus 9.3 ± 8.5 dB HL in NEES group, whereby the difference between the two groups was not statistically significant. Conclusion Endoscopic type I tympanoplasty shows comparable results and learning curves in two beginning endoscopic ear surgeons independent of the previous microscopic experience. We recommend if available the parallel learning of both techniques.
Collapse
Affiliation(s)
| | - Sven Beckmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Freiburgstrasse 16, 3010, Bern, Switzerland.
| | - Maísa Mendes Pedrosa
- Department of Otorhinolaryngology, Hospital Felicio Rocho, Belo Horizonte, Brasil
| | - Till Siggemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Freiburgstrasse 16, 3010, Bern, Switzerland
| | | | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Freiburgstrasse 16, 3010, Bern, Switzerland
| |
Collapse
|
18
|
Gülşen S, Arıcı M. Reply to the letter to the editor concerning ‘The of elevation of the mucosal flap without additional anterior canal wall incisions for repairing anterior perforations using endoscopic cartilage tympanoplasty’. Eur Arch Otorhinolaryngol 2020; 277:1853-1854. [DOI: 10.1007/s00405-020-05882-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
|
19
|
Lou Z. The elevation of the mucosal flap without additional anterior canal wall incisions for repairing anterior perforations using endoscopic cartilage tympanoplasty. Eur Arch Otorhinolaryngol 2020; 277:1851-1852. [PMID: 32100131 DOI: 10.1007/s00405-020-05870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
| |
Collapse
|