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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.
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Affiliation(s)
- Eleni Gkrinia
- ENT Department, University Hospital of Larissa, Larisa, Greece
| | | | | | | | | | - Christos Korais
- ENT Department, University Hospital of Larissa, Larisa, Greece
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Garcia A, Shave S, Cheng YS, Santos F, Quesnel A, Cohen MS, Lee DJ. Initial Experience With Robotic-Assisted Otologic and Lateral Skull Base Surgery. Otolaryngol Head Neck Surg 2024; 170:1190-1194. [PMID: 38230445 DOI: 10.1002/ohn.571] [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: 08/28/2023] [Accepted: 09/23/2023] [Indexed: 01/18/2024]
Abstract
Robotic-assisted surgery has gained popularity for otolaryngology procedures. It provides high-definition images and surgical precision to perform diverse procedures. It is an alternative to the operating microscope, endoscope, or exoscope when reaching hidden anatomical structures in the ear. In this proof-of-concept study, we aim to demonstrate the possibility of using a robotic-assisted device to perform ear surgery in conjunction with the microscope or the endoscope. In total, there were 9 ear and lateral skull base procedures performed with the use of robotic-assisted surgery. All surgeons underwent surveys to assess the performance and workload of the device compared to the microscope or endoscope. There were no postoperative complications. Robotic-assisted surgery was optimal for providing high image quality, ergonomics, and maintaining surgical performance. The size of the device and mental demand were higher compared to the microscope or endoscope. Robotic-assisted surgery can be an adjuvant to perform otologic and neurotologic surgery.
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Affiliation(s)
- Alejandro Garcia
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha Shave
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Yew S Cheng
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Felipe Santos
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Quesnel
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (MEEI), Harvard Medical School, Boston, Massachusetts, USA
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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.
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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
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Kallyadan A, Sarkar S, Pradhan P, Karakkandy V, Parida PK, Chappity P, Samal DK, Sharma P, Adhikari A, Shah A, Nayak S. Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction. Indian J Otolaryngol Head Neck Surg 2024; 76:469-476. [PMID: 38440479 PMCID: PMC10908901 DOI: 10.1007/s12070-023-04184-4] [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: 06/30/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
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.
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Affiliation(s)
- Aswathi Kallyadan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Sarkar
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradipta Kumar Parida
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Preetam Chappity
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prity Sharma
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anwer Shah
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Nayak
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
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Koyama H, Kashio A, Uranaka T, Matsumoto Y, Yamasoba T. Application of Machine Learning to Predict Hearing Outcomes of Tympanoplasty. Laryngoscope 2023; 133:2371-2378. [PMID: 36286238 DOI: 10.1002/lary.30457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This retrospective study aimed to evaluate the performance of machine learning techniques in predicting air-bone gap after tympanoplasty compared with conventional scoring models and to identify the influential factors. METHODS We reviewed the charts of 105 patients (114 ears) with chronic otitis media who underwent tympanoplasty. Two numerical scoring systems (middle ear risk index [MERI] and ossiculoplasty outcome parameter staging [OOPS]) and three algorithms (random forest [RF], support vector machine [SVM], and k nearest neighbor [kNN]) were created. Experimental variables included age, preoperative air-bone gap, soft-tissue density lesion in the tympanic cavity in CT, otorrhea, surgical history, ossicular bone problems in CT, tympanic perforation location, perforation type (central or marginal), grafting material, smoking history, endoscopy use, and the operator whose experience was 20 years or longer, or shorter. Binary classification, postoperative air-bone gap ≤15 or >15 dB, and multiclass classification, classification into seven categories by 10 dB, were performed, and the percentages of correct prediction were calculated. The importance of features in the RF model was calculated to identify influential factors. RESULTS The percentages of correct prediction in binary classification were 62.3%, 72.8%, 81.5%, 81.5%, and 81.5% in MERI, OOPS, RF, SVM, and kNN, respectively, and those in multiclass classification were 29.8%, 21.9%, 63.1%, 44.7%, and 50% in the same order. The RF model suggested larger preoperative air-bone gap, and older age could make the postoperative air-bone gap larger. CONCLUSION The machine learning techniques, especially the RF model, are promising methods for precise postoperative air-bone gap prediction. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2371-2378, 2023.
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Affiliation(s)
- Hajime Koyama
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Kashio
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Uranaka
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Matsumoto
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Bueno H, Moonis G. Imaging of the Postoperative Temporal Bone. Semin Roentgenol 2023; 58:237-247. [PMID: 37507166 DOI: 10.1053/j.ro.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/24/2023] [Accepted: 04/02/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Hugo Bueno
- NYU Langone Neuroradiology, New York, NY.
| | - Gul Moonis
- NYU Langone Neuroradiology, New York, NY
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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.
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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
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Deosthale N, Khadakkar SP, Dhote KS, Dhoke PR, Harkare VV, Garikapati P, Wani MK, Nagrale R. Comparison of Surgical Outcome of Endoscopic with Microscopic Type I Tympanoplasty in Chronic Otitis Media: A Randomized Controlled Trial. Indian J Otolaryngol Head Neck Surg 2022; 74:4329-4335. [PMID: 36742601 PMCID: PMC9895472 DOI: 10.1007/s12070-021-02987-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: 07/16/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Aim of the study was to compare the surgical outcome of endoscopic with microscopic Type 1 tympanoplasty in dry, mucosal type of chronic otitis media with respect to graft uptake rate, hearing gain and duration of surgery. This randomized controlled trial of 3 years was carried out at Tertiary Care Hospital of Central India. Total 80 cases of mucosal type of chronic otitis media posted for Type I tympanoplasty were included in the study. They were randomly divided into two groups viz. Endoscopic tympanoplasty and microscopic tympanoplasty with 40 patients in each group. Chi-square test was used to compare the qualitative results and student's t-test was used to compare quantitative results with a level of significance of p ≤ 0.05. Intraoperatively, widening of external auditory canal and auxiliary incision were required in 45% and 47.5% patients of microscopic group respectively. Mean operative time for endoscopic tympanoplasty (62.5 ±14.94 mins) was less as compared to microscopic tympanoplasty (74.88 ± 15.83 mins). Graft uptake rate was 95% and 92.5% in endoscopic and microscopic tympanoplasty groups respectively with statistically insignificant difference (p = 0.32). The preoperative mean air bone gap in both the groups was improved significantly 6 months postoperatively. Air bone gap closure was of 13.21± 4.37 dB in endoscopic group and 12.54 ± 4.14 dB in microscopic group with statistically insignificant difference. Endoscope provides superior visualization of hidden areas of middle ear cavity and has shorter operative time than microscopic tympanoplasty with comparable surgical and functional outcomes. hence endoscopic tympanoplasty can be a good option to microscopic surgery.
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Affiliation(s)
- Nitin Deosthale
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Sonali P. Khadakkar
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Kanchan S. Dhote
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Priti R. Dhoke
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Vivek V. Harkare
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Pavani Garikapati
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Mateen Khursheed Wani
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
| | - Ria Nagrale
- Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra India
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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.
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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
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Zhou Q, Jin L, Song X, Zheng H, Huang Y. Endoscopic type 1 tympanoplasty: comparison of the effects of three different thicknesses grafts. Acta Otolaryngol 2022; 142:375-380. [PMID: 35549633 DOI: 10.1080/00016489.2022.2071987] [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 The effects of graft thickness on tympanoplasty is uncertain. OBJECTIVE To compare the results of endoscopic tympanoplasty using different thicknesses of autologous tissues. METHODS This retrospective analysis included 186 patients who received type I tympanoplasty, divided into three main groups based of grafting material: perichondrium (A), cartilage-perichondrium (B), or cartilage-perichondrium plus additional perichondrium (C). Group A was subdivided based on whether the placement was inside (A1) or outside (A2) of the malleus. The hearing improvement, graft success rate, and surgery duration were analysed. RESULTS Statistical analysis showed significant hearing improvement in the three main groups (p < .001); recovery in group A occurred the earliest. Six months postoperatively, group A1 showed significantly greater hearing recovery compared with groups B and C (p < .05). There were no statistical differences the other groups (p > .05) or in the graft success rate among the three main groups (p = .235). The surgery duration of group A was significantly longer than that of groups B and C (p < .001). CONCLUSION AND SIGNIFICANCE Our results suggest that graft thickness affects hearing recovery; however, graft thickness does not affect the rate of grafting success. Endoscopic transplantation of the perichondrium is more difficult and requires more time.
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Affiliation(s)
- Qinshuang Zhou
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Lanlan Jin
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Xiaoxiao Song
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Haifeng Zheng
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Yideng Huang
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
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Celik O, Ulkumen B. Endoscopic versus microscopic ossiculoplasty: Does the functional outcome vary according to the type of osciculoplasty? Braz J Otorhinolaryngol 2022; 89:213-221. [PMID: 35428604 PMCID: PMC10071538 DOI: 10.1016/j.bjorl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/05/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. METHODS In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. RESULTS A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p > 0.05). CONCLUSIONS According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. LEVEL OF EVIDENCE In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.
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Affiliation(s)
- Onur Celik
- Manisa Celal Bayar University, Department of Otorhinolaryngology, Manisa, Turkey
| | - Burak Ulkumen
- Manisa Celal Bayar University, Department of Otorhinolaryngology, Manisa, Turkey.
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