Endoscopic type 1 cartilage tympanoplasty in children

Effects of no perforation margin trimming and EAC packing in cartilage underlay myringoplasty for chronic large perforations in children

OBJECTIVE

Trimming of perforation margins and external auditory canal (EAC) packing are basic procedures in underlay myringoplasty for repairing chronic perforations. The objective of this study was to compare the operation time, graft outcome, hearing improvement, and complications of endoscopic cartilage underlay myringoplasty with and without trimming of perforation margins and EAC packing in children.

STUDY DESIGN

Prospective, randomized study.

SETTING

Tertiary referral center.

MATERIAL AND METHODS

Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups: myringoplasty with trimming of perforation margin and EAC packing (TPME) group or no trimming of perforation margin and EAC packing (NTPME) group. The operation time, graft success rate, hearing improvement, and complications were compared between the two groups.

RESULTS

Fifty-two patients were ultimately included in the study. The mean operation time was 31.4 ± 4.2 min in the TPME group and 23.6 ± 1.7 min in the NTPME group; the difference was significant (P < 0.01). The rate of aural fullness significantly differed between the TPME and NTPME groups (P = 0.000). All participants were followed up for 12 months; the graft success rate did not significantly differ between the groups (88.5% vs. 96.2%; P = 0.603). No patients developed adhesive otitis media. Between the preoperative and postoperative measurements, the mean air-bone gap improved by 10.2 ± 2.8 dB in the TPME group and 11.6 ± 0.7 dB in the NTPME group; this was significant (P < 0.001) in both groups.

CONCLUSIONS

Endoscopic cartilage underlay myringoplasty NTPME shorted the operation time and avoided aural fullness and EAC discomfort compared with the TPME technique; however, graft success and hearing improvement were comparable between the two techniques for repairing large perforations in children.

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

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.

Endoscopic Versus Microscopic Pediatric Tympanoplasty: Is There a Difference Between Closure Rates and Hearing Outcomes?

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.

Endoscopic transcanal tympanoplasty type I in children: Evolving experience in tragus perichondrium vs. acellular porcine small intestinal sub-mucosa grafts

OBJECTIVES

Endoscopic trans-canal tympanoplasty type I (ETT) is gradually diffusing worldwide. It mainly allows less invasive surgery in children with respect to a microscope approach by avoiding post-auricular access. The aim of this study is to illustrate our experience in endoscopic reconstruction of tympanic membrane, using autologous tragus perichondrium (TP) and non-autologous acellular porcine small intestinal sub-mucosa (SIS) as grafts.

METHODS

Between January 2011 and December 2020, the results of a prospective non-randomized series of consecutive ETT were analyzed. The primary outcome was closure rate at 6 months and secondary outcomes are closure rates associated with age, size of perforation, type of perforation and middle ear status, presence of myringosclerosis, type of graft, status of contralateral ear, adenoidectomy and pre-postoperative ABG change. Statistical analysis was performed using the SPSS statistical package.

RESULTS

One hundred and sixteen consecutive procedures, mean age 9.4 years (range 4-17 years), were evaluated. TP and SIS grafts were used in 65 (56%) and 51 (44%) procedures, respectively. Mean duration of surgical procedure was 53 ± 21 min for SIS and 77 ± 18 min for TP (P = 0.001) Total graft intake was 82.8%; TP and SIS intake were 86.2% and 78.4% (P = 0.3), respectively. Graft intake w.r.t. in age stratified age groups was not statistically significant. Average preoperative and postoperative air-bone gap was 12.1 ± 7.6 dB and 5.5 ± 3.8 dB, respectively (P = 0.001). The difference in closure rates was not significant. Neither intra- nor postoperative complications were observed.

CONCLUSIONS

In children, ETT is an applicable and less invasive technique compared to the microscope and offers less morbidity. The use of SIS contributes additional less invasiveness to endoscopic surgery by avoiding tragus harvesting with a comparable success rate and granting significantly less surgical duration.

The study of otoendoscopic tympanoplasty (type I)

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.

Myringoplasty for pediatric chronic otitis media: An uncritical closure of a natural middle ear drainage?

BACKGROUND

Performing tympanoplasty for tympanic perforations in children and adolescents is often considered to be less successful than in adults.

OBJECTIVES

The aim of our study was to evaluate the surgical outcome of tympanoplasty type I in patients under 15 years of age with chronic otitis media and to identify potential factors that influence the success rate.

MATERIALS UND METHODS

The present study was based on a retrospective analysis of the medical records of all patients under the age of 15 who were treated for chronic otitis media by means of type I tympanoplasty between 2005 and 2020. The minimum follow-up period was 6 months. The data were analyzed with regard to epidemiological parameters, tube-related pathologies in the contralateral ear, the local condition and the extent of the eardrum perforation as well as the extent of the surgical intervention (tympanoplasty type I with or without adenotomy).

RESULTS

83 cases were included in our study. The mean age at the time of the surgery was 8.9 years. The mean follow-up time was 46 months (6-182 months). The anatomical closure rate was 88.0%. Children with "dry" tympanic perforations tended to perform better (p = 0.052). The average improvement in the air bone gap was 2.0 dB.

CONCLUSION

Detailed preoperative counseling about the advantages and disadvantages as well as the expected success rate of an early myringoplasty in this age group is just as important as an individualized approach for a high level of patient satisfaction.

Pediatric type 1 tympanoplasty - Does age matter?

INTRODUCTION

Tympanic membrane perforations might have a negative impact on the patient's quality of life, especially in the pediatric population. Surgery is therefore often required. The most adequate age for surgery remains unclear and is debated in the current literature. The aim of this study was to investigate outcomes of type I tympanoplasty in children and examine the impact of age on surgical outcome.

METHODS

Retrospective cohort study. All patients under the age of 18 undergoing type I tympanoplasty at Regional Hospital West Jutland, Denmark, from 1/1-2013 to 31/12-2017 had their medical files reviewed. The primary endpoint of interest was tympanic membrane closure rate six months following surgery, i.e. surgical success. Secondary outcomes were air-bone-gap reduction and the correlation between age and surgical success.

RESULTS

A total of 180 patients undergoing 197 procedures met the predefined criteria. Age at the time of surgery ranged between five and 17 years. Mean age at the time of surgery was 10.1 years (95% CI 9.1-11.2). Surgical success was achieved in 91,3% of the cases. No correlation between age and surgical success was found. Mean air-bone gap was reduced from 19.8 dB (95% CI 18.5-21.0) preoperatively, to 6.9 dB (95% CI 6.1-7.7) at follow-up, p < 0.05. Air-bone gaps ≤10 dB at follow-up were achieved in 155 of the cases (78.6%). Postoperative infection seemed to increase the risk of surgical failure, RR 2.80 ((95% CI 1.06-7.38), p = 0.037).

CONCLUSIONS

Type 1 tympanoplasty in children is an effective treatment in terms of achieving an intact tympanic membrane and improved hearing. No correlation could be found between age and surgical success. Postoperative infection influences surgical outcome negatively.

The evaluation of prognostic factors in endoscopic cartilage tympanoplasty

PURPOSE

The aim of the present study was to evaluate the prognostic factors that may affect the success in endoscopic cartilage tympanoplasty and determine the outcomes of endoscopic cartilage tympanoplasty.

METHODS

This study included 312 patients who underwent transcanal endoscopic type I cartilage tympanoplasty. The effects of sex, the affected side, the size of the perforation, the location of the perforation, the absence of myringosclerosis, external ear canal protrusion, the condition of the contralateral ear, and surgical experience on the rate of graft success and hearing improvement were investigated.

RESULTS

The affected side, sex, location of the perforation, myringosclerosis, the condition of contralateral ear, and surgical experience did not significantly affect the surgical success (p > 0.05). However, the size of perforation and ear canal wall protrusion were significantly related to both functional and anatomical success (p < 0.05).

CONCLUSION

Endoscopic transcanal type I cartilage tympanoplasty can be performed with a high anatomical and functional success rate. However, surgeons should be more careful and design a case-specific operation strategy in patients with external ear canal anterior wall protrusion and large perforations.