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Albazee E, Salamah M, Althaidy M, Hagr A. Underlay Myringoplasty Versus Overlay Myringoplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Indian J Otolaryngol Head Neck Surg 2024; 76:1848-1856. [PMID: 38566745 PMCID: PMC10982238 DOI: 10.1007/s12070-023-04425-6] [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: 10/12/2023] [Accepted: 12/03/2023] [Indexed: 04/04/2024] Open
Abstract
Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43], P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04425-6.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Marzouqi Salamah
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Mubarak Althaidy
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
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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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Fahy R, Corbett M, Crotty T, Chadwick L, Keogh I. Totally endoscopic cartilage tympanoplasty: a hierarchical task analysis. J Laryngol Otol 2023; 137:1326-1333. [PMID: 36093951 DOI: 10.1017/s0022215122001992] [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: 11/06/2022]
Abstract
BACKGROUND Totally endoscopic ear surgery is a novel method of conducting otological surgery. Hierarchical task analysis and the systematic human error reduction and prediction approach ('SHERPA') are valuable tools that can effectively deconstruct the technical and non-technical skills required to successfully complete a surgical procedure. METHODS Twenty-five endoscopic tragal cartilage tympanoplasties were observed, to identify the tasks and subtasks required for completion of totally endoscopic tragal cartilage tympanoplasty. The systematic human error reduction and prediction approach was used to identify the potential risks and methods, to reduce or remediate these risks. RESULTS A hierarchical task analysis was performed, identifying 8 tasks and 50 subtasks for a safe approach to completing totally endoscopic tragal cartilage tympanoplasty. A risk score for each subtask was calculated to produce a systematic human error reduction and prediction approach and to highlight potential errors. CONCLUSION This hierarchical task analysis allowed for quick reference to a correct method of endoscopic tympanoplasty. The systematic human error reduction and prediction approach was employed to reduce the risks associated with undergoing endoscopic tympanoplasty, to improve patient safety.
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Affiliation(s)
- R Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - M Corbett
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - T Crotty
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - L Chadwick
- Department of Mechanical and Biomedical Engineering, National University of Ireland, Galway, Ireland
| | - I Keogh
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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Coleman H, Tikka T, Curran J, Iyer A. Comparison of endoscopic vs microscopic ossiculoplasty: a study of 157 consecutive cases. Eur Arch Otorhinolaryngol 2023; 280:89-96. [PMID: 35598229 DOI: 10.1007/s00405-022-07451-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/13/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery. MATERIALS AND METHODS Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used. RESULTS Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft. CONCLUSION TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Holli Coleman
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK
| | - Theofano Tikka
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK
| | - John Curran
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK
| | - Arunachalam Iyer
- Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK.
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Takahashi M, Motegi M, Yamamoto K, Yamamoto Y, Kojima H. Endoscopic tympanoplasty type I using interlay technique. JOURNAL OF OTOLARYNGOLOGY - HEAD & NECK SURGERY 2022; 51:45. [PMCID: PMC9670569 DOI: 10.1186/s40463-022-00597-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Background
Tympanoplasty using the interlay technique has rarely been reported in transcanal endoscopic ear surgery, unlike the underlay technique. This is because many surgeons find it challenging to detach the epithelial layer of the tympanic membrane using only one hand. However, the epithelial layer can be easily detached from the inferior part of the tympanic membrane. Another key point is to actively improve anteroinferior visibility even if the overhang is slight because most perforations and postoperative reperforations are found in the anteroinferior quadrant of the tympanic membrane. We report the application of the interlay technique in endoscopic tympanoplasty type I for tympanic perforations.
Methods
We retrospectively reviewed the medical records of 51 patients who had undergone tympanoplasty using the interlay technique without ossiculoplasty between 2017 and 2020. We then compared the data with those of patients who underwent microscopic surgery (MS) using the underlay technique between 1998 and 2009 (n = 104). No other technique was used in each group during this period. Repair of tympanic membrane perforation and hearing outcomes were assessed for > 1 year postoperatively.
Results
The perforation sites were limited to the anterior, posterior, and anterior–posterior quadrants in 23, 1, and 27 ears, respectively. Perforations were closed in 50 of the 51 ears (98.0%), and the postoperative hearing was good (average air-bone [A-B] gap was 6.8 ± 5.8 dB). The surgical success rate for the repair of tympanic membrane perforation was not significantly different from the MS group (93.3%, P = 0.15). The average postoperative average A-B gap in the group that underwent the interlay technique was significantly different from that in the MS group (10.1 ± 6.6 dB, P < 0.01).
Conclusion
The interlay technique should be considered as one of the treatment methods in endoscopic surgery for tympanic perforations. Further study of the postoperative outcomes of this procedure should be conducted to establish the optimal surgical procedure for tympanic perforations.
Trial registration: This study was retrospectively approved by the Institutional Review Board of the Jikei University, Tokyo, Japan (approval number: 32-205 10286).
Video abstract
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Bao JW, Zhan KY, Wick CC. Comparison of endoscopic underlay and
over‐under
tympanoplasty techniques for type I tympanoplasty. Laryngoscope Investig Otolaryngol 2022; 7:1186-1193. [PMID: 36000055 PMCID: PMC9392374 DOI: 10.1002/lio2.879] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the indications and efficacy of endoscopic over‐under tympanoplasty versus endoscopic underlay tympanoplasty. Methods Retrospective cohort study of patients undergoing type I endoscopic tympanoplasty via either an underlay or over‐under technique by a single surgeon from 2017 to 2021. Patients were excluded if they had a concurrent mastoidectomy, ossiculoplasty, or advanced cholesteatoma defined by involvement of multiple subsites. Patient demographics, perforation size and location, middle ear status, preoperative and postoperative audiograms, and perforation closure were reviewed. Middle ear status was represented using the Ossiculoplasty Outcome Parameter Score (OOPS). The primary outcome was perforation closure at most recent follow‐up and secondary outcomes were change in postoperative pure‐tone average (PTA) and air‐bone gap (ABG). Results Of 48 patients, 27 underwent endoscopic underlay tympanoplasty and 21 underwent endoscopic over‐under tympanoplasty. Tragal cartilage‐perichondrium graft was used in 90% of procedures. Distribution of OOPS scores was not significantly different between groups. Over‐ under technique addressed significantly larger perforations (mean size of 54% vs. 31%, p < .001) and a higher rate of anterior extension (95% vs. 22%, p < .001) than underlay technique. Perforation closure rate was not different between groups (95% vs. 96%). Patients experienced significant improvement in PTA and ABG in both groups. Conclusion The endoscopic over‐under tympanoplasty is comparable to endoscopic underlay tympanoplasty in terms of graft take and audiologic improvement. The over‐under technique is effective for repairing larger perforations or those with anterior extension. Level of evidence IV
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Affiliation(s)
- James W. Bao
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA
| | - Kevin Y. Zhan
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA
| | - Cameron C. Wick
- Department of Otolaryngology—Head and Neck Surgery Washington University School of Medicine St. Louis Missouri USA
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Coutinho LL, Barros PMD, Leal MDC, Caldas Neto SDS, Bezerra TFP. Descriptive study of goat external and middle ear through computed tomography and endoscopic evaluation, compared with the human ear. Braz J Otorhinolaryngol 2021; 89:35-47. [PMID: 34740556 PMCID: PMC9874343 DOI: 10.1016/j.bjorl.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To describe the external and middle ear of goats, using computed tomography and endoscopic dissection, comparing them with the anatomy of the human ear, aiming to evaluate the viability of this animal model for training in otological endoscopic surgery. METHODS Images of the external and middle ear of goats were produced by computed tomography in the coronal and axial planes and analyzed. The radiological anatomy of the external and middle goat and human ear are described. Some measures of surgical interest were described, such as the length of the external auditory canal, external and internal cross-sectional area of the external auditory canal, middle ear depth, vertical angle of the external auditory canal, length of malleus and incus. After the tomographic study, we analyzed the importance of evaluations through the endoscopic dissection of the goat ear. RESULTS The bony canal is extremely tortuous and shows a bony prominence with significant elevation near the lower edge of the tympanic membrane. The middle ear has a large tympanic bulla in the hypotympanum region. The malleus is shaped similarly to that of the human, but its handle is located anterior to its head. The mastoid is not pneumatized. Compared to the human mastoid, there was a statistically significant difference in the external and internal cross-sectional area, at the depth of the middle ear, in the vertical angle of the canal and in the length of the incus. CONCLUSION Goat morphometric anatomy showed that this model is suitable for surgical simulation in the initial training for endoscopic otological surgery. It is an important contribution to the development of skills to accelerate the subsequent endoscopic otological surgical training in humans, despite some differences found.
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Choi SW, Kim H, Na HS, Lee JW, Lee S, Oh SJ, Kong SK. Comparison of Medial Underlay and Lateral Underlay Endoscopic Type I Tympanoplasty for Anterior Perforations of the Tympanic Membrane. Otol Neurotol 2021; 42:1177-1183. [PMID: 33661239 DOI: 10.1097/mao.0000000000003138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the outcomes of medial and lateral underlay endoscopic type I tympanoplasty for anterior tympanic membrane (TM) perforations. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic referral center. PATIENTS Patients who were diagnosed with either chronic otitis media with dry and stable anterior TM perforations or traumatic anterior TM perforations and underwent endoscopic type I tympanoplasty between 2017 and 2019. INTERVENTIONS Medial or lateral underlay type I endoscopic tympanoplasty. MAIN OUTCOME MEASURES Patient demographics, size, and location of TM perforation, graft success rate, and hearing outcome. RESULTS Of the 170 patients, 68 and 102 patients underwent the medial and lateral underlay techniques, respectively. Patient demographics were not significantly different between groups, except the middle ear mucosa status. Graft success rates were significantly different between groups regardless of the perforation size (85.3 and 95.1%, p < 0.001). The lateral underlay group had a significantly better outcome (p < 0.001) when anterior superior quadrant TM perforation was included than the medial underlay group (p = 0.552). Hearing outcomes did not significantly differ between groups, but a significant audiological improvement was observed in both groups (p < 0.05). CONCLUSION Lateral underlay type I endoscopic tympanoplasty can be challenging as it requires dissection of the malleus. However, the lateral underlay group had a high graft success rate without sensorineural hearing loss in the repair of anterior TM perforations. Thus, lateral underlay type I endoscopic tympanoplasty should be considered for repairing anterior TM perforations, especially when the anterior superior quadrant is involved.
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Affiliation(s)
- Sung-Won Choi
- Department of Otorhinolaryngology and Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Ranguis SC, Leonard CG, James AL. Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty. Otol Neurotol 2021; 42:867-875. [PMID: 34111050 DOI: 10.1097/mao.0000000000003053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare outcomes and complications of endoscopic lateral graft (LGT) and interlay (IT) tympanoplasty. STUDY DESIGN Prospective observational cohort study of totally endoscopic ear surgery (TEES) tympanoplasty. SETTING Pediatric tertiary referral center. PATIENTS One hundred fourteen surgeries for children with tympanic membrane perforation without cholesteatoma. INTERVENTION Porcine-derived collagen graft tympanoplasty using either LGT or IT. MAIN OUTCOME MEASURES Closure rates of perforation, hearing outcomes (four-tone average air conduction [AC] and air bone gap), and complications that required further surgery were assessed 12 months postoperatively. RESULTS Perforation closure rates did not differ between LGT (52/59 (88%)) and IT (45/51 (88%)), (Fisher's exact p = 1.00) (four ears lost to follow-up). AC thresholds (p = 0.32) and air bone gap (p = 0.88) improved similarly after surgery with LGT (median 8.8 dB) and IT (median 7.5 dB). The proportion of ears with serviceably normal hearing (AC ≤ 30 dB HL) postoperatively was similar (LGT 40/49 (82%), IT 36/46 (78%), Fisher's exact p = 0.80). Following IT, three (6%) ears developed inclusion cholesteatoma requiring revision surgery. One (2%) LGT ear developed blunting after myringitis. CONCLUSIONS IT and LGT provide similar perforation closure rates and hearing outcomes. When choosing between these two techniques to repair pediatric tympanic membrane perforations, LGT would seem to be preferable than IT due to the risk of inclusion cholesteatoma after IT. There is a small risk of anterior blunting after LGT.
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Affiliation(s)
- Sebastian C Ranguis
- Department of Otolaryngology, Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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James AL. Totally endoscopic tympanic membrane repair. HNO 2021; 69:791-796. [PMID: 34041565 DOI: 10.1007/s00106-021-01052-x] [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] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transcanal totally endoscopic ear surgery (TEES) has become increasingly popular internationally; however, for surgeons trained with a two-handed microscope-guided approach, the potential challenges of adopting TEES can appear off-putting. OBJECTIVES This article outlines the pros and cons of TEES for tympanic membrane repair and describes aspects of surgical technique relevant to those who might adopt this approach. MATERIALS AND METHODS Data are provided from the author's experience along with a review of relevant literature, including several meta-analyses of tympanoplasty outcome. RESULTS Meta-analyses show that TEES tympanoplasty is as effective at closing tympanic membrane perforations and improving hearing as microscope-guided surgery. Yet patients benefit from avoidance of a skin incision and faster recovery. CONCLUSION Repair of the tympanic membrane with TEES is feasible and effective. This minimally invasive approach is very appealing to patients.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
- Department of Otolaryngology, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada.
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Endoscopic Transcanal Push-Trough Myringoplasty for Different Types of Tympanic Membrane Perforations. Otol Neurotol 2021; 42:726-732. [PMID: 33967248 DOI: 10.1097/mao.0000000000003029] [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 aims to explore the feasibility of endoscopic transcanal push-trough myringoplasty (ETPM) for all types of tympanic membrane perforations (TMPs), and compare the outcomes with those of endoscopic type 1 tympanoplasty (ETT) with meatal flap elevation. STUDY DESIGN A prospective, controlled study. METHODS In the present study, inpatients with TMPs were divided into two groups according to the manner of tympanic membrane repair: one group received ETPM without raising the meatal flap, and the other received ETT. The operation duration, postoperative healing rate, visual analogue scale (VAS) of pain, and complication rates were compared between these two groups. RESULTS Regardless of the size and location of the perforation, and its relationship with the malleus manubrium, myringoplasty can be completed using the ETPM method. The operation duration for different types of TMPs was shorter in the ETPM group than in the ETT group, and the difference was statistically significant (p<0.05). However, there was no statistical difference in the short-term healing rate (p>0.05) and pain VAS score (p>0.05) between these two groups. Furthermore, no intraoperative or postoperative complications occurred in both groups. CONCLUSION ETPM without raising the meatal flap can be applied for all types of TMPs, regardless of how large the perforation is, or where it is located. This can shorten the operation duration, and has a high healing rate comparable to ETT and mild postoperative pain. Mastering some essential surgical skills under the endoscope would be helpful to ensure the success of the surgery.
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Linares Casas A, Ruiz R, De Pauli D. Endoscopic type 1 tympanoplasty; a composite graft technique for subtotal and total perforations. Eur Arch Otorhinolaryngol 2021; 279:181-186. [PMID: 33582847 DOI: 10.1007/s00405-021-06668-x] [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] [Received: 10/16/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Demonstrate feasibility of performing endoscopic transcanal type 1 tympanoplasty in total and subtotal perforations, using an underlay technique that minimizes the risk of anterior medialization of the graft. Compare audiometric and clinical outcomes of this technique with our series of endoscopic tympanoplasty with classical underlay grafts, and with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty and other transcanal techniques. METHODS We describe a surgical technique using an L-shaped cartilage and its perichondrium, with exclusive transcanal endoscopic approach. A retrospective review of patients undergoing this technique at the Centenario University Hospital of Rosario, Argentina between January 2017 and December 2019 was performed, and it was compared with a group of patients who underwent endoscopic tympanoplasty with classical underlay technique in a previous period of time. Patients with smaller perforations and other middle ear pathologies that required other techniques were not included in this study. Minimum follow up was 6 months. The main outcome measures were membrane closure rates and hearing results. RESULTS 73 patients with total or subtotal perforations undergoing endoscopic transcanal tympanoplasty between 2015 and 2019 were included. The group of patients that underwent the technique described showed no anterior medialization of the graft, and better graft take rates. The hearing outcomes were similar in all successful graft patients, with postoperative average air-bone gap of 10db (+ - 10 dB). CONCLUSION Transcanal endoscopic tympanoplasty with the technique described is an excellent option for closure of total and subtotal tympanic perforations. The rate of perforation closure is better than endoscopic tympanoplasty with classical underlay graft with similar audiometric outcome.
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Affiliation(s)
- Alejo Linares Casas
- Department of Otolaryngology Chair, Centenario University Hospital of Rosario, Rosario, Argentina.
| | - Roque Ruiz
- Department of Otolaryngology-Head and Neck Surgery Clinical Assistant Professor, Centenario University Hospital of Rosario, Urquiza 3101, 2000, Rosario, SF, Argentina
| | - Daniela De Pauli
- Department of Otolaryngology Head of Residents, Centenario University Hospital of Rosario, Rosario, Argentina
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Abstract
Herein we provide a broad overview of the literature as it applies to endoscopic myringoplasty and type I tympanoplasty. Advantages and disadvantages of the endoscopic approach are reviewed for both the adult and pediatric populations and are compared with conventional microscopic techniques.
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Affiliation(s)
- Zachary G Schwam
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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Endoscopic revision tympanoplasties: our experience. JOURNAL OF BIO-X RESEARCH 2020. [DOI: 10.1097/jbr.0000000000000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees. The Journal of Laryngology & Otology 2020; 134:213-218. [PMID: 32172694 DOI: 10.1017/s0022215120000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to examine the impact of trainee involvement in performing tympanoplasty or tympano-ossiculoplasty on outcomes. METHODS A retrospective analysis was performed of a prospective database of all patients undergoing tympanoplasty and tympano-ossiculoplasty in a single centre during a three-year period. Patients were divided into three primary surgeon groups: consultants, fellows and residents. The outcomes of operative time, surgical complications, length of hospital stay, and air-bone gap improvement were compared among the groups. RESULTS The study included 398 tympanoplasty and tympano-ossiculoplasty surgical procedures, 71 per cent of which were performed by junior trainees (residents). The junior trainee group was associated with a significantly longer surgical time, without adverse impact on outcomes. CONCLUSION Trainee participation in tympanoplasty and tympano-ossiculoplasty surgery was associated with longer surgical time, but did not negatively affect the peri-operative course or hearing outcome. Therefore, resident involvement in these types of surgery is safe.
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Das A, Mitra S, Ghosh D, Sengupta A. Endoscopic ossiculoplasty: Is there any edge over the microscopic technique? Laryngoscope 2020; 130:797-802. [PMID: 32073145 DOI: 10.1002/lary.28074] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare endoscopic ossiculoplasty with conventional microscopic technique in terms of postoperative hearing outcomes and complications. STUDY DESIGN Randomized controlled trial. METHODS One hundred eighteen patients diagnosed with ossicular chain discontinuity were randomly assigned into two groups, one undergoing endoscopic ossiculoplasty and the other undergoing ossiculoplasty by the microscopic technique, with the operating surgeon being same for both groups. The two groups were compared in terms of operative time, postoperative air-bone gap, mean air-bone gap closure, and incidence of complications. Teflon prostheses (partial ossicular chain replacement prosthesis [PORP] and total ossicular chain replacement prosthesis [TORP]) were used for reconstruction in all cases. RESULTS Endoscopic ossiculoplasty with PORP rendered a statistically significant mean postoperative air-bone gap and air-bone gap closure at 1 month when compared to that of microscopic PORP ossiculoplasty. However, there was no significant difference between the two techniques in terms of mean postoperative air-bone gap and air-bone gap closure at 3 and 6 months. In the TORP ossiculoplasty cases, there was no significant difference in mean postoperative air-bone gap and air-bone gap closure at 1, 3, and 6 months. In terms of operative time and incidence of complications, no statistical significance was found between the two groups. CONCLUSIONS Endoscopic ossiculoplasty appears to provide superior visualization and better early audiological outcome (in PORP ossiculoplasty cases) when compared to microscopic technique. However, long-term audiological outcomes and incidence of complications remain comparable. LEVEL OF EVIDENCE 1 Laryngoscope, 130:797-802, 2020.
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Affiliation(s)
- Arindam Das
- Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Sandipta Mitra
- Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Debasish Ghosh
- Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Arunabha Sengupta
- Department of Otorhinolaryngology and Head Neck Surgery, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
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The Management of Tympanic Membrane Perforation With Endoscopic Type I Tympanoplasty. Otol Neurotol 2020; 41:214-221. [DOI: 10.1097/mao.0000000000002465] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Das A, Mitra S, Ghosh D, Sengupta A. Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial. Laryngoscope 2019; 130:2461-2466. [DOI: 10.1002/lary.28446] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Arindam Das
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
| | - Sandipta Mitra
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
| | - Debasish Ghosh
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
| | - Arunabha Sengupta
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
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Pontes-Madruga TDC, Nogueira Neto FB, Suzuki FADB, Testa JRG, Onishi ET. Endoscopic tympanoplasty with inlay cartilage graft in an university hospital. Braz J Otorhinolaryngol 2019; 87:434-439. [PMID: 31874832 PMCID: PMC9422507 DOI: 10.1016/j.bjorl.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/26/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.
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Affiliation(s)
| | | | | | - José Ricardo Gurgel Testa
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Otorrinolaringologia, São Paulo, SP, Brazil
| | - Ektor Tsuneo Onishi
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Otorrinolaringologia, São Paulo, SP, Brazil
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Bayram A, Marchioni D, Peng K, Moon IJ, Cingi C. How do you perform your tympanoplasty, endoscopically or microscopically? ENT UPDATES 2019. [DOI: 10.32448/entupdates.594625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Maas AI, Kosyakov SI, Kharlamov KA. [The methodology of simulation training of the skills]. Vestn Otorinolaringol 2019; 84:60-63. [PMID: 30938345 DOI: 10.17116/otorino20198401160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The technical aspects of endoscopic otosugery imply the necessity of the long-term intense preparation of the specialists. Mastering new endoscopic techniques constitute a serious challenge even for a physician having the many years' experience of work with the binocular microscope which dictates the necessity of introduction of the simulation technologies for the training in endoscopic operations. The results of the analysis of the relevant literature publications provided a basis for the development of the methodology for teaching the skills of endoscopic tympanoplasty (ET) based on the use of the simulation models. MATERIAL AND METHODS: We have undertaken the morphometric analysis of various structures of the sheep external and internal ears based on the results of investigations with the use of computed tomography (n=15). The consideration of the data obtained by this radiodiagnostic technique made it possible to determine the mean length and the horizontal diameter of the external auditory meatus, the horizontal size and the area of the tympanic membrane, and the slope angle of the tympanic membrane with respect to the external auditory meatus, the volume of the tympanic cavity, and the length and width of hypotympanum. The results of the analysis of the technical aspects of endoscopic surgery of the middle ear were used to propose the approach to the mastering of the skills necessary for the performance of endoscopic tympanoplasty using a sheep head as the learning aid. This approach comprises the detailed algorithm of all stages of the surgical intervention including the preparation of the working place for the surgeon, various aspects of space ergonomics in the training laboratory, and step-by-step operations on the sheep head with the description of all phases of the surgical intervention. RESULTS: The results of the present study allowed to recommend the simulation training for the mastering of ET skills with the use of the biological model in the form of the sheep's head. The specific technical peculiarities of endoscopic tympanoplasty have been adapted to the proposed simulation system. It is concluded that the system has all anatomical topographic and morphometric characteristics necessary for the development of the ET skills in the future specialists in endoscopic otosurgery.
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Affiliation(s)
- A I Maas
- Department of otorhinolaryngology, Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia, 125993
| | - S Ia Kosyakov
- Department of otorhinolaryngology, Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia, 125993
| | - K A Kharlamov
- Department of otorhinolaryngology, Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia, 125993
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Isaacson B. Anatomy and Surgical Approach of the Ear and Temporal Bone. Head Neck Pathol 2018; 12:321-327. [PMID: 30069845 PMCID: PMC6081290 DOI: 10.1007/s12105-018-0926-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/27/2018] [Indexed: 12/01/2022]
Abstract
The temporal bone is one of the more complex structures at the skull base that houses the hearing and vestibular organs, numerous nerves, and vessels. A host of inflammatory and neoplastic processes can occur within the temporal bone that often necessitate permanent and frozen section pathologic examination. A number of simple to complex surgical procedures are used to manage temporal bone pathology. This chapter will provide a brief overview of normal temporal bone anatomy, common surgical approaches, normal histology, and indications for pathologic examination.
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Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology – HNS, UT – Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9035 USA
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