Results of pediatric endoscopic and endoscopically assisted tympanoplasty

Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction

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.

Comparison between endoscopic and microscopic butterfly cartilage graft inlay tympanoplasty: a systematic review and meta-analysis

PURPOSE

The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis.

METHODS

A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap.

RESULTS

Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I² 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48).

CONCLUSION

Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.

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.

Preparation of Antibacterial Gelatin/Genipin Nanofibrous Membrane for Tympanic Membrane Repair

Tympanic membrane perforation (TMP), a common disease, often needs a scaffold as the patch to support surgery. Due to the environment of auditory meatus, the patch can be infected by bacteria that results in failure; therefore, the ideal scaffold may combine biomimetic and antibacterial features. In this work, gelatin was used as the electrospinning framework, genipin as the crosslinking agent, and levofloxacin as an antibacterial in order to prepare the scaffold for TMP. Different contents of levofloxacin have been added to gelatin/genipin. It was found that, with the addition of levofloxacin, the gelatin/genipin membranes exhibit improved hydrophilia and enhanced tensile strength. The antibacterial and cell-cultured experiments showed that the prepared antibacterial membranes had excellent antibacterial properties and good biocompatibility, respectively. In summary, levofloxacin is a good group for the gelatin/genipin scaffold because it improves the physical properties and antibacterial action. Compared with different amounts of levofloxacin, a gelatin/genipin membrane with 1% levofloxacin is more suitable for a TM.

The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty

OBJECTIVE

To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia.

STUDY DESIGN

Retrospective patient review and posttreatment questionnaire survey.

SETTING

Tertiary referral center.

PATIENTS

Sixty adult patients with chronic dry tympanic membrane perforation.

INTERVENTIONS

Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used.

MAIN OUTCOME MEASURES

Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey.

RESULTS

Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method.

CONCLUSION

This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.

Endoscopic tympanoplasty with inlay cartilage graft in an university hospital

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.