Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations

Endoscopic Versus Microscopic Type I Tympanoplasty: An Updated Systematic Review and Meta-analysis

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.

Endoscopic Versus Microscopic Tympanoplasty: A Systematic Review and Metanalysis

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, 2024.

[Chronic mesotympanic Otitis media - Part 2: Surgical Therapy]

Chronic mesotympanal otitis media (CMOM) is a well-developed clinical presentation that is established in diagnostics and therapy. On closer inspection, however, this principle cannot be confirmed in all its facets. Already the physiology and pathophysiology of the middle ear mucosa leave questions unanswered, starting with the distribution of the ciliated epithelium in the middle ear and mastoid to the function of gas exchange.In addition, there are new diagnostic and therapeutic approaches. In the future, optical coherence tomography could help to determine the status of the middle ear mucosa. In addition, there are new findings on the effectiveness of local and systemic antibiotics as well as antiseptics in chronic otorrhea. Other new developments include minimally invasive surgical procedures using endoscopic techniques. All this gives reason to provide an update on the topic of chronic mesotympanal otitis media, which should contribute in preparation for the specialist examination or refreshing.Basics of physiology and pathophysiology as well as new diagnostic approaches and medical treatment were covered in Part 1 of this paper. In Part 2, in addition to established methods, new developments in surgical therapy with minimally invasive surgical procedures are described in more detail.

Endoscopic transcanal transtympanic myringoplasty vs. endoscopic transcanal tympanoplasty: 1-year follow-up study

BACKGROUND

Endoscopic transcanal transtympanic myringoplasty (ETTM) is a relatively easier technique than endoscopic transcanal tympanoplasty (ETT) for repairing tympanic membrane perforations. No studies have compared the outcomes of these two procedures with tragal perichondrium after 1-year. Furthermore, there is no evidence-based stratification according to variations in perforation size in endoscopic ear surgery. Therefore, we compared the 1-year outcomes of ETTM and ETT stratified according to perforation size.

METHODS

Patients who underwent ETT and ETTM to repair eardrum perforations with a tragal perichondrium graft were identified. Pure-tone audiometric tests and otoscopic examination were performed to assess hearing outcomes and perforation sizes both preoperatively and at least 1 year postoperatively.

RESULTS

In total, 158 patients (159 ears) were included. ETT was performed on 83 ears, and ETTM was performed on 76 ears. The ETTM procedure time was 10-minutes shorter than that for ETT ( p < 0.001). Perforation size was significantly correlated with graft take-rate. For large perforations, the ETT success rate was significantly higher than that of ETTM (91.7% vs. 78.9%). Success rates for small-medium perforations were comparable for both methods ( p > 0.05). However, for medium perforations, the graft take-rate of ETT reached a plateau after 6 months, while that of ETTM gradually declined during the 12-month follow-up. Both groups had a comparable mean postoperative air-bone gap gain ( p = 0.666).

CONCLUSION

ETTM is suitable for repairing small perforations, whereas ETT is preferred for large perforations. Both methods, and particularly ETTM, should be employed cautiously for medium perforations.

Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs

Background

The conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated.

Methods

A retrospective case–control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration.

Results

Medical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group.

Conclusions

Endoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media

BACKGROUND

To compare the results between type I tympanoplasty performed with transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) for treatment of chronic otitis media in a homogenous group of patients.

METHODS

A retrospective study was performed in our department between January 2011 and January 2016 to review primary type I tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least 1 month, normal middle ear mucosa, and a follow-up period of at least 6 months post surgery. The adoption of TEES or MES was divided temporally (before and since 2013). TEES was undertaken in 224 patients (224 ears) and MES in 121 patients (121 ears).

RESULTS

The successful graft take rate was 94.64% (212/224) in the TEES group and 90.91% (110/121) in the MES group (P = 0.239). The improvements in the air conduction levels between the 2 groups were not statistically different at 1, 3, or 6 (> 6) months (P > 0.05) after surgery. The improvements in the air-bone gaps were not significantly different between the 2 groups (P > 0.05). The average hearing gains in the TEES group 6 (and > 6) months post surgery were 11.85 ± 5.47 dB, which was better than 10.48 ± 5.18 dB in the MES group (P = 0.031). The use of medical resources was lower in the TEES group than in the MES group regarding the average operating time (49.22 ± 8.24 min vs 81.22 ± 14.73 min, respectively; P < 0.0001). Patients receiving MES had a significant higher incidence of the wound problems (ear pain, numbness around the ears, and wet ear; P < 0.05).

CONCLUSION

TEES for type I tympanoplasty seems to achieve a shorter operative time and ideal tympanic membrane healing rate and hearing results in patients with chronic otitis media.

Endoscopic inlay cartilage and perichondrium myringoplasty for repairing large perforations in teenagers

OBJECTIVE

This study compared the long-term graft success rates and hearing outcomes of overlay-underlay and underly cartilage myringoplasty for repairing large perforations in Teenagers.

STUDY DESIGN

prospective, randomized study.

SETTING

Tertiary referral center.

METHODS

Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups:intervention group (n = 39) and control group (n = 41). The graft success rate, hearing improvement, and complications were compared between the two groups.

RESULTS

A total of 80 patients were included in this study. The graft success rate was 100% in the intervention group and 95.1% in the control group at postoperative 3 months, the difference wasn't significant (P = 0.496). Also, the graft success rate was not significantly different between the two groups at 12 months postoperatively (100.0% vs 87.8%, p = 0.073). However, the difference of graft success rate was significant between the two groups at 24 months postoperatively (97.4% vs 75.6%, p = 0.012). CT examination revealed well-pneumatized middle ears 24 months after surgery in both group. However, epithelial pearls near the umbo were seen at 31 months postoperatively in one patient in the observation group.

CONCLUSIONS

Compared to the endoscopic cartilage with perichondrium composite graft underlay technique, endoscopic perichondrial graft overlay and cartilage underlay had a better long-term graft success rate and lower rate of long-term re-perforation in teenagers. However, the graft technique had no effect on hearing outcome.

Endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation for tympanic membrane perforation

BACKGROUND

The elevation of the tympanomeatal flap in endoscopic myringoplasty will cause considerable tissue damage.

OBJECTIVE

To analyze anatomic and audiological results of tympanic membrane perforation underwent endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation (EPM) and their relationship with the size of perforation.

METHODS

A clinical retrospective study was performed on 75 cases of tympanic membrane perforation that underwent EPM from January 2019 to March 2021. Graft success and hearing outcomes were evaluated 3 months after surgery.

RESULTS

The overall graft success rate for EPM was 94.7% (71/75). The total rate of hearing success, postoperative ABG ≤ 20 dB was achieved in 96.0% (72/75). The overall mean AC threshold of 35.1 ± 5.6 dB was lowered to 25.0 ± 4.8 dB postoperatively (p < .01). The mean pre- and postoperative ABG of all patients were 20.5 ± 4.6 dB and 10.4 ± 3.9 dB (p < .01), respectively. The graft success rates for the small, middle and large perforations groups were 100% (11/11), 100% (34/34) and 86.7% (26/30), respectively.

CONCLUSION

It is revealed that EPM is an effective method to repair perforation of tympanic membrane. The size of the tympanic membrane perforation may be a risk factor for perforation healing and hearing recovery, although EPM is available for large perforations.

Comparison of long-term outcome of two endoscopic transtympanic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations

OBJECTIVE

We compare the long-term efficacy of the cartilage-perichondrium modified over-underlay technique and transtympanic underlay alone technique using endoscopic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations.

MATERIAL AND METHODS

Nine chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage-perichondrium modified over-underlay myringoplasty (MOUM, n = 55) and endoscopic cartilage-perichondrium transtympanic underlay alone myringoplasty (TUAM, n = 54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months.

RESULTS

In total, 99 patients were finally analysed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0% vs 96.0%, p = 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%, p = 0.028). In addition, postoperative ABG < 10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group, the difference wasn't significant (p = 0.953). CT examination revealed well-pneumatised middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed.

CONCLUSION

Endoscopic modified cartilage-perichondrium over-underlay myringoplasty without tympanomeatal flap elevating is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic cartilage-perichondrium transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal.

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.

Interlay Myringoplasty With Anterior Subannular Grafting Technique for Anterior and Subtotal Perforations

OBJECTIVE

To describe the interlay myringoplasty with anterior subannular grafting technique and evaluate postoperative hearing and complications of this technique.

STUDY DESIGN

Retrospective chart review.

PATIENTS

We included 141 patients with anterior and subtotal tympanic membrane (TM) perforation. Patients who underwent concurrent ossicular chain reconstruction were included in graft success and complication rates evaluations, and were excluded from audiometric evaluation.

INTERVENTIONS

Only squamous layer of the TM continuous with posterior meatal skin is elevated except one of anterioinferior annulus. The inner tympanic remnant is released from the anterioinferior annulus and then the subannular mucosa is separated from the annulus to fashion a subannular pocket. The anterior edge of the graft is inserted into the pocket, and the rest of the graft is sandwiched between the two divided layers of the TM.

MAIN OUTCOME MEASURES

Graft success rate and hearing results were evaluated at 6 months postoperatively. Postoperative complications were also noted.

RESULTS

The technique was successfully performed in 132 (93.6%) cases. Graft success rate was 98.3% (111/113) and the mean improvement of the air-bone gap was 9.5 dB, which was statistically significant (p < 0.001). There was no anterior blunting or TM lateralization. The pearl formations were found in six (5.3%) patients. All of them were easily removed at follow-up examination.

CONCLUSIONS

The present study showed the interlay myringoplasty with anterior subannular grafting technique produces excellent results to repair anterior or subtotal TM perforations with few risk of anterior blunting and lateralization of the TM.

Endoscopic myringoplasty in pediatric patients: a comparison of cartilage graft push-through and underlay fascia graft techniques

BACKGROUND

Although myringoplasty is performed in pediatric patients, there is still no consensus on the graft material and surgerical procedure.

OBJECTIVE

To compare the short-and long- term graft take rates of the cartilage push-through and fascia graft techniques employed during pediatric myringoplasty.

MATERIALS AND METHODS

93 pediatric patients with perforation who underwent myringoplasty were randomized into the cartilage push-through and underlay fascia graft group. The outcomes evaluated were hearing gains, and graft success rates at 12 and 24 months.

RESULTS

The graft success rate was similar between two groups (95.7% vs 91.3%, p = .653) at postoperative 12th months, however, the graft success rate was significantly higher 91.5% for the cartilage graft group compared with 73.9% for the fascia group at postoperative 24th months. No significant between-group differences were observed pre- (p = .694) or post- (p = .812) operative ABG values or mean ABG gain (p = .745).The re-perforation rate in fascia group was significantly higher than that in push through group (19.05 vs. 4.44%). No middle ear cholesteatoma formation was found in either group.

CONCLUSION

Endoscopic cartilage push-through and underlay fascia graft myringoplasty afforded comparable hearing results in pediatric patients; however, the push-through technique without the elevation of a tympanomeatal flap exhibited better long-term graft success rate compared to underlay fascia graft.

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

OBJECTIVE

This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications.

METHOD

This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained.

RESULTS

Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring.

CONCLUSION

Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

Endoscopic myringoplasty: comparison of double layer cartilage-perichondrium graft and single fascia grafting

Objective

To compare surgical results of endoscopic myringoplasty using double layer cartilage-perichondrium grafts versus single fascia grafts.

Study design

Prospective, randomized, controlled.

Setting

University-affiliated teaching hospital.

Subjects and methods

In total,134 patients who underwent endoscopic myringoplasty were included in this study. Patients in group A received a double layer tragal cartilage-perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air-bone gap (ABG) and the graft success rate.

Results

The graft success rate was 98.5% (66/67) in the Group A and 94.0% (63/67) in the Group B at 6 months, the difference wasn’t statistically significant (p = 0.362). However, the graft success rate was 97.0% (65/67) in the Group A and 85.1% (57/67) in the Group B at 12 months, the difference was statistically significant (p = 0.034).

In addition, only one patient (1.49%) had small keratin pearls in the Group A, no patients developed cholesteatoma of middle ear in either group.

Conclusions

The endoscopic double layer perichondrium-cartilage graft technique is feasible for repairing medium or larger perforations, it has a better long-term graft success rate and less operative time compared with the single layer fascia graft technique. However, long-term hearing outcomes were the same for the single and double layer closure techniques.

The Elevation of Tympanomeatal Skin Flap Could Not be Necessary for Endoscopic Cartilage Myringoplasty

Endoscope provide the excellent view and observe the entire perforation edges, endoscopic cartilage myringoplasty doesn't require the lateral circumferential incision and the elevation of tympanomeatal skin flap in most cases. The cartilage graft may be pushed through the perforation and place medial to the remnant tympanic membrane and annulus.

Comparison of endoscopic butterfly-inlay versus endoscopic push-through myringoplasty in repairing anterior perforations of the tympanic membrane

OBJECTIVE

The aim of the present study was to evaluate the surgical and functional results of endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty in the treatment of anterior perforation of the tympanic membrane.

METHOD

This open-label randomised clinical study was conducted on 71 patients with small- and medium-sized anterior perforations of the tympanic membrane. Graft success rate, hearing results, operative time and complications were analysed.

RESULTS

Graft success rates for endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty were 94.1 and 91.8 per cent, respectively (p > 0.05). Post-operative air-bone gap values significantly improved in both the endoscopic butterfly-inlay cartilage myringoplasty and endoscopic push-through myringoplasty groups. The average operative time was significantly shorter in the endoscopic butterfly-inlay cartilage myringoplasty group (31.5 minutes) compared to the endoscopic push-through myringoplasty group (41.7 minutes; p < 0.05).

CONCLUSION

When compared with the endoscopic push-through myringoplasty, the endoscopic butterfly-inlay cartilage myringoplasty technique, which is technically easier to perform, does not require packing and has a shorter operating time. It is a reasonable approach for repair of anterior perforations of the tympanic membrane.

Endoscopic transcanal versus conventional microscopic tympanoplasty in treatment of anterior tympanic membrane perforations

PURPOSE

To compare the surgical outcomes of endoscopic transcanal tympanoplasty (ETT) and conventional microscopic tympanoplasty (CMT) in repairing anterior tympanic membrane perforations (ATMPs).

METHODS

We retrospectively analyzed the graft success rate, hearing outcomes, operative time, hospitalization period and complications in patients who underwent ETT and CMT between October 2015 and July 2018. In addition, the authors investigated whether anterior canal wall protrusion (ACWP) affects the graft success rate and operative time.

RESULTS

The graft success rates for ETT and CMT were 93.7% (30 out of 32 patients) and 91.4% (32 out of 35 patients), respectively (p = 0.640). There was no significant relationship between ACWP and graft success rates in either the endoscopic (p = 0.685) and microscopic (p = 0.894) group. The mean operative time was significantly shorter in the ETT group (37.2 ± 3.1 min) than in the CMT group (52.9 ± 9.2 min) (p < 0.001). Regarding operative time, there was no statistically significant difference between patients with and without ACWP (38.3 versus 36.3 min, respectively (p = 0.124)) in the ETT group. However, the mean operative time of patients with ACWP in the CMT group was significantly longer than patients without ACWP [62.3 versus 48.8 min, respectively (p < 0.001)].

CONCLUSIONS

ETT offering fewer complication rates and shorter duration of surgery may serve as a reasonable alternative to CMT in repairing ATMPs, with comparable graft success rates.

Comparison of endoscopic transcanal and microscopic approach in Type 1 tympanoplasty

Introduction

Endoscopic tympanoplasty is a minimally invasive surgery that may be performed via a solely transcanal approach. The use of endoscopes in otologic procedures has been increasing worldwide. The endoscopic approach facilitates the transcanal tympanoplasty, even in patients having the narrow external ear canal with an anterior wall protrusion.

Objectives

The present study aimed to compare the surgical and audiological outcomes of endoscopic transcanal and conventional microscopic approach in Type 1 tympanoplasty.

Methods

The graft success rates, hearing outcomes, complications, and duration of surgery in patients who underwent endoscopic and microscopic tympanoplasty between October 2015 and April 2018 were retrospectively analysed.

Results

Graft success rates were 94.8 per cent and 92.9 per cent for the endoscopic and microscopic group, respectively (p >  0.05). Postoperative air-bone gap values were improved significantly in both groups (p <  0.001). The average duration of surgery was significantly shorter in the endoscopic group (mean 34.9 min) relative to the microscopic group (mean 52.7 min) (p <  0.05). The average hospitalization period was 5.2 h (range 3–6 h) in Group I whereas it was 26.1 h (range 18–36 h) in Group II (p <  0.05).

Conclusion

The endoscopic transcanal tympanoplasty approach is a reasonable alternative to conventional microscopic tympanoplasty in the treatment of chronic otitis media, with comparable graft success rates and hearing outcomes.