1
|
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.
Collapse
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
| |
Collapse
|
2
|
Kallyadan A, Sarkar S, Pradhan P, Karakkandy V, Parida PK, Chappity P, Samal DK, Sharma P, Adhikari A, Shah A, Nayak S. Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction. Indian J Otolaryngol Head Neck Surg 2024; 76:469-476. [PMID: 38440479 PMCID: PMC10908901 DOI: 10.1007/s12070-023-04184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
Background Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition. Materials and Methods This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups. Results Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37 min in the Endoscopic group and 91.92 ± 15.35 min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group. Conclusion Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04184-4.
Collapse
Affiliation(s)
- Aswathi Kallyadan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Sarkar
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pradipta Kumar Parida
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Preetam Chappity
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prity Sharma
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anwer Shah
- Department of ENT and HNS, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Saurav Nayak
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
| |
Collapse
|
3
|
Bianchini AJ, Berlitz VG, Mocelin AG, Ribeiro JF, Keruk JG, Hamerschmidt R. Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review. Int Arch Otorhinolaryngol 2023; 27:e528-e535. [PMID: 37564466 PMCID: PMC10411212 DOI: 10.1055/s-0042-1748808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 10/17/2022] Open
Abstract
Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this. Objectives The present systematic review attempted to compare endoscopic and microscopic surgery techniques and to discover whether there would be superiority in the results of any of them, based on data currently available in the literature. Data Synthesis The objectives of the present review were organized according to the PICO planning and strategy adapted for systematic reviews. The inclusion and exclusion criteria were established aiming to select only select primary data. The main medical databases were searched using an optimized search string with appropriate descriptors. The searched databases were MEDLINE, LILACS, SciELO, and EMBASE. A total of 99 studies were selected and 38 were fully assessed after the inclusion criteria were applied. All included articles were reviewed by all authors and their results were discussed and summarized. Conclusion The endoscopic technique was shown to be a safer technique comparable in effectiveness to the use of microscopy. In addition, it provides possible advantages such as shortening the surgical time and better postoperative pain outcomes.
Collapse
Affiliation(s)
- Ana Júlia Bianchini
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Vitória Gabriela Berlitz
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Aurenzo Gonçalves Mocelin
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Juliana Ferraz Ribeiro
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - João Gabriel Keruk
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| | - Rogério Hamerschmidt
- Otorhinolaryngology Department, Universidade Federal do Paraná, Alto da Glória, Curitiba, PR, Brazil
| |
Collapse
|
4
|
Stefan I, Stefanescu CD, Vlad AM, Zainea V, Hainarosie R. Postoperative Outcomes of Endoscopic versus Microscopic Myringoplasty in Patients with Chronic Otitis Media-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1074. [PMID: 37374278 DOI: 10.3390/medicina59061074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope's advantages. The aim of this review is to compare the surgical outcomes of a totally endoscopic transcanal approach with a conventional microscopic approach for type 1 tympanoplasty in patients with chronic otitis media (COM) in order to establish if endoscopic myringoplasty (EM) could be a better alternative to microscopic myringoplasty (MM). A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. The selected articles were identified by searching PubMed Central, PubMed, MEDLINE and Embase databases for the relevant publications. Only studies where the same surgeon in the department performed both endoscopic and microscopic myringoplasty have been included in the review. The results suggest that with an endoscopic approach, minimally invasive myringoplasty can be achieved with a similar graft success rate and postoperative air-bone gap (ABG) improvement, a shorter operative time and less postoperative complications compared to a microscopic approach.
Collapse
Affiliation(s)
- Iemima Stefan
- Medical Center of Special Telecommunications Service, 060044 Bucharest, Romania
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Cristian Dragos Stefanescu
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Ana Maria Vlad
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Viorel Zainea
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Răzvan Hainarosie
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 030167 Bucharest, Romania
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| |
Collapse
|
5
|
Zhou Q, Jin L, Song X, Zheng H, Huang Y. Endoscopic type 1 tympanoplasty: comparison of the effects of three different thicknesses grafts. Acta Otolaryngol 2022; 142:375-380. [PMID: 35549633 DOI: 10.1080/00016489.2022.2071987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effects of graft thickness on tympanoplasty is uncertain. OBJECTIVE To compare the results of endoscopic tympanoplasty using different thicknesses of autologous tissues. METHODS This retrospective analysis included 186 patients who received type I tympanoplasty, divided into three main groups based of grafting material: perichondrium (A), cartilage-perichondrium (B), or cartilage-perichondrium plus additional perichondrium (C). Group A was subdivided based on whether the placement was inside (A1) or outside (A2) of the malleus. The hearing improvement, graft success rate, and surgery duration were analysed. RESULTS Statistical analysis showed significant hearing improvement in the three main groups (p < .001); recovery in group A occurred the earliest. Six months postoperatively, group A1 showed significantly greater hearing recovery compared with groups B and C (p < .05). There were no statistical differences the other groups (p > .05) or in the graft success rate among the three main groups (p = .235). The surgery duration of group A was significantly longer than that of groups B and C (p < .001). CONCLUSION AND SIGNIFICANCE Our results suggest that graft thickness affects hearing recovery; however, graft thickness does not affect the rate of grafting success. Endoscopic transplantation of the perichondrium is more difficult and requires more time.
Collapse
Affiliation(s)
- Qinshuang Zhou
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Lanlan Jin
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Xiaoxiao Song
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Haifeng Zheng
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Yideng Huang
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| |
Collapse
|