Endoscopic ventilation tube placement in the pediatric age

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Tympanic membrane perforation in children: Endoscopic type I tympanoplasty, a newly technique, is it worthwhile?

OBJECTIVES

To evaluate the results of a newly introduced technique to our Department of endoscopic assisted transcanal myringoplasty applied in tympanic membrane perforation in children of any age and compare them to that of the previously standard microscopic assisted myringoplasty technique.

METHODS

A retrospective study of myringoplasties performed between January 2005 and June 2014 in children suffering from chronic otitis media with perforation. In microscope-assisted cases, a transcanal approach was applied when the anterior tympanic annulus was completely visible through the ear speculum, and a postauricular approach was used in all other cases. A transcanal approach was used in all endoscopic-assisted cases.

RESULTS

Between January 2005 and December 2010 and January 2011 and June 2014, 23 and 22 myringoplasties were performed by means of an operative microscope and an endoscope, respectively. Patient age varied from 5 to 16 years. Median duration of microscopic and endoscopic approaches was 90 min and 80 min (P=0.3), respectively. Hospital stay after surgery was significantly longer in the microscope group than the endoscope group (P<0.001). The intact graft success rate was 82.6% in microscopic and 90.9% in endoscopic approaches. Median postoperative air-bone gap of microscopic and endoscopic approaches was 6.2 dB and 6.6 dB, respectively (P=0.9). Neither intra- nor postoperative complications were observed.

CONCLUSION

Endoscopic transcanal myringoplasty is an alternative surgical approach to traditional technique. This surgery is more conservative than microscopic approach and can be performed in all pediatric cases independently from age. Moreover, it offers comparable anatomical and functional results to the traditional surgery, and grants better comfort for the child.

Endoscopic ear surgery: A case series and first United Kingdom experience

AIM: To present the United Kingdom’s first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries.

METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery.

RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps (P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications.

CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed.