ENDOSCOPIC TRANSCANAL TRANSTYMPANIC POP THROUGH TECHNIQUE OF MYRINGOPLASTY USING TRAGAL PERICHONDRIUM GRAFT

Abstract

INTRODUCTION A perforated tympanic membrane is most commonly repaired using temporalis fascia graft by microscope assisted post auricular approach and underlay technique, we present an alternative technique to repair the perforated tympanic membrane using an alternative easily accessible graft material like tragal perichondrium, by endoscope assisted trans canalicular approach, where the graft is placed medial to the tympanic membrane remnant by pop through technique. OBJECTIVE T h e u s a g e o f r i g i d 4 m m e n d o s c o p e f o r myringoplasty allows better visualization, magnification and reconstruction of perforated tympanic membrane using tragal perichondrium is minimally invasive. The purpose of the study is to put across our experience in 69 patients where endoscopic assisted myringoplasty was done using tragal perichondrium graft. The graft was placed medial to the tympanic membrane remnant by trans tympanic pop through technique and tympanomeatal flap was not raised. METHOD This study was done over a period of 3 years, 69 patients with chronic suppurative otitis media fitting into the inclusion criteria underwent endoscopic transcanal myringoplasty using tragal perichondrium as graft material by underlay pop t h r o u g h t e c h n i q u e . T h e p o s t o p e r a t i v e audiological improvement in closure of air bone gap on pure tone audiometry, success in tragal perichondrium graft uptake, and mean operative time was evaluated. RESULTS The study population was 69 with predominantly females, the post operative pure tone audiometry showed that 39.1% had closure of airbone gap of 10db, 17.4% showed air bone gap closure of 20bd and 43.5 % showed air bone closure of 15db. 85% had success of graft uptake (i.e. complete closure of perforation) at 6 weeks post op .The mean operative time was 80 minutes. CONCLUSION Endoscopic assisted trans-canalicular (pop t h r o u g h t e c h n i q u e ) o f s i m p l e u n d e r l a y myringoplasty using tragal perichondrial graft is simple, minimally invasive with good post operative improvement in hearing and can be d o n e a s a d a y c a r e p r o c e d u r e w i t h o u t complications. KEYWORDS Endoscopic myringoplasty, tragal perichondrium , pop in technique.