Abstract
Aim: To evaluate the role of newly created transcanal endoscopic antrostomy hole as a passage in restoring the aeration of epitympanum and mastoid antrum.Materials & Methods: Study design: Retrospective case series study. Study duration: From January 2013 to January 2014. Study place: Private tertiary care hospital. Patients: 27 ears of 23 adult patients (age ranging from 15years to 54years) underwent transcanal endoscopic tympanoplasty for their chronic middle ear diseases in presence of inflamed middle ear mucosa along with radiological shadows of stagnant fluid in their epitympanum and mastoid antrum. Structured three months follow-up was ensured in every case. Intervention: A hole was created at a selected site of posterior meatal wall purely through transcanal endoscopic approach that established direct communication between mastoid antrum and external auditory canal. Thereafter this newly created passage was used for three purposes- assessment of the condition of mastoid antrum, performing the water test for checking epitympanic patency and in few cases placement of temporary tube for postoperative ventilation and drainage of middle ear. Main out come measures: The feasibility, performance and management of transcanal endoscopic antrostomy hole as passage for reestablishing the aeration of epitympanum and mastoid antrum.Results: The chosen site for antrostomy hole was found effective and safe in providing convenient entrance into the mastoid antrum in every case in this study with out facing technical complexity and failure. Postoperative healing of skin over antrostomy hole was found complete in all ears without any inward growth of skin in to mastoid antrum. Available post operative CT scan imaging of temporal bones showed improved aeration in their epitympanum and mastoid antrum.Conclusions: The role of transcanal antrostomy hole has been proved worthy in restoring ventilation pathway to epitympanum and mastoid antrum during tympanoplasty. This antrostomy hole has the potentiality to be considered in future for placement of long term mastoid ventilation tube in order to treat persistent atelectatic middle ear.
Highlights
Securing the ventilation of different compartments of middle ear cleft during tympanoplasty has enormous impact on its surgical outcome
This study described a novel procedure that was used to secure the ventilation of epitympanum and mastoid antrum purely through transcanal endoscopic guidance
This study evaluated the medical records of selected 27 ears of 23 adult patients underwent transcanal endoscopic tympanoplasty in presence of congested edematous middle ear mucosa along with clinical and radiological evidences of insufficient ventilation of epitympanum and mastoid antrum in a tertiary care private hospital in Chittagong, Bangladesh from January 2013 to January 2014
Summary
Securing the ventilation of different compartments of middle ear cleft during tympanoplasty has enormous impact on its surgical outcome. Ventilation of Middle ear cleft usually depends on the function of eustachian tube, patency of tympanic isthmus, posterior epitympanum, volume of mastoid antrum and the condition of mucosa of middle ear cleft. Mucosal adhesions around tympanic isthmus or ossicles, cholesteatoma, granulation tissue polyps are the common reasons causing blockage of the ventilation pathway to epitympanum and mastoid antrum. To restore this ventilation pathway two approaches have been usually practicing. One is antero-posterior approach involving extended atticotomy, removal of blockage and reconstruction of attic wall. Another is posterior-anterior approach involving cortical mastoidectomy and water test to evaluate epitympanic patency along with removal of blockage
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