Zastosowanie endoskopii śródoperacyjnej w chirurgii przewlekłego zapalenia ucha środkowego

Abstract

IntroductionIntraoperative use of endoscopy in the treatment of chronic otitis media is one of the trends in otology. The aim of this study was to evaluate the use of the endoscope as an additional tool during canal wall up tympanoplasty with posterior tympanotomy (endoscopy-assisted tympanoplasty). Material and methodsThe study included eighty patients with chronic otitis media, the average age being 42.8 (+/-17.9) years. Intraoperative recordings endoscopic and microscopic camera were collected and visibility of anterior recess of epitympanum, sinus tympani, Eustachian tube, myryngo- and ossiculoplasty were compared on a visual analogue scale. The average value of air bone gap preoperative was compared to postoperative in main frequencies and statistical analysis by Wilcoxon test was performed. ResultsOptic of microscope allowed the partial visualization of anterior recess of epitympanum in 68% of the ears, while the endoscope allowed in 68% for total control of attic. Sinus tympani was completely visible in 64% of the ears in endoscopic optics, while it was not available for visual inspection in 80% of the ears in microscopic optic. Visibility of the Eustachian tube was poor in 78% of the ears in microscope, while in the endoscopic optics accurate insight into the Eustachian tube was achieved in 58% of the evaluable ears. An endoscope provided the total visibility of the tympanic membrane graft in 90% of the ears, while the microscope in 64% of the cases allowed only poor control of myryngoplasty. The endoscope has enabled the total evaluation of ossiculoplasty in 56% of the cases, and in further 24% of control was assessed on 4 points on 5-point scale, while the optics of microscope allowed to be exposed to 2 points in the adopted scale in 82% of ears. Average air bone gap postoperative statistically significant decreased in comparison to preoperative value (p=0.0277). ConclusionsAdditional use of the endoscope through posterior tympanotomy during canal wall up tympanoplasty allows for much better visualization of recesses of the tympanic cavity and reconstruction of the conduction system of the middle ear.