Endoscopic Cartilage Tympanoplasty Research Articles

The outcome of a single-stage endoscopic tympanoplasty with septoplasty using autologous septal cartilage graft in patients with mucosal chronic otitis media and deviated nasal septum

Background: Single-stage endoscopic tympanoplasty with septoplasty using autologous septal cartilage graft in patients with mucosal chronic otitis media and deviated nasal septum had resulted in successful repair of the tympanic membrane perforation and correction of the deviated nasal septum with improved eustachian tube dysfunction at the same time. Aims and Objectives: To study the structural and functional outcome of single-stage endoscopic Type 1 tympanoplasty using autologous septal cartilage graft after septoplasty in patients having mucosal chronic otitis media and deviated nasal septum. Material and Methods: We prospectively analysed 102 patients with chronic mucosal otitis media and central perforation of the tympanic membrane and deviated nasal septum with Eustachian tube dysfunction. The patients underwent endoscopic Type I tympanoplasty using an autologous septal cartilage graft with a thickness of approximately 0.5 mm that was harvested during endoscopic septoplasty. Morphological and functional results were recorded at 1, 6 and 12 month follow ups. Result: All patients were between years of age 31 to 40 years (31%). The average age of the study subject was 33.38 ± 12.63 years, with the male to female ratio of 1.31. Postoperatively the patients were looked for the acceptance of the cartilage graft and hearing gain. Of the total 102 patients, in 90 patients, eardrums perforations were closed satisfactorily, and 12 patients suffered from residual perforation (12%). On the functional front the mean pre-operative hearing loss of 40.98 ± 8.71 dB, improved significantly to 32 ± 9.06 dB postoperatively (P-value < 0.001). with a mean gain of 8.98 dB. Also, the mean pre-operative Air-Bone gap (27 ± 9.13 dB) was reduced postoperatively (13.82 ± 8.45 dB) (P-value < 0.001). Thus, improvement was noted to be 13.18 dB. Conclusion: Endoscopic cartilage tympanoplasty with autologous septal cartilage graft of the nose is a safe and effective way for Type I tympanoplasty with good structural and functional results and added benefits of reduced operating time, optimal graft uptake rate, minimal morbidity and pain and more importantly, ear surgery without a postauricular scar.

A Comparative Study: Platelet-Rich Fibrin Packing as an Alternative to the Absorbable Gelatine in Tympanoplasty.

Background:We aimed to investigate platelet-rich fibrin’s potential role as packing material in both the middle ear and external auditory canal.Methods:Twenty-nine patients undergoing transcanal endoscopic type 1 cartilage tympanoplasty were included in this controlled prospective clinical study. Patients were randomly assigned to platelet-rich fibrin (n = 14) or absorbable gelatine (n = 15) groups. Preoperative and postoperative pure-tone audiometry results, graft healing rates, tympanometry values, and Glasgow Benefit Inventory scores were compared.Results:No significant postoperative complications were observed and the graft intake rate was 100% in both groups. Mean air-bone gap gain was 9.82 ± 4 dB HL in the postoperative first month and 10.08 ± 4.91 dB HL in the sixth postoperative month in the platelet-rich fibrin group. There was no statistically significant difference between the postoperative air-bone gap gains of the groups in the first (P = .537) and sixth month (P = .723) controls. There was no statistically significant difference in compliance (P = .453) between groups. The physical benefit scores of the Glasgow Benefit Inventory were significantly higher in the platelet-rich fibrin group (P = .01). There was no difference in general and social benefit scores (P > .05).Conclusion:As a middle and external auditory canal packing agent, platelet-rich fibrin was as successful as absorbable gelatine in transcanal endoscopic cartilage tympanoplasty with similar functional results and graft healing rate.

ENDOSCOPIC CARTILAGE TYMPANOPLASTY. OUR TECHNIQUE AND EXPERIENCE OF 157 CASES

Objective: To assess the graft take rate and hearing gain in trans-canal endoscopic tympanoplasty Study&#x0D; Design: Descriptive study.&#x0D; Place and Duration of Study: Pakistan Naval Ship Hafeez, Islamabad Pakistan, form Dec 2015 to Jun 2018&#x0D; Methodology: All patients with dry central perforations of &gt;3 months history were included in the study. All Patients with perforations of pars tensa were booked for endoscopic cartilage tympanoplasty. All perforations were divided into four types small, medium, large and subtotal or total based on size of the tympanic membrane perforations. Small perforations involving &lt;25% area of Pars Tensa. Medium perforation are Perforations involving 25-50% of Tympanic membrane. Large perforations include Perforations involving 50-75% of pars tensa. Subtotal or total perforations are defined as perforations with &gt;75% perforation of the tympanic membranes. Wet Ears and perforations involving the Pars Flacida were excluded from the study. Preoperative Audiogram was carried out for all patients and A-B Gap were noted for all groups separately so as the demographic data including age and gender. Success was defined as complete closure of Tympanic membrane perforation at 3 months. All patients were operated with 0 Degree 3mm, 14cm rigid endoscope under general anesthesia.&#x0D; Results: Mean age of patients was. 37 years and standard deviation was 12.34 (range 12-58 years). Out of total 157 cases 81 patients male were males (51%) and 76 patients were females (49). Out of 157 ears operated 146 Perforations healed completely an overall success rate of 92%. Patients with small perforations had 100 percent success.....

Endoscopic Over Under Cartilage Tympanoplasty Is Not Inferior to Underlay Cartilage Tympanoplasty.

Evaluate whether elevating the tympanic membrane from the malleus during endoscopic tympanoplasty may negatively affect postoperative hearing outcomes or perforation rates by comparing 2 similar endoscopic tympanoplasty techniques. Retrospective cohort. Tertiary care center. Endoscopic over-under cartilage tympanoplasties age and gender matched to endoscopic underlay cartilage tympanoplasties between January 2015 and January 2019. Exclusion criteria included preoperative or intraoperative cholesteatoma, performance of mastoidectomy or ossicular chain reconstruction, and lack of postoperative audiogram. Endoscopic cartilage tympanoplasty via over-under or underlay technique. Pre- and postoperative pure-tone average and word recognition score, graft success. A total of 52 patients were evaluated: 26 endoscopic over-under cartilage tympanoplasties were matched to endoscopic underlay cartilage tympanoplasties. Both groups demonstrated a statistically significant improvement in air conduction hearing (9 dB [P < 0.001] and 6 dB [P < 0.01], respectively), and bone pure-tone average did not worsen in either group (P < 0.001 and P < 0.05, respectively). Postoperative air conduction pure-tone average was statistically noninferior in the over-under group compared with the underlay group (P < 0.05). Reperforation was present in 3 patients (12%) in the underlay group and none in the over-under group, but this difference was not statistically significant (P = 0.24). Endoscopic over-under cartilage tympanoplasty effectively closes tympanic membrane perforations and improves hearing, without greater risk than underlay tympanoplasty. Elevating the tympanic membrane from the malleus does not confer worsen hearing outcomes.

Endoscopic management of middle ear atelectasis

Objective To assess the efficacy of otoendoscopy in the surgical management of atelectatic ear to improve the clinical and the audiological outcomes. Patients and methods A total of 38 ears in 24 patients with middle ear atelectasis and intact ossicular chain were randomly assigned into two groups: group I (27 ears) underwent endoscopic T-tube insertion and group II (11 ears) underwent endoscopic cartilage tympanoplasty. Assessment of hearing was performed for all cases preoperatively and 3 months postoperatively. Results There is a significant postoperative improvement of air-bone gap averages reported in the two studied groups, with mean hearing gain of 21.67±7.97 dB in group I and 19.72±5.3 dB in group II. Conclusions At 3 months postoperatively, there was a significant statistical difference concerning different audiological parameters among the two groups.

Endoscopic Cartilage Umberlla Ossiculoplasty: As Total Ossicular Replacement Using Endoscope Holder.

The online version contains supplementary material available at 10.1007/s12070-021-02518-8.

Endoscopic Management of Middle Ear Atelectasis

Objective: To determine the contribution of otoendoscopy in the surgical management of atelectatic ear to improve clinical and audiological results. Methods and Materials: Thirty eight ears in 24 patients with middle ear atelectasis and intact ossicular chain were randomly assigned into 2 groups: Group I included 27 ears who were underwent endoscopic T- tube insertion and Group II included 11ears who were underwent endoscopic cartilage tympanoplasty. Assessment of hearing was performed for all cases preoperatively, 3 months postoperatively. Statistical analysis used: The analysis of the data was carried out using the IBM SPSS 20.0 statistical package software. Data were expressed as mean and standard deviation for quantitative measures in addition to both number and percentage for categorized data. Chi-square test or Fisher’s exact test were used to compare categorical variables. A P-value less than 0.05 was considered to be statistically significant. Results: There is significant postoperative improvement of ABG averages reported in the two studied groups with mean hearing gain of 21.67±7.97dB in group I and 19.72±5.3 dB in group II. Conclusion: At three months, there was significant statistical difference concerning different audiological parameters among the two groups.

Our Results of Endoscopic Cartilage Tympanoplasty in Patients with Tympanic Membrane Anterior Perforation

Amaç: Birçok greftleme tekniği ve cerrahi yaklaşım tanımlanmasına rağmen timpanik membran anterior kadran perforasyonlarının onarımı teknik olarak kulak burun boğaz uzmanları için zorlayıcıdır. Bu çalışmada, timpanik membran ön kadran perforasyonlarının onarımında endoskopik kıkırdak timpanoplastinin cerrahi ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır. Materyal ve Metod: 1 Ocak 2015- 30 Nisan 2019 tarihleri arasında transkanal endoskopik Tip 1 kıkırdak timpanoplasti yapılan anterior kadran timpanik membran perforasyonu olan hastaların greft başarısı, odyolojik verileri ve komplikasyonlar geriye dönük olarak incelendi. Kemikçik zincir rekonstrüksiyonu yapılan, kolesteatomu olan veya takiplerine düzenli gelmeyen hastalar ve timpanik membran perforasyonu anterior kadranda olmayan hastalar çalışma dışı bırakıldı. Bulgular: Endoskopik transkanal kıkırdak timpanoplasti yapılan 34 hastanın tıbbi kayıtları incelendi. 15 erkek (%44,1) ve 19 kadın (%55,9) hasta vardı. Ortalama yaş 35,44’dü (17-53 yaş aralığı). Hastaların 15’i sağ kulak (%44,1), 19’u sol kulaktan (%55,9) ameliyat oldu. Ortalama ameliyat süresi 31,56±4,04 dakika (aralık 24-38 dakika) idi. Greft başarı oranları postoperatif 3. Ayda %94,1 ve postoperatif 6. Ayda %91,2 idi. Ameliyat sonrası altıncı ayda yapılan saf ses odyometri ölçümlerine göre postoperatif hava-kemik aralığı değerleri, preoperatif değerlere göre istatistiksel olarak anlamlı derecede düzeldi (p&amp;lt;0,001). Sonuç: Endoskopik transkanal Tip 1 kıkırdak timpanoplasti karşılaştırılabilir greft başarı oranı ve odyolojik sonuçlarıyla, timpanik membran ön perforasyonlarını onarmak için minimal invaziv, etkili ve güvenilir bir cerrahi tedavi seçeneğidir.

The evaluation of prognostic factors in endoscopic cartilage tympanoplasty.

The aim of the present study was to evaluate the prognostic factors that may affect the success in endoscopic cartilage tympanoplasty and determine the outcomes of endoscopic cartilage tympanoplasty. This study included 312 patients who underwent transcanal endoscopic type I cartilage tympanoplasty. The effects of sex, the affected side, the size of the perforation, the location of the perforation, the absence of myringosclerosis, external ear canal protrusion, the condition of the contralateral ear, and surgical experience on the rate of graft success and hearing improvement were investigated. The affected side, sex, location of the perforation, myringosclerosis, the condition of contralateral ear, and surgical experience did not significantly affect the surgical success (p > 0.05). However, the size of perforation and ear canal wall protrusion were significantly related to both functional and anatomical success (p < 0.05). Endoscopic transcanal type I cartilage tympanoplasty can be performed with a high anatomical and functional success rate. However, surgeons should be more careful and design a case-specific operation strategy in patients with external ear canal anterior wall protrusion and large perforations.

Endoscopic Management of Tympanic Membrane Retraction Pockets: A Two Handed Technique with Endoscope Holder.

The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction pocket are pars flaccida and postero-superior parts. Decision about the procedure and the timing of the treatment of retraction pockets is debatable and depends on the functional and anatomic condition of the ear. To evaluate the results of the technique of two handed endoscopic management of retraction pockets with sliced tragal cartilage. Prospective Non Randomized Clinical Study. The study included 41 ears operated with the technique of two handed endoscopic cartilage tympanoplasty for retraction pockets with endoscope holders from November 2013 to May 2016 with a follow up period ranging from 22 to 53months. Cases of cholesteatoma and tympanic membrane perforation were excluded from the study. Pre and postoperative symptoms and air-bone gaps were recorded. The average preoperative air-bone gap in the study group was 24.53 ± 4.326dB. 28 ears were of pars tensa retractions (stage II-4, stage III-15, and stage IV-9) and 13 were pars flaccida retractions (stage III-8 and stage IV-5). 24 ears had ossicular erosion. The follow up revealed that, the results of two handed endoscopic sliced cartilage tympanoplasty for retraction pockets were stable and there was no recurrence of the retraction and the post-operative air-bone-gap closure was achieved to 13.62 ± 4.78, 14.13 ± 5.91dB, 14.32 ± 3.46 and 14.57 ± 3.88dB at 6months, 1 year, 2 years, 3 years respectively. Though, indications for surgery are based mostly on anatomic status and observation of behaviour of retraction pocket over time, we recommend early management of retraction pockets by the technique of endoscopic sliced tragal cartilage tympanoplasty with tragal cartilage of 0.5mm thickness using endoscope holder. Level of Evidence: Level 4.

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft

IntroductionCartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. ObjectiveThe present study was carried out to report a personal experience with “tragal cartilage shield” tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. MethodsFifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. ResultsOut of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. ConclusionThis study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

A comparison of graft uptake and hearing improvement in endoscopic cartilage tympanoplasty and endoscopic emporalis fascia tympanoplasty

A comparison of graft uptake and hearing improvement in endoscopic cartilage tympanoplasty and endoscopic emporalis fascia tympanoplasty

Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision

Objective: The aim of this study was to evaluate the outcomes of this minimally invasive tympanomeatal incision technique performed during endoscopic transcanal cartilage tympanoplasty.Study design: Prospective clinical study.Methods: Eighty-seven patients (87 ears) who had TM perforation with noncomplicated COM were included. All of the patients were operated with the endoscopic transcanal cartilage tympanoplasty technique. All of the data were prospectively collected. These included demographic data, date of the surgery, preoperative and postoperative pure-tone audiometry (PTA), localization of TM perforation and graft healing success.Results: Mean follow-up time was 14.76 ± 4.32 months. Graft-healing rate was 100%. Mean air bone gap level improvement (dB HL) at 0.5, 1, 2 and 4 kHz were 13.87 ± 7.30 dB HL, 9.09 ± 7.59 dB HL, 9.74 ± 6.40 dB HL and 7.46 ± 6.37 dB HL, respectively. At all frequencies, there was significant difference between pre and postoperative mean air bone gap levels (p < .05). There was no significant correlation between the postoperative mean air bone gap level improvement and the localization of the perforation (p > .05).Conclusions: Endoscopic ear surgery has successful surgical outcomes with low complication rates. In this study, the outcomes of limited tympanomeatal flap incision was discussed. It is suggested that this technique is reliable with good hearing results with low postoperative complications rates.

Endoscopic Tympanoplasty Using Nasal Septal Cartilage Allograft.

The purpose of the study was to analyze the morphological and functional outcomes in a series of 60 patients for whom Type I tympanoplasty was done using alcohol preserved nasal septal cartilage allograft through endoscopic permeatal route. The study was a prospective, interventional (surgical) study of 60 patients between October 2012 and September 2014. Patients were operated using 0°, 4mm, 18cm long Hopkin's rod endoscope through permeatal route. 70% ethyl alcohol preserved allogeneic nasal septal cartilage with thickness of around 0.5mm was used for grafting. At the end of 6months, final assessment of morphological outcome i.e. intact tympanic membrane and functional outcome i.e. reduction in Air Bone gap, was done. At the end of 6months, 57 patients (95%) had intact tympanic membrane. Mean ABG in postoperative patients was 11.83dB. The operative time taken in 42 patients (70%) was 30-45min. 42 patients (70%) returned to normal activity in 3-5days. Endoscopic cartilage tympanoplasty using allogenic nasal septal cartilage can be safely and effectively used for Type I tympanoplasty with good anatomical and audiological results with benefits of reduced operating time, morbidity, pain and 'No scar'.

Bilateral same-day endoscopic transcanal cartilage tympanoplasty: initial results

IntroductionSame-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications. ObjectiveTo evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations. MethodsFrom February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5cm×1.5cm cartilage seemed to be enough for tympanoplasty in both sides. ResultsNine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88dB preoperatively to 9.16dB postoperatively (p<0.05). ConclusionBilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications.

Endoscopic cartilage tympanoplasty: A two-handed technique using dr khan's endoscope holder “EndoHold”

Endoscopic cartilage tympanoplasty: A two-handed technique using dr khan's endoscope holder “EndoHold”

Endoscopic cartilage tympanoplasty: A two-handed technique using an endoscope holder.

Endoscopic ear surgery provides a minimally invasive approach to the middle ear. The disadvantage of endoscopic ear surgery is that it is a single-handed surgical technique. The nondominant hand of the surgeon is utilized for holding and manipulating the endoscope. This necessitated the need for the development of an endoscope holder that would allow both hands to be free for surgical manipulation. The aim of this article is to report our preliminary experience using our newly designed and developed endoscope holder, which allowed us to perform cartilage tympanoplasty utilizing both hands for surgery. Retrospective nonrandomized clinical study. The endoscope holder was designed and developed to aid in endoscopic ear surgery and to overcome the disadvantage of single-handed endoscopic surgery. The design of the endoscope holder is described in detail, along with instructions on how it can be used. A total of 179 endoscope holder-assisted cartilage tympanoplasties were performed to evaluate the feasibility of a two-handed technique and to evaluate the results of surgery. In an early follow-up period ranging from 6 to 20 months, the graft take was seen in 174 ears, with one residual perforation and four recurrent perforations, giving a success rate of 97%. The endoscope holder eliminates the disadvantages of single-handed surgery and is a good option for those who wish to perform endoscopic ear surgery using both hands. The study reports the successful application and use of the endoscope holder in a two-handed technique of endoscopic tympanoplasty. 4. Laryngoscope, 126:1893-1898, 2016.