Endoscopic Transcanal Myringoplasty Research Articles

Endoscopic transcanal underlay myringoplasty using a platelet-rich fibrin (PRF) membrane

BackgroundTympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty.MethodsWe conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry.ResultsSixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported.ConclusionEndoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision.

Endoscopic closure of tympanic membrane perforations by platelet-richplasma laden cartilage with perichondrium

Background: Myringoplasty surgery, also known as tympanic membrane repair, is performed to correct hearing loss brought on by TM perforation and to eliminate recurrent ear discharge. Platelets are the primary players in the process of tissue healing. They provide essential growth factors that stimulate fibroblasts to produce new blood vessels and lay down extracellular matrix. The study aim: Is to assess the efficacy of incorporating plateletrichplasma into tragal cartilage grafts with its perichondrium in order to speed healing and enhance the results of endoscopic transcanalmyringoplasty. Patients, and methods: Fifty people suffer from dry central TM perforation participated in this prospective case-control study. Under local anaesthesia, each of them had endoscopic transcanal myringoplasty by using tragal perichondrium grafts. 25 patients underwent myringoplasty surgery and also received platelet-richplasma (PRP) from the same patient in group A, compared to 25 patients in group B who underwent myringoplasty surgery but did not get PRP. Results: There were 25 patients in each group, and no statistically significant demographic differences existed between the two groups. A p-value of (0.01) indicates that there was a significant difference between the plattelet-rich plasma group's (100%) and the non-plattelet-rich plasma group's (72%) graft absorption success rates.

Endoscopic transcanal myringoplasty with anterior tab flap underlay technique: An analysis of 35 cases

IntroductionThe repair of the tympanic membrane can present a problem, especially in anterior perforation, because the anterior portion was not enough to inadequate contact between tympanic membrane remnant and graft. Various surgical techniques were recommended to achieve an acceptable graft success rate in anterior perforation. Endoscopic transcanal myringoplasty with anterior tab flap could provide the better stability of the graft. ObjectiveThe aim of this study was to report the minimally invasive technique for the anterior tympanic membrane perforation closure and investigate the graft success rate of this technique. Patients and methodsWe performed a prospective, randomized study of 35 patients who consulted the otorhinolaryngology department at the university hospital for surgery of perforation tympanic membrane repair. ResultsThe average age was 35.1 ± 11.9 years. The size of the perforation was dominant at small-size and large-size, 51.4%, 34.3%, respectively. There was a significant difference between the Preoperative air conduction of small and large perforations (34.44 8.68 and 49.79 14.54, respectively). Of 35 patients, 31 (88.6%) had closure of their perforations. The mean preoperative ABG was 24.11 ± 10.79 dB, while The mean postoperative ABG was 13.97 ± 10.03 dB (p < 0.05). Approximately 34.3% patients had ABG within 20 dB preoperatively, which increased to 82.9% after intervention (p < 0.05). ConclusionsThe endoscopic transcanal myringoplasty with anterior tab flap underlay technique is a safe, suitable and effective method for cases with anterior tympanic membrane perforations, and showed improvement in postoperative hearing.

ENDOSCOPIC EAR SURGERY IN CROATIA - INITIAL RESULTS OF TOTAL ENDOSCOPIC TRANSCANAL MYRINGOPLASTY.

The aim of this study was to show clinical outcome in 56 patients with tympanic membrane perforation operated on by total endoscopic transcanal myringoplasty. Out of the total of 74 patients operated on exclusively endoscopically, we identified 56 patients in whom tympanoplasty type I (myringoplasty) was performed. In 43 patients (45 ears), myringoplasty was performed in a standard transcanal fashion with lifting of the tympanomeatal flap, and in 13 patient butterfly myringoplasty was performed. The size and position of perforation, surgery duration, hearing status and closure of the perforation were evaluated. Perforation closure was obtained in 50 of 58 ears (86.21%). The mean surgery duration was 62.69±22.56 minutes in both groups. Hearing improved significantly, with the preoperative mean air-bone gap of 20.41±9.29 dB improving to the postoperative mean air-bone gap of 9.05±7.77 dB. No major complications were recorded. Our results of graft success rate and hearing outcomes are comparable with those of microscopic myringoplasties but without the need for external incisions and with reduced surgical morbidity. Hence, we recommend total endoscopic transcanal myringoplasty as the method of choice for tympanic membrane perforation regardless of its size and location.

Effect of addition of platelet-rich fibrin to tragal perichondrium graft in the endoscopic trans-canal myringoplasty

BackgroundMyringoplasty operation is the reconstruction of the tympanic membrane (TM) which is performed to prevent recurrent discharge of the ear and to improve the hearing impairment which is caused by TM perforation. Platelets are the key factors in tissue repair mechanisms. They provide essential growth factors, which stimulate fibroblasts to create extracellular matrix deposition and neovascularization. The aim of this study is the assessment of the topical use of autologous platelet-rich fibrin (PRF) in the improvement of myringoplasty success rate.ResultsPatients were divided to two groups, group A included 20 patients who were submitted to myringoplasty operation with adding of PRF from the same patient, and group B included 20 patients who were submitted to myringoplasty operation without adding of PRF. At 6 months postoperatively, the success rate (graft taking) in case group A (95%) was significantly higher than in the control group (70%) (P value = 0.037). Success in terms of hearing gain of the air-bone gap was more than 10 dB achieved in 19 patients (95%) in case group A, and 14 patients (70%) in control group B were with a statistically non-significant difference (P value = 0.079). There was no effect of PRF use on hearing gain in graft-taken cases because hearing gain is related to the closure of TM.ConclusionTopical PRF application over tragal perichondreal graft during myringoplasty is successful, safe, and highly efficient with no complications. PRF improves healing of chronic TM perforations and prevents postoperative infection.

Transcanal endoscopic myringoplasty: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study was conducted in the Department of ENT and Head and Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. Patients attending ENT OPD with central dry perforation of tympanic membrane were selected for endoscopic transcanal myringoplasty. Written and Informed consent were taken. During surgery, various parameters were noted including duration of surgery and hospitalization. These patients were followed through a period of 6 months and assessed using pure tone audiometry and graft uptake was seen. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 40 patients, male: female ratio was 1.2:1. Time taken for surgery was less than 60 minutes in 16 (40%) patients whereas in 24 (60%) patients it was between 60-120 minutes. In our study the patients with small perforation had excellent graft uptake rates (18/19 patients, 94.73%), whereas patients with medium sized perforation showed graft uptake rate of 76.47% (13/17 patients). Objective analysis of cosmetic result was done at the end of six month and revealed that none of the patient had visible scar. Mean pre-operative air bone gap was 24.38 dB whereas mean postoperative air bone gap was 8.34 dB. Mean improvement comes out to be 16.04 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic myringoplasty was found to be equally effective, less morbid and very cost effective in small central perforations.&lt;/p&gt;

Endoscopic Transcanal Myringoplasty-Smart Myringoplasty for Nex Gen ENT Surgeons: Our Experience.

Otolaryngology is one of the branch where endoscopes is being widely used nowadays to perform different surgeries. Ear surgeries are of special interest among the ENT surgeons. It has several advantages compared to the microscopes. 60 patients underwent endoscopic transcanal myringoplasty by the postgraduate residents under direct supervision of same consultants, using temporalis facia graft. The overall success rate in terms of graft uptake was 86.67% and the AB gap closure of < 10 dB in 63.3% of cases and 10-20 dB in 33.3%. Endoscopic myringoplasty was found to be equally effective, less morbid and very cost effective than the microscopic myringoplasty. This was applicable irrespective of the size of the perforation and condition of the middle ear (dry/wet) in our centre.

Comparative Study between Endoscopic Transcanal Myringoplasty Versus Microscopic Myringoplasty in middle age group (20-40 years)

Background: The surgical goals of myringoplasty are the closure of the tympanic membrane perforation and improvement of the hearing levels. Aim of the work: To compare the results, advantages and disadvantages between endoscope and microscope in myringoplasty. PATIENTS AND METHODS: This study was carried out in the Otorhinolaryngology Department at Alhussin and Bab-Alsharia University Hospitals. The study included 40 patients with a diagnosis of chronic suppurative otitis media of tubo-tympanic type, divided into two groups and each group contained 20 patients. All patients were operated by one surgeon. Results: The difference in age, sex, side of diseased ear and size of perforation between the two groups was not significant. In group (A) the circumference of the perforation was clearly visualized in all patients (100%). While, in group (B) the circumference of the perforation could not be visualized in 7 patients (35%), 5 patients (25%) required external auditory canal curettage and 2 patients (10%) required endoscope-assisted microscopic myringoplasty to evaluate the ossicular chain. The difference between the 2 groups was significant (P.value = 0.004). In group (A) the graft was uptaken in 85% of patients while in group (B) the graft was uptaken in 80% of patients with no significant difference between the two groups (p = 0.677). Conclusion: The ability to easily negotiate through EAC, Panoramic, wide angle, and magnified view provided by the endoscope and uninterrupted picture overcomes most of the disadvantage of the microscope.

Comparative Study between Endoscopic Transcanal Myringoplasty Versus Microscopic Myringoplasty in middle age group (20-40 years)

Background: The surgical goals of myringoplasty are the closure of the tympanic membrane perforation and improvement of the hearing levels. Aim of the work: To compare the results, advantages and disadvantages between endoscope and microscope in myringoplasty. PATIENTS AND METHODS: This study was carried out in the Otorhinolaryngology Department at Alhussin and Bab-Alsharia University Hospitals. The study included 40 patients with a diagnosis of chronic suppurative otitis media of tubo-tympanic type, divided into two groups and each group contained 20 patients. All patients were operated by one surgeon. Results: The difference in age, sex, side of diseased ear and size of perforation between the two groups was not significant. In group (A) the circumference of the perforation was clearly visualized in all patients (100%). While, in group (B) the circumference of the perforation could not be visualized in 7 patients (35%), 5 patients (25%) required external auditory canal curettage and 2 patients (10%) required endoscope-assisted microscopic myringoplasty to evaluate the ossicular chain. The difference between the 2 groups was significant (P.value = 0.004). In group (A) the graft was uptaken in 85% of patients while in group (B) the graft was uptaken in 80% of patients with no significant difference between the two groups (p = 0.677). Conclusion: The ability to easily negotiate through EAC, Panoramic, wide angle, and magnified view provided by the endoscope and uninterrupted picture overcomes most of the disadvantage of the microscope.

Endoscopic transcanal myringoplasty:Is learning curve a myth?

ObjectiveTo investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme. MethodsIn a three year period (August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region. ResultsOf the 42 patient, 19 were male and 23 female. The mean age was 26.23 years (range: 15–47 years). In 40 ears, complete perforation closure was achieved at six months (success rate: 90.9%). The mean air conduction PTA preoperatively was 40.84 dB HL and improved to 28.06 dB HL postoperatively (p < .001). The mean AB gap preoperatively was 22.40 dB, which improved to 9.1 dB postoperatively (p < .001). ConclusionEndoscopic transcanal myringoplasty is safe and reliable even in young beginners' hands. Surgeons can consider endoscopic approach early in their careers without the fear of learning curve. The cost of endoscopic equipment is about one tenth as compared to open approach under a operating microscope, and an added advantage.

Short-term Subjective and Objective Outcomes of Patients Receiving Endoscopic Transcanal Myringoplasty for Repairing Tympanic Perforations.

Objective Endoscopic transcanal myringoplasty (ETM) has been an emerging technique for repairing tympanic perforations since the late 1990s. Objective outcomes (ie, graft success rates and hearing results) of patients who received ETM are well documented; however, subjective outcomes of these patients have rarely been reported. Hence, this study evaluated subjective and objective outcomes of patients who received ETM for repairing tympanic perforations. Study Design Prospective study. Setting Tertiary care university hospital. Patients and Methods Patients who underwent ETM for perforations of the tympanic membrane were included. We evaluated subjective variables of patients receiving ETM as the primary outcome and objective variables as the secondary outcome. Results In total, 91 ears that underwent ETM were included. The mean pain scale score was 0.1 (range, 0-2) on postoperative day 3. The mean duration of pain medication was 2.0 (range, 0-3) days. The mean number of days required to resume routine activities was 1.0 (range, 1-2) days. The overall graft success was determined postoperatively at 3 months in 80 of 91 ears (87.9%). Closure of the air-bone gap to within 20 dB was achieved in 79 (86.8%) ears. Conclusion In this study, patients who received ETM had mild postoperative pain and resumed routine activities early. These patients also exhibited favorable graft success rates and hearing results at 3 months postoperatively. On the basis of our results, we conclude that patients who receive ETM for the repair of tympanic perforations have favorable short-term subjective and objective outcomes.

Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure

ObjectiveSince the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty). MethodsWe retrospectively reviewed the medical records of patients who underwent endoscopic transcanal myringoplasty for perforations of the tympanic membrane. The main outcome was the overall rate of graft success of endoscopic transcanal myringoplasty. ResultsA total of 181 patients were included in the analysis. The overall graft success was determined in 163 of 181 patients (92.8%). The mean preoperative and postoperative air-bone gaps were 19.3dB and 7.8dB, respectively, revealing a significant improvement of 11.5dB (Cohen’s d, 1.27; 95% CI, 1.03–1.50; P<0.05; paired t test) in the air-bone gap. The rate of graft success with partial visualization of the perforation margin was comparable to that with complete visualization of the perforation margin. Larger sizes of perforations were significantly associated with lower rates of graft success (P<0.01). ConclusionOur study revealed that the rate of graft success and hearing results of endoscopic transcanal myringoplasty and microscopic myringoplasty are comparable for repairing perforations of the tympanic membrane. Visualization of the perforation margin by otoscopy did not affect the rate of graft success. However, endoscopic transcanal myringoplasty is less invasive because this technique does not require postauricular incision, canalplasty, and general anesthesia.

Comparison of endoscopic transcanal myringoplasty and endoscopic type I tympanoplasty in repairing medium-sized tympanic perforations

ObjectiveThe tympanomeatal flap elevation technique has been used in tympanoplasty for decades; however, this procedure has disadvantages. In recent years, endoscopic transcanal myringoplasty (ETM) has been increasingly practiced and has yielded positive results.This study compares the efficacy of ETM and endoscopic type I tympanoplasty (ETT) in repairing medium-sized perforations of the tympanic membrane. MethodsThis retrospective medical record review included patients undergoing surgery for medium-sized perforations of the tympanic membrane from January 1, 2013 to August 1, 2015. We divided our patients into 2 groups: the ETM group and ETT group. The main outcome measure was comparison of the graft take rates and hearing results between ETM and ETT. ResultsA total of 113 patients were enrolled in this study; of these patients, 64 underwent ETM and 49 received ETT. The overall graft take rates and improvement of air–bone gaps were comparable between the groups. However, the patients in the ETM group had shorter operative times and fewer follow-up visits over 3 months than those in the ETT group did. ConclusionWe recommend that ETM (instead of ETT) be used for repairing medium-sized perforations of the tympanic membrane.

Retrospective study of outcome of endoscopic transcanal myringoplasty using 0* nasal endoscope

Retrospective study of outcome of endoscopic transcanal myringoplasty using 0* nasal endoscope

Endoscopic Transcanal Myringoplasty for Anterior Perforations of the Tympanic Membrane

Repairing anterior perforations of the tympanic membrane has been challenging for otolaryngologists. Therefore, devising a simple and effective technique for performing the repair is crucial. To assess the results of endoscopic transcanal myringoplasty for repairing anterior perforations of the tympanic membrane. This medical record review included 59 patients who underwent endoscopic transcanal myringoplasty from January 1, 2013, to June 1, 2015, at PoJen General Hospital, Taipei, Taiwan. Patients with ossicular chain disease and cholesteatoma or inadequate follow-up were excluded. Patients were followed up for 6 months, and final follow-up was completed on January 1, 2016. The main outcome was the rate of overall graft success after endoscopic transcanal myringoplasty. Secondary outcomes included hearing results and prognostic factors. The study sample included the medical records of 59 patients (30 men [51%]; 29 women [49%]; mean [SD] age, 49.5 [13.1] years) who underwent endoscopic transcanal myringoplasty. Overall, 55 patients (93%) had a successful graft at 6 postoperative months. The mean (SD) preoperative and postoperative air-bone gaps were 15.9 (9.4) and 5.4 (7.0) dB, respectively, revealing a significant mean (SD) improvement of 10.3 (7.6) dB (Cohen d, 1.27; 95% CI, 0.90-1.63; P < .001, paired t test) in the gap. The postoperative air-bone gap in 46 patients (78%) was less than 10 dB; in 12 patients (20%), 10 to 20 dB; and in 1 patient (2%), more than 20 dB. Postoperative otorrhea significantly affected the graft success rate (odds ratio, 52.00; 95% CI, 4.08-662.55; P < .01, χ2 test). The visualization of the perforation margin (complete or partial) was not significantly associated with the graft success rate. However, partial visualization of the perforation margin significantly prolonged the mean (SD) operative time (complete vs partial, 59.2 [13.7] vs 68.1 [14.1] minutes; Cohen d, 0.64; 95% CI, 0.12-1.18; P = .02, t test). The rate of graft success and hearing outcomes for endoscopic transcanal myringoplasty are comparable with those of microscopic myringoplasty for repairing anterior perforations of the tympanic membrane. However, the present technique is simpler because postauricular incision, canalplasty, and general anesthesia are not required. Thus, endoscopic transcanal myringoplasty should be considered for repairing anterior perforations of the tympanic membrane.