Transcanal Endoscopic Tympanoplasty Research Articles

Management of conductive hearing loss in tympanic perforation: Novel techniques and materials

Tympanic membrane (TM) perforation is a common medical condition often resulting from trauma or infection. TM perforation can lead to significant morbidity including pain, recurrent infections and conductive hearing loss. There are many methods of TM repair that have evolved to incorporate advancements in technology and reduce procedural burden. Three methods of repair that will be discussed include: transcanal endoscopic tympanoplasty, total drum replacement tympanoplasty, and in office TM repair. The size and location of the perforation, in addition to patient factors and physician preference influence the type of repair indicated. Closure rate of TM perforations and conductive hearing loss improvement have been shown to be similar across techniques. Steps to successfully master each technique including preoperative indications, specific surgical steps, and expected post-operative outcomes are discussed herein.

Transcanal Endoscopic Versus Microscopic Tympanoplasty: Is There a Difference in Perforation Closure Rates?

To compare closure rates of endoscopic and microscopic tympanoplasty (MT) as influenced by perforation size, perforation location, and graft position. Retrospective chart review. Tertiary university medical center. Adult patients who underwent tympanoplasty by a fellowship-trained neurotologist from January 2010 to December 2019, had at least 2 months of follow-up, and had a tympanic perforation with no cholesteatoma before surgery. Transcanal endoscopic tympanoplasty (ET) or MT. The primary outcome is postoperative closure of the tympanic membrane perforation as assessed using otomicroscopy at the last follow-up appointment. Two-hundred and eleven patients-98 in the transcanal ET group and 113 in the MT group-were identified. Tympanic membrane closure rates were not significantly different between the ET and MT groups (79.6% and 84.1% respectively; P = 0.473), and further multivariable analysis revealed that closure rates for ET relative to MT had an insignificant odds ratio (0.56; P = 0.144). Similar analyses also found no significant difference between the 2 methods in subsets of perforation size (small, large, subtotal/total), perforation location (anterior, posterior, inferior), and graft position (underlay, overlay). ET resulted in similar rates of postoperative closure rates compared with the microscopic technique.

Endoscopic Fascia-Cartilage Composite Grafting in Chronic Suppurative Otitis Media

Objective: To evaluate perforation of an air-bone gap closure success using fascia-cartilage composite graft in endoscopic Trans canal tympanoplasty.
 Study Design: Randomized Control Trial (Clinical Trials.gov Identifier: NCT04945811)
 Place and Duration of Study: ENT Department Combined Military Hospital, Quetta Pakistan, from Apr 2020 to May 2021
 Methodology: One hundred and thirty-three cases of chronic Suppurative otitis media fulfilling the selection criteria were operated upon, and an endoscopic fascia-cartilage composite graft was used. A successful outcome in terms of perforation closure and air-bone gap closure was evaluated in all patients.
 Results: In the 138 patients operated, complete fascia-cartilage composite graft uptake was achieved in 129 (93.5%) patients. Nine (6.5%) patients had graft failure. The pre-operative mean air-bone gap was 36.49 ± 4.61 decibels, and the postoperative mean air-bone gap was 12.57 ± 5.09 decibels. This improvement was found to be significant, with the p-value < 0.001.
 Conclusion: Endoscopic per-meatal fascia-cartilage composite grafting has a high graft uptake and air-bone gap closure percentage in chronic Suppurative otitis media cases.

Endoscopic transcanal transtympanic myringoplasty vs. endoscopic transcanal tympanoplasty: 1-year follow-up study.

Endoscopic transcanal transtympanic myringoplasty (ETTM) is a relatively easier technique than endoscopic transcanal tympanoplasty (ETT) for repairing tympanic membrane perforations. No studies have compared the outcomes of these two procedures with tragal perichondrium after 1-year. Furthermore, there is no evidence-based stratification according to variations in perforation size in endoscopic ear surgery. Therefore, we compared the 1-year outcomes of ETTM and ETT stratified according to perforation size. Patients who underwent ETT and ETTM to repair eardrum perforations with a tragal perichondrium graft were identified. Pure-tone audiometric tests and otoscopic examination were performed to assess hearing outcomes and perforation sizes both preoperatively and at least 1 year postoperatively. In total, 158 patients (159 ears) were included. ETT was performed on 83 ears, and ETTM was performed on 76 ears. The ETTM procedure time was 10-minutes shorter than that for ETT ( p < 0.001). Perforation size was significantly correlated with graft take-rate. For large perforations, the ETT success rate was significantly higher than that of ETTM (91.7% vs. 78.9%). Success rates for small-medium perforations were comparable for both methods ( p > 0.05). However, for medium perforations, the graft take-rate of ETT reached a plateau after 6 months, while that of ETTM gradually declined during the 12-month follow-up. Both groups had a comparable mean postoperative air-bone gap gain ( p = 0.666). ETTM is suitable for repairing small perforations, whereas ETT is preferred for large perforations. Both methods, and particularly ETTM, should be employed cautiously for medium perforations.

ASSESSMENT OF HEARING OUTCOME IN ENDOSCOPIC TYMPANOPLASTY BY UNDERLAY TECHNIQUE

AIM: To study the hearing outcome of “Endoscopic Tympanoplasty” by underlay technique. METHODS: This study includes 30 patients presenting with Chronic Suppurative Otitis MediaTubotympanic type. Preoperative assessment includes complete clinical history, thorough ENT examination, X-ray mastoids, Pure Tone Audiogram and routine investigations. Informed and written consent was obtained from all the patients. All the patients were subjected to endoscopic transcanal tympanoplasty by underlay technique using temporalis fascia. Patients were regularly followed up for a period of 3 months and at the end of 3 months pure tone audiogram was done to assess hearing. RESULTS: In our study of 30 patients postoperatively, 80% of the patients had successful graft uptake. In our study, postoperative air-bone gap closure was in the range of 0-10 dB in 55% of patients, 11-20 dB in 20% of patients, 21-30 dB in 5% of patients and 31-40 dB in 20% of patients. CONCLUSION: Transcanal Endoscopic Tympanoplasty is a minimally invasive surgical approach as the endoscope usage provides good exposure of tympanic membrane and improves the visualisation of middle ear structures without canaloplasty

Transcanal Endoscopic Tympanoplasty: Our Experience at a Tertiary Care Centre.

Transcanal Myringoplasty can be performed with both microscope and endoscopes. Advancement in endoscopes has started the new era of minimal invasive surgery in otology practice. Endoscopic approach offers improved visualization with wider field of view, easy access to the hidden recesses of the middle ear, avoidance of a postauricular incision and less bony drilling. To report our experience with transcanal endoscopic tympanoplasty for tubotympanic type of COM and to evaluate its outcome in terms of morphological and functional success. Prospective study, conducted during September 2017 to August 2019, including 60 patients of tubotympanic type of COM. All patients underwent transcanal endoscopic type 1 tympanoplasty. Postoperative results i.e. graft uptake (morphological success) and hearing improvement (functional success) were evaluated at 6months. The graft take up rate was 93.33%. Preoperatively mean AB gap was 23.15 ± 7.23dB which was reduced to 11.68 ± 4.65dB at 6month postoperative follow up. The mean gain in AC threshold and AB gap was 15.43 ± 4.37dB and 11.46 ± 1.13dB respectively. Improvement in both AC threshold and AB gap was statistically significant (p < 0.0001). No major surgical or thermal injury related complications were observed. Although both microscopic and endoscopic techniques have their advantages and disadvantages, endoscopic technique can effectively replace traditional microscopic techniques in management of COM with satisfactory outcomes. We infer that EES offers less operative time, less postoperative pain, least complications and less hospital stay thus helping to reduce the physical and psychological burden placed on patients.

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.....

Underlay Versus Modified Circumferential Subannular Graft Technique in Endoscopic Tympanoplasty

Background and Objectives To describe and evaluate modified circumferential subannular tympanoplasty (MCST) via endoscopic approach, we compared the results of MCST to those of the underlay technique and the results of previous studies.Subjects and Method A retrospective comparative study was conducted of 31 patients who underwent endoscopic transcanal tympanoplasty. Patients were classified into the MCST group (n=11) and the underlay group (n=20) according to the graft technique. Demographic data, size and location of the perforation, pre- and postoperative hearing, operating time, complication rate, and graft success rate were analyzed in each group.Results No significant differences between the two groups were observed in the demographic data or the locations of the perforations. The sizes of the perforations were 31.4±14.3% and 25.0±18.1%, respectively. The average operating times were 68.6±16.5 min and 64.9±9.3 min, respectively, and canaloplasty was not required in any patient. The postoperative hearing improvement and air-bone gap were not significantly different. No postoperative complications were observed in either group.Conclusion MCST is a feasible and effective technique for endoscopic transcanal tympanoplasty. The postoperative results and operating times of MCST were comparable to those of other graft techniques. MCST showed more stable results in anterior perforation than in underlay graft.

Endoscopic transcanal attico-antrostomy versus endoscopic-assisted canal wall up mastoidectomy in management of localized cholesteatoma: a randomized clinical trial.

This study aims to compare results of endoscopic transcanal tympanoplasty with attico-antrostomy with endoscopic-assisted canal wall up mastoidectomy in treatment of cases of limited attic cholesteatoma. A prospective randomized single-blinded study involving 40 patients with limited attic cholesteatoma was conducted. Randomization of the patients into two groups was done; 20 patients are managed by endoscopic transcanal tympanoplasty with attico-antrostomy, while the other 20 patients are managed by endoscopic-assisted canal wall up mastoidectomy. Primary outcome is recidivism, while secondary outcomes include hearing results, operative time, pain score and associated complications. Comparable recidivism rate was found in the two groups. The endoscopic-assisted canal wall up mastoidectomy group was associated with significantly longer duration of surgery and higher postoperative pain score. There was no significant difference between both the groups regarding hearing results and associated complications. In localized attic cholesteatoma cases, endoscopic transcanal tympanoplasty with attico-antrostomy is a time-saving less-invasive reliable technique with good eradication results. ClinicalTrials.gov (NCT04959539) "retrospectively registered" at 12/7/2021.

Comparative Study Between Post Aural Microscopic and Transcanal Endoscopic Tympanoplasty.

Chronic otitis media, inactive mucosal disease needs surgical treatment for complete relief from symptoms like hearing loss and discharging ear. There are various surgical approaches mentioned in literature; among which postauricular microscopic tympanoplasty is the most commonly used. With optics advancements, endoscopic surgeries are gaining more popularity due to reduced operative time, less post-operative pain, better cosmesis and reduced hospital stay. To study the clinical profile of patients with chronic otitis media inactive mucosal disease and compare conventional postauricular microscopic tympanoplasty to transcanal endoscopic tympanoplasty on the basis of operative time, postoperative pain, subjective cosmesis, postoperative complications and postoperative hearing gain. 60 patients of chronic otitis media inactive mucosal type, coming in our out-patient department over 2years and willing to participate were taken for surgery. Patients were divided into 2 groups of 30 each by computerized random technique. Group A underwent conventional postauricular microscopic tympanoplasty and Group B underwent transcanal endoscopic tympanoplasty. Patients were evaluated on the basis of intraoperative time, postoperative pain score, postoperative complications, subjective cosmesis and postoperative hearing gain. Tympanoplasty by transcanal endoscopic approach had better outcomes in terms of less intraoperative time, less postoperative pain, less postoperative complications, and better subjective cosmetic outcome. Postoperative hearing gain (ABG) in both the groups was similar. Endoscopic tympanoplasty has many advantages over microscopic tympanoplasty as it is a natural access point to tympanic membrane and middle ear cleft. It preserves most of normal anatomy by minimizing dissection of bone and soft tissue. It is possible to obtain a wide angle and a magnified view of the operating field using endoscope with minimum manipulation. Therefore endoscope can be a good alternative of microscope for tympanoplasty.

Endoskopik modifiye kelebek timpanoplasti ile incudostapedial rekonstrüksiyon sonuçları

Purpose: The aim of this study was to evaluate the results of endoscopic butterfly tympanoplasty in perforations that involve the ossicular chain pathologies.&#x0D; Materials and Methods: We assessed the outcome of endoscopic modified butterfly tympanoplasty in 29 patients. The study included those with large tympanic membrane perforations covering the manubrium of malleus and has ossicular chain pathologies, operated via endoscopic transcanal tympanoplasty. &#x0D; Results: The tympanic membrane closure rate was 89.7% (26 of 29 ears). The mean air conduction in the pre- and postoperative period was 37.75±5.20 dB and 18.96±6.52 dB, respectively, with a statistically significant decrease of 18.79±7.33. The mean pre- and the postoperative air-bone gap was 27.82±4.74 dB and 9.17±4.89 dB, respectively, with a statistically significant decrease of 18.62±7.11 &#x0D; Conclusion: The endoscopic modified butterfly tympanoplasty technique is a minimally invasive technique that can provide successful results in large perforations with defective incudostapedial joint.

Management of Jugular Bulb Injury During Transcanal Endoscopic Tympanoplasty.

Variable internal jugular vein anatomy is not rare. A high jugular bulb (JB) is reported in 6 to 34% of cases and, it can be jeopardized during middle ear surgery, especially if dehiscent. Its injury represents a threatening complication of ear surgery. In recent years there has been an increasing trend in the use of endoscopic ear surgery for a wide range of otologic procedures, but being a one-hand technique, the management of bleeding still represents a challenge. The aim of this video, http://links.lww.com/MAO/B280 is to report the endoscopic surgical management of internal jugular vein hemorrhage during endoscopic type I tympanoplasty.

Endoscopic transcanal management of tympanosclerosis.

The objectives of this study are to describe our experiences in endoscopic transcanal management of tympanosclerosis, to explain our surgical approaches to reconstruct the sound conduction system and to analyze the hearing results obtained with our surgical approaches. A retrospective cohort study, using medical records of 28 cases that underwent endoscopic transcanal tympanoplasty surgery due to tympanosclerosis from January 2016 to January 2020. Private otology clinic PATIENTS: Twenty-eight ears of 26 patients were enrolled into study. Patients were grouped according to Wielinga-Kerr classification and only type II, III and IV patients were included in the study. Exclusively transcanal endoscopic surgery was performed in all cases. Primary goal was to mobilize the affected ossicles by removing the offending TS and reconstruct the ossicular chain. Malleostapediopexy was preferred when attic by-pass procedures were needed. Glass ionemer bone cement was used to reconstruct the ossicular defects. Preoperative and postoperative pure tone average of air conduction and bone conduction and air-bone gap results were evaluated. Operation was considered successful if postoperative ABG < 20dB was achieved. Complications and graft take rate were also evaluated. Single-staged surgery was performed in 23 of 28 cases (82.1%). Graft take rate was 93%. The mean preoperative ABG significantly decreased from 33.9 ± 5.19 to 12.55 ± 5.52dB postoperatively for 23 cases who had single-staged surgeries (p < 0.001, Wilcoxon signed rank test) at the end of the mean follow-up period of 23months. For this group, the mean preoperative AC-PTA significantly improved from 48.64 ± 9.30 to 22.93 ± 7.45dB (p < 0.001, Wilcoxon signed rank test) postoperatively with a mean PTA improvement of 25.71 ± 6.02dB. Success criterion was achieved in 22 of 23 cases (95.7%). There was no sensorineural hearing loss, facial nerve paralysis and postoperative vertigo after the surgical procedures. All patients had been discharged within the first 24h. Surgical treatment of tympanosclerosis is still a controversial issue. Endoscopic surgery seems a safe technique for the management of tympanosclerosis. Single-stage surgery is possible in most of the cases with a satisfactory hearing result. We speculate that addition of endoscopic view may increase the single-stage surgery ratio.

Endoscopic type 1 tympanoplasty; a composite graft technique for subtotal and total perforations.

Demonstrate feasibility of performing endoscopic transcanal type 1 tympanoplasty in total and subtotal perforations, using an underlay technique that minimizes the risk of anterior medialization of the graft. Compare audiometric and clinical outcomes of this technique with our series of endoscopic tympanoplasty with classical underlay grafts, and with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty and other transcanal techniques. We describe a surgical technique using an L-shaped cartilage and its perichondrium, with exclusive transcanal endoscopic approach. A retrospective review of patients undergoing this technique at the Centenario University Hospital of Rosario, Argentina between January 2017 and December 2019 was performed, and it was compared with a group of patients who underwent endoscopic tympanoplasty with classical underlay technique in a previous period of time. Patients with smaller perforations and other middle ear pathologies that required other techniques were not included in this study. Minimum follow up was 6months. The main outcome measures were membrane closure rates and hearing results. 73 patients with total or subtotal perforations undergoing endoscopic transcanal tympanoplasty between 2015 and 2019 were included. The group of patients that underwent the technique described showed no anterior medialization of the graft, and better graft take rates. The hearing outcomes were similar in all successful graft patients, with postoperative average air-bone gap of 10db (+ -10dB). Transcanal endoscopic tympanoplasty with the technique described is an excellent option for closure of total and subtotal tympanic perforations. The rate of perforation closure is better than endoscopic tympanoplasty with classical underlay graft with similar audiometric outcome.

Endoscopic tympanoplasty type I for tympanic perforations: analysis of prognostic factors.

To assess the anatomical and functional outcomes of endoscopic transcanal tympanoplasty type I for tympanic membrane perforations. Eight hundred thirty-five patients who underwent tympanoplasty between January 2011 and January 2019 were selected. Patients with tympanic membrane perforation treated with a transcanal endoscopic tympanoplasty type 1 and a follow-up period longer than 6months have been retrospectively reviewed. The presence of cholesteatoma or ossicular chain dysfunctions were considered exclusion criteria. Eighty-one patients were included in the present study population. The main outcome was the rate of overall graft success. Secondary outcomes included hearing results. Prognostic factors related to both the abovementioned outcomes were assessed. Overall, 66 patients (81.5%) had a successful graft at the last follow-up evaluation. Mean follow-up was 22.1 (range 6-104) months. The anterior quadrants were entailed by the perforation in 62 (76.5%) cases. The overall success rate with cartilage (or cartilage and perichondrium) was 91.2% (p < 0.01). The median preoperative and postoperative ABG were 18.7 (13.4-25.6) and 7.5 (2.5-12.5), respectively, revealing a significant median improvement of 11.2 (p < 0.001). The type of graft and the postoperative tympanic membrane status were significantly associated with the audiologic outcome with p = 0.01 and p = 0.02, respectively. Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results. Tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results. Anterior eardrum perforations can be successfully and safely managed with transcanal endoscopic approach avoiding postauricular approach and canalplasty.

The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty.

To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia. Retrospective patient review and posttreatment questionnaire survey. Tertiary referral center. Sixty adult patients with chronic dry tympanic membrane perforation. Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used. Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey. Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method. This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.

COMPARATIVE STUDY BETWEEN ENDOSCOPIC AND MICROSCOPIC TYMPANOPLASTY THROUGH TRANSCANAL APPROACH

Background: Since the introduction of tympanoplasty in the 1950s, variety of surgical techniques has been developed for closure of tympanic membrane perforation. Tympanoplasty and myringoplasty are commonly used procedures for the treatment of chronic otitis media. Objective: The aim of the present work was to compare the success rate between endoscopic and microscopic tympanoplasty through transcanal approach as regard improvement of hearing, closure of tympanic membrane perforation and the time of operation. Patients and Methods: This prospective study was carried out on thirty patients who attended to outpatient clinic of Al-Hussien University Hospital from November 2018 to June 2019. All patients with the complaint of discharging ear and decreased hearing were screened. They were divided randomly into two equal groups; group A was treated by transcanal endoscopic tympanoplasty, and group B was treated by transcanal microscopic tympanoplasty. All operations were done at AL-Azhar University Hospitals (Al-Hussein University Hospital). Results: The graft success rate was 80 % in group A, and 73.3 % in group B. There was significant improvement in hearing in both groups pre- and post – operatively, but the difference between both groups was not statistically significant. Microscopic tympanoplasty was shorter than endoscopic with no significant difference between both groups. Conclusion: Tympanoplasty is an effective technique for recovering hearing thresholds secondary to a tympanic membrane perforation. In transcanal approach, postoperative cares were easy as the technique is minimally invasive in surgical approach, scar, bleeding and pain. The telescopic wide angle magnified view of the endoscope overcame most of the disadvantages of the microscope. Endoscopes provided good exposure of the tympanic membrane, usually without canaloplasty.

COMPARATIVE STUDY BETWEEN ENDOSCOPIC AND MICROSCOPIC TYMPANOPLASTY THROUGH TRANSCANAL APPROACH

Background: Since the introduction of tympanoplasty in the 1950s, variety of surgical techniques has been developed for closure of tympanic membrane perforation. Tympanoplasty and myringoplasty are commonly used procedures for the treatment of chronic otitis media. Objective: The aim of the present work was to compare the success rate between endoscopic and microscopic tympanoplasty through transcanal approach as regard improvement of hearing, closure of tympanic membrane perforation and the time of operation. Patients and Methods: This prospective study was carried out on thirty patients who attended to outpatient clinic of Al-Hussien University Hospital from November 2018 to June 2019. All patients with the complaint of discharging ear and decreased hearing were screened. They were divided randomly into two equal groups; group A was treated by transcanal endoscopic tympanoplasty, and group B was treated by transcanal microscopic tympanoplasty. All operations were done at AL-Azhar University Hospitals (Al-Hussein University Hospital). Results: The graft success rate was 80 % in group A, and 73.3 % in group B. There was significant improvement in hearing in both groups pre- and post – operatively, but the difference between both groups was not statistically significant. Microscopic tympanoplasty was shorter than endoscopic with no significant difference between both groups. Conclusion: Tympanoplasty is an effective technique for recovering hearing thresholds secondary to a tympanic membrane perforation. In transcanal approach, postoperative cares were easy as the technique is minimally invasive in surgical approach, scar, bleeding and pain. The telescopic wide angle magnified view of the endoscope overcame most of the disadvantages of the microscope. Endoscopes provided good exposure of the tympanic membrane, usually without canaloplasty.

Endoscopic transcanal versus conventional microscopic tympanoplasty in treatment of anterior tympanic membrane perforations.

To compare the surgical outcomes of endoscopic transcanal tympanoplasty (ETT) and conventional microscopic tympanoplasty (CMT) in repairing anterior tympanic membrane perforations (ATMPs). We retrospectively analyzed the graft success rate, hearing outcomes, operative time, hospitalization period and complications in patients who underwent ETT and CMT between October 2015 and July 2018. In addition, the authors investigated whether anterior canal wall protrusion (ACWP) affects the graft success rate and operative time. The graft success rates for ETT and CMT were 93.7% (30 out of 32 patients) and 91.4% (32 out of 35 patients), respectively (p = 0.640). There was no significant relationship between ACWP and graft success rates in either the endoscopic (p = 0.685) and microscopic (p = 0.894) group. The mean operative time was significantly shorter in the ETT group (37.2 ± 3.1min) than in the CMT group (52.9 ± 9.2min) (p < 0.001). Regarding operative time, there was no statistically significant difference between patients with and without ACWP (38.3 versus 36.3min, respectively (p = 0.124)) in the ETT group. However, the mean operative time of patients with ACWP in the CMT group was significantly longer than patients without ACWP [62.3 versus 48.8min, respectively (p < 0.001)]. ETT offering fewer complication rates and shorter duration of surgery may serve as a reasonable alternative to CMT in repairing ATMPs, with comparable graft success rates.

Comparison of endoscopic transcanal and microscopic approach in Type 1 tympanoplasty

IntroductionEndoscopic tympanoplasty is a minimally invasive surgery that may be performed via a solely transcanal approach. The use of endoscopes in otologic procedures has been increasing worldwide. The endoscopic approach facilitates the transcanal tympanoplasty, even in patients having the narrow external ear canal with an anterior wall protrusion. ObjectivesThe present study aimed to compare the surgical and audiological outcomes of endoscopic transcanal and conventional microscopic approach in Type 1 tympanoplasty. MethodsThe graft success rates, hearing outcomes, complications, and duration of surgery in patients who underwent endoscopic and microscopic tympanoplasty between October 2015 and April 2018 were retrospectively analysed. ResultsGraft success rates were 94.8 per cent and 92.9 per cent for the endoscopic and microscopic group, respectively (p > 0.05). Postoperative air-bone gap values were improved significantly in both groups (p < 0.001). The average duration of surgery was significantly shorter in the endoscopic group (mean 34.9 min) relative to the microscopic group (mean 52.7 min) (p < 0.05). The average hospitalization period was 5.2 h (range 3–6 h) in Group I whereas it was 26.1 h (range 18–36 h) in Group II (p < 0.05). ConclusionThe endoscopic transcanal tympanoplasty approach is a reasonable alternative to conventional microscopic tympanoplasty in the treatment of chronic otitis media, with comparable graft success rates and hearing outcomes.