Tympanomeatal Flap Research Articles

A study on the outcome of various methods of administration of intratympanic dexamethasone in tinnitus of cochlear pathology

<p class="abstract"><strong>Background:</strong> The aim of the study was to compare the outcome of various methods of injecting intra tympanic steroids in patients with tinnitus of cochlear pathology.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted on 56 patients with subjective tinnitus of cochlear pathology who were then divided into three groups. After thorough otological and audiological evaluation using standard questionnaire, ENT examination, pure tone audiometry, tone decay test, tinnitogram, CT scans of temporal bone and brain. Each patient underwent one of the three chosen methods of intra tympanic steroids administration randomly. The methods are 1-Tympanomeatal flap elevationand application of steroid soaked gelfoam sponge; 2-Transtympanic steroid injection; 3-Grommet insertion followed by steroid administration. These methods were performed for subjects with tinnitus of cochlear pathology from 2009 to 2011 at a neurotological clinic at Chennai. After following up on 1st, 3rd and 6 months the observations were statistically analysed. </p><p class="abstract"><strong>Results:</strong> Success rate for techniques viz tympanomeatal flap was 70%, transtympanic - 63%, grommet - 50%. But when comparing statistically all the three methods were equally successful.</p><p class="abstract"><strong>Conclusions:</strong> Intratympanic steroids for tinnitus (cochlear pathology) are a safe, simple and promising treatment option. Though all the methods of intra tympanic steroids injection had similar success rate, the tympanomeatal flap elevation method may be preferred since it can be done in a single sitting. However transtympanic injection remains the easiest and cost effective compared to the other two methods.</p>

Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between 'U' flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation. Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sized anterior and subtotal perforation of tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in 'U' flap group and thirty two cases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups. Graft uptake rate was 90.3%(28/31) in'U' flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in 'U' flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504). The graft uptake rate and hearing results of 'U' flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group.

Outcome of Graft Uptake and Hearing Results between ‘U’ Flap Technique and Conventional Tympanomeatal Flap Technique for Anterior and Subtotal Tympanic Membrane Perforation

Background: Myringoplasty done for anterior and subtotal perforation needs expertise and practice than conventional underlay myringoplasty. The objective of this study was to compare the graft uptake and postoperative hearing results between ‘U’ flap and conventional tympanomeatal flap technique in anterior and subtotal tympanic membrane perforation.Methods: Sixty three patients of age fifteen years and above with chronic otitis media mucosal type with any sized anterior and subtotal perforation of tympanic membrane were randomly allocated for myringoplasty by lottery method. There were thirty one cases in ‘U’ flap group and thirty two cases in conventional tympanomeatal flap group. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.Results: Graft uptake rate was 90.3%(28/31) in‘U’ flap group and it was 87.5%(28/32) in conventional tympanomeatal flap group with no statistically significant difference (p= 0.772) between the two groups. The mean pre and post-operative air bone gap in ‘U’ flap group were 23.63dB±7.77dB; 13.26dB±5.50dB and that in the conventional tympanomeatal flap group were 20.88±9.88dB, 9.42dB±6.70dB respectively. There was no statistically significant difference in hearing results between the two groups (p= 0.504).Conclusions: The graft uptake rate and hearing results of ‘U’ flap group were comparable and showed no statistically significant difference to those of conventional tympanomeatal flap group. Keywords: Anterior perforation; myringoplasty; subtotal perforation; ‘U’ flap.

Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study

PurposeEffective operative approaches for the treatment of refractory vertigo in Meniere's disease are invasive. Vestibular neurectomy can preserve hearing and has been shown to be effective; however, current approaches require an extensive craniotomy. Transcanal endoscopic approaches to the internal auditory canal (IAC) with cochlear preservation have been recently described and may offer a minimally invasive approach to selectively sectioning the distal vestibular nerves while preserving residual hearing. Materials and methodsThree cadaveric human heads were imaged using high resolution computed tomography (CT). Anatomic analysis of preoperative CT scans showed adequate diameters (>3 mm) of the infracochlear surgical corridor for access to the IAC. A transcanal endoscopic approach was attempted to section the vestibular nerve. Post-operative CT scans were assessed to define the operative tract, determine cochlear preservation and assess cochlear and facial nerve preservation. ResultsTranscanal endoscopic approach was successfully performed (n = 3) using 3 mm-diameter, 14 cm-length 0°, 30°, and 45° endoscopes and microsurgical drills. In all cases the tympanomeatal flap and ossicular chain remained intact. Internal auditory canalotomy was performed using angled instruments and confirmed in real time via lateral skull base navigation. The vestibular nerves were readily identified and sectioned with preservation of the facial and cochlear nerves. Post-procedure CT showed no violation of the cochlea. ConclusionA transcanal, infracochlear approach to the IAC may permit a minimally invasive approach to distal vestibular neurectomy in cadavers with appropriate anatomy.

Outcomes of circumferential tympanomeatal flap tympanoplasty in large central perforation

<p class="abstract"><strong>Background:</strong> Tympanoplasty is the commonest procedure performed in patients with chronic otitis media. Circumferential elevation of tympanomeatal flap and underlay graft placement is thought to be a good surgical technique as it ensures elevation of canal skin over the Eustachian tube area to form a good assemble between the temporalis graft and the flap to increase the success rate. In our study we intend to study the surgical and hearing outcome in patients undergoing tympanoplasty with circumferential tympanomeatal flap in large central perforations.</p><p class="abstract"><strong>Methods:</strong> A prospective study with 25 patients in a tertiary care hospital for a period of 2 years, who underwent circumferential tympanomeatal flap tympanoplasty. Patients were followed up on one month and two months. Graft outcomes and hearing outcomes were studied. </p><p class="abstract"><strong>Results:</strong> Graft uptake was 92%. Blunting was noticed in 4% and medialisation in 4% of patients in circumferential group. Average air-bone gap closure achieved was 17.468 dB.</p><p><strong>Conclusions:</strong> Circumferential flap elevation in tympanoplasty is an effective surgical technique in patients with anterior and large central perforations with satisfactory outcomes. </p>

A comparative study between endoscope assisted transtympanic pop-in tympanoplasty and permeatal underlay tympanoplasty

Background: Otoscopic procedure like tympanoplasty is one of the magic wands that an ear nose throat surgeon possesses to alleviate the suffering of a hearing impaired patient. Endoscopic trans-tympanic pop in technique is an alternative method where tympanic fascial graft is placed medial to tympanic membrane remnant through the perforation without elevation of tympanomeatal flap and angled endoscope is used to assess the ossicular chain.Objective: The study was done to compare the results of endoscope assisted trans-tympanic pop-in tympanoplasty with permeatal underlay tympanoplasty.Methods: The study is a prospective, longitudinal and experimental study conducted in Kathmandu Medical College Teaching Hospital from January 2016 to June 2016. A total of sixty-two patients, thirty-one in study and thirty-one in control group were present. The comparison was made in terms of success rate, decrease in taste sensation and time taken for the procedure. Data analysis was done by SPSS version 20. Categorical data were tested by Fisher Exact test and p-value of <0.005 was considered statistically significant.Result: Among 62 patients, 55 had successful graft uptake (88.7% success rate). Hearing improvement was seen in 51 patients (88.25%). Regarding taste sensation 5 out of 62 had decrease in taste sensation after surgery (8%). Time taken was approximately 30 to 45 minutes (mean =44.1min) in endoscopic transtympanic pop-in type and 60 to 90 minutes (mean =73.8 min) in permeatal underlay type.Conclusion: We can conclude that endoscopic trans-tympanic pop-in tympanoplasty gives similar hearing and graft uptake result but with less time and greater ease as compared to permeatal underlay technique.

A comparative study of superiorly based circumferential tympanomeatal flap tympanoplasty with anteriorly anchoring flap tympanoplasty in large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The main objective of the study was to assess and compare the graft uptake, hearing improvement, complications in large, subtotal, and anterior moderate perforations by each technique viz; superiorly based circumferential tympanomeatal flap tympanoplasty (STT)/full cuff and anterior anchoring flap tympanoplasty (AAT)/anterior tucking. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In our study of 30 cases age group in the range of 10 years to 60 years. The mean air bone gap for the 8 patients with anterior moderate perforation was 31.75 db, for 17 patients with large central perforations was 38.75 db and for 5 patients with subtotal perforations was 41.4 db. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Mean air bone gap closure after 3 months of surgery in the STT group was 21.4 db while that after 6months of the surgery for the same group was 22.06 db. Mean air bone gap closure after 3 months of surgery in the AAT group was 18.2 db while that after 6months of the surgery for the same group was 18.73 db. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Comparing the air bone gap closure in patients who underwent surgery by AAT and STT technique we found that there is no statistical difference. Both techniques (viz: superiorly based circumferential tympanomeatal flap tympanoplasty and anteriorly anchoring flap tympanoplasty) can be used for the repair of large, subtotal, and anterior tympanic membrane central perforations in chronic suppurative otitis media of mucosal type.</span></p>

The effect of direct application of dexamethasone on the round window membrane in patients with sudden sensorineural hearing loss

ObjectiveThe aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL).Study designThis investigation was designed to be a prospective cohort study.Patients and methodsThis study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability.ResultsPost-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL.ConclusionThere is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.

Ultrasonic bone aspirator use in endoscopic ear surgery: feasibility and safety assessed using cadaveric temporal bones.

To describe the feasibility and assess the safety of using an ultrasonic bone aspirator in endoscopic ear surgery. Five temporal bones were dissected via endoscopic ear surgery using a Sonopet ultrasonic bone aspirator. Atticoantrostomy was undertaken. Another four bones were dissected using routine endoscopic equipment and standard bone curettes in a similar manner. Feasibility and safety were assessed in terms of: dissection time, atticoantrostomy adequacy, tympanomeatal flap damage, chorda tympani nerve injury, ossicular injury, ossicular chain disruption, facial nerve exposure and dural injury. The time taken to perform atticoantrostomy was significantly less with the use of the ultrasonic bone aspirator as compared to conventional bone curettes. The ultrasonic bone aspirator is a feasible option in endoscopic ear surgery. It enables easy bone removal, with no additional complications and greater efficacy than traditional bone curettes. It should be a part of the armamentarium for transcanal endoscopic ear surgery.

Clinical and economic evaluation of minimally invasive cartilaginous palisade myringoplasty

Objectives: To test the clinical and audiometric efficacy of a minimally invasive myringoplasty technique, combining cartilaginous palisades while avoiding flap elevation, for small and wide perforations.Methods: Over 4 years, this retrospective study included all patients over 6 years of age presenting an indication for myringoplasty. Several clinical and economic criteria were noted at 7 d, 2 months, 6 months and 2 years postoperative. The main outcome was the absence of perforation 2 years postoperative. The secondary outcomes were an audiometric gain at 6 months and the evaluation of the treatment cost.Results: Thirty patients underwent the minimally invasive technique and 28 patients the technique with an elevation of the tympanomeatal flap. The minimally invasive surgical procedure was shorter (p = .001). At 2 years, the tympanic closure rate was equivalent (95% versus 89.5%, p = .77). The audiometric gain was similar between the two techniques (p = .09). From a medico-economic point of view, the minimally invasive procedure was the most effective because it was three times less expensive than the conventional technique with no reduction in efficacy (p = .02).Conclusion: This quick and easy technique could be developed in an ambulatory setting or even in conditions adapted to consultation.

Results of pediatric endoscopic and endoscopically assisted tympanoplasty.

ObjectivesTo evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.MethodsRetrospective review of single surgeon experience.ResultsDuring a 3 year period, 30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts. There were 22 boys and 8 girls, ranging in age from 3.5 to 17 years (median 6 years). All tragal cartilage grafts (31/31; 100%) survived. Twenty-seven surgeries (27/31; 82%) resulted in an intact drum (17/31; 55%) or a microperforation (10/31; 32%). In four cases (4/31; 13%) significant perforations formed in previously unaffected portions of the drum.ConclusionTranscanal endoscopic cartilage inlay tympanoplasty offers a practical, minimally invasive approach to tympanoplasty for children of any age. It avoids postauricular or endaural incisions, tympanomeatal flap elevation, and canalplasty. Graft survival is uniform. Microperforation at the graft margins remained in 1/3 of children. Technical modifications may lead to higher rates of tympanic closure.

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.

Round window accessibility in transcanal approach

AimOur aim of this study is to evaluate the transcanal approach to visualize the round window whose visualization is a very important and challenging topic as it is used as a portal for electrode insertion during cochlear implantation.MethodsThis study was carried out over fifty patients suffered from conductive or mixed hearing loss with intact tympanic membrane suggested to be otosclerotic patients irrespective to their age or sex. The exploratory tympanotomy procedures were performed. The tympanomeatal flap is considered to be completely elevated when the posterior edge of long process of malleus, the long process of incus, the stapes and the stapedial tendon were visible and the flap is reflected anteriorly without tension. At this step, visualization of round window is assessed microscopically and endoscopically by using an oto-endoscope of 2.7mm diameter and 30 angle.ResultsBy using the microscope, we found that 48 cases were fully visible (Type 1), 1 case was partially visible (Type 2) and 1 case was not visible (Type 3). By using the endoscope, we found that the round window details are fully visible in all the fifty cases.ConclusionWe experienced that better exposure of round window could be achieved with less effort via transcanal approach. Using the endoscope gives panoramic view with clear details. So, transcanal approach can be used instead of classic posterior tympanotomy to visualize the round window.

Transcanal totally endoscopic stapes surgery: step-by-step procedure

ObjectivesThe purpose of the present work was to evaluate the role of otoendoscopy in performing stapedotomy in clinically otosclerotic patients.Patients and methodsTwenty patients presenting with clinically diagnosed otosclerosis were randomly selected from the outpatient ENT clinic in a tertiary referral Institutional Hospital. All patients were subjected to transcanal totally endoscopic stapes surgery (TTESS) from early 2013 to the fall of 2014.MethodsThis prospective study demonstrated the detailed technique of TTESS using mainly 0° lens of 14 cm length rigid endoscope for elevating the tympanomeatal flap, handling the chorda tympani nerve, curettage of posterior bony canal wall, visualization of oval window niche structures, creation of stapedotomy, and accurate prosthesis insertion. Postoperative audiogram was performed after 2 months. Assessment of postoperative complications, especially change in taste sensation, was carried out.ResultsThe chorda tympani nerve was preserved in all cases. Two cases had change in taste sensation that was improved within 6 months postoperatively. There was a significant improvement in hearing. The preoperative air-bone gap mean value was 40.30±6.38, and the postoperative mean value was 7.15±4.27 (P=0.001), with complete closure of air-bone gap in four cases. No facial paralysis or tympanic membrane perforation was encountered during the follow-up period.ConclusionTranscanal totally endoscopic stapes surgery is a feasible and safe technique for the surgical management of conductive hearing loss associated with otosclerosis, which is recommended in bilateral and revision cases.

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.

Role of circumferential subannular tympanoplasty in anterior and subtotal perforations.

This study aimed to evaluate the surgical success of a modified inlay tympanoplasty technique, known as circumferential subannular tympanoplasty, for anterior and subtotal perforations. This prospective study was performed in a tertiary care teaching hospital between October 2013 and April 2016. A total of 58 adult patients of both sexes with anterior or subtotal perforations underwent circumferential subannular tympanoplasty under local anaesthesia. In this technique, after tympanomeatal flap elevation, the temporalis fascia graft is placed directly onto the annulus instead of being tucked underneath the tympanic membrane remnant. Outcome data were graft uptake and hearing improvement. This technique had a surgical success rate of 97 per cent and led to significant hearing improvement. Circumferential subannular tympanoplasty has a definitive role in managing anterior and subtotal perforations.

Outcome Measurement Between Transtympanic and Tympanomeatal Flap Elevation Approach in Myringoplasty: A Day Care Procedure

Background: Transtympanic myringoplasty is an alternate technique that allows graft placement medial to tympanic membrane remnant through the perforation without the need for tympanomeatal flap elevation. Objectives: The aim of this study is to evaluate the efficacy and compare the results of transtympanic myringoplasty without tympanomeatal flap elevation with the usual method of graft placement by the elevation of a tympanomeatal flap. Materials and Methods: This is a prospective study done on fifty patients divided into two groups, each consisting of 25 patients. Group I patients underwent transtympanic myringoplasty without elevation of tympanomeatal flap and group II patients underwent tympanomeatal flap elevation myringoplasty. Both the procedures were done by underlay technique through transcanal approach using only tragal perichondrium as graft material. Results and Observations: Graft uptake was successful in 88% and 92% ears while hearing improvement was seen in 84% and 91.3% in the group I and II patients respectively. The mean hearing gain was 15.04 dB and 15.57 dB in group I and II respectively. Conclusion: Transtympanic myringoplasty is a simple and less traumatic yet equally effective approach for the repair of tympanic membrane perforation. It has the added advantages of minimal post-operative pain, cost-effectiveness, no potential risk of injury to chorda tympani and results comparable to conventional techniques of myringoplasty.

Endoscopic-Assisted Cochlear Implantation: A Case Series.

The aim of the present study was to describe the use of the endoscopic-assisted cochlear implantation in cases with an unsuccessful standard surgical technique because of not achieving adequate exposure to the round window (RW). Three patients with a bilateral profound hearing loss were operated using an endoscopic-assisted cochlear implant procedure at our tertiary university referral center between 2012 and 2014. In all of the patients, a retroauricular "c" shaped incision was performed and a subperiosteal pocket was created. Standard cortical mastoidectomy and posterior tympanotomy were accomplished using a otomicroscope. However, RW and promontory could not be seen using this approach. The tympanomeatal flap was elevated and the middle ear cavity was entered A rigid 0 degree endoscope (2.7 mm wide, 18 cm in length) (Karl Storz company, Tuttlingen, Germany) and a connected HD camera system (Karl Storz Company, Tuttlingen, Germany) were used to expose RW through posterior tympanotomy, and a drill was passed through the external ear canal. The RW niche was removed using a diamond burr under endoscopic view; the endoscope was placed through the external ear canal, and electrodes were transferred through posterior tympanotomy. The electrodes were fully inserted under the endoscopic view in all cases. Endoscopic-assisted cochlear implantation may be a safe alternative surgical technique in cases where surgeons are not able to visualize RW and promontory using a microscope.

An Ovine Model for Exclusive Endoscopic Ear Surgery

ImportanceWith the international spread of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown during the past years.ObjectiveTo develop and validate an ex vivo animal model for exclusive endoscopic ear surgery.Design, Setting, and Animal ModelsIn an experimental study, we compared ovine and human middle ear anatomy in 4 specimens and assessed the lamb as a model for endoscopic ear surgery. After confirming its suitability, we developed a surgical training program for canaloplasty, myringoplasty, and ossiculoplasty. From March 1 to May 31, 2016, the ex vivo model was tested, assessing the time needed for dissection and complications. Each experience was subjectively validated on a scale from 1 (very poor) to 10 (excellent).Main Outcomes and MeasuresSuitability of the lamb model for training in exclusive endoscopic ear surgery.ResultsWe assessed the suitability of our novel lamb model on 20 ovine middle ears. All interventions could be performed in a satisfactory manner. The mean (SD) time required to perform canaloplasty was 29.7 (13.2) minutes, for middle ear dissection was 7.7 (2.6) minutes, for myringoplasty was 7.7 (4.3) minutes, and for ossiculoplasty was 10.4 (2.7) minutes. The time required for canaloplasty and tympano-meatal flap elevation during dissection decreased from 46.4 minutes in the first 5 cases to 16.2 minutes in the last 5 cases, representing an absolute difference of 30.2 minutes (95% CI, 22.28-38.12). Subjective ratings revealed excellent values for tissue quality (8.9 points of 10), overall satisfaction (8.3 points), and the learning experience (8.8 points).Conclusions and RelevanceThe ovine model is suitable for endoscopic ear surgery. We describe a novel, exclusively endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program leads the trainee step by step through the main otologic procedures and is able to enhance his or her surgical skills.

Development and validation of a low-cost microsurgery Ear Trainer for low-resource settings.

Chronic suppurative otitis media is a neglected condition affecting up to 330 million people worldwide, with the burden of the disease in impoverished countries. The need for non-governmental organisations to hardwire training into their programmes has been highlighted. An ear surgery simulator appropriate for training in resource-poor settings was developed, and its effectiveness in facilitating the acquisition of headlight and microsurgical skills necessary to safely perform procedures via the ear canal was investigated. Face validity was assessed via questionnaires. Six tasks were developed: a headlight foreign body removal task, and microscope tasks of foreign body removal, ventilation tube insertion, tympanomeatal flap raising, myringoplasty and middle-ear manipulation. Participants with varying ENT experience were video-recorded performing each task and scored by a blinded expert observer to assess construct validity. Face validity results confirmed that our Ear Trainer was a realistic representation of the ear. Construct validity results showed a statistically significant trend, with experts performing the best and those with limited experience performing better than novices. This study validates our Ear Trainer as a useful training tool for assessing headlight and microsurgical skills required to perform otological procedures.