Comparison of Endoscopic Tympanoplasty with Microscopic Tympanoplasty
Minimally invasive surgery has recently been developed along with endoscopic techniques. Endoscopic Ear Surgery is becoming popular with its anatomic and physiologic concepts. Tympanoplasty is one of the commonest operations performed for the middle ear. While using the endoscope we can place the graft accurately while avoiding unnecessary post or endaural incision and soft tissue dissections which are mandatory during tympanoplasty using a microscope. Our study was aimed to compare the outcomes of endoscopic and microscopic tympanoplasty in terms of graft uptake, hearing outcome and postoperative pain.
This is a retrospective comparative study of 63 patients who underwent type 1 tympanoplasty at Holy Family Hospital ENT Department from March 2017 to March 2020. The subjects were classified into 2 groups; Endoscopic tympanoplasty (ET, n=30), Microscopic Tympanoplasty (MT, n=33). Type 1 Tympanoplasty, was the procedure done on patients of both the groups.
Demographic data, perforation size of the tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.
The perforation size of the tympanic membrane in the Endoscopic group and the microscopic group was nearly the same (p=.877). Pre and post-operative air-bone gaps including air and bone conduction thresholds were not significantly different between the two groups. The graft success rate in the endoscopic and Microscopic group was 93.3% and 63.3% respectively; the values were significantly different(p=0.0046). Immediate and 6 hours postoperative pain was similar in both the groups, however pain on ist postoperative day was significantly lower in the endoscopic group.
We can do minimal invasive tympanoplasty with the help of endoscopes with better graft success rate, less preoperative time, and less postoperative pain.
2) Dornhoffer JL. Surgical Management of the atelectatic ear.Am J Otol 2000;21(03):315-321.
3 )Mudry A.History of myringoplasty and tympanoplasty type 1.Otolaryngology-head and neck surgery:official journal of American Academy of Otolaryngology-Head Neck surg2008;139(05):613-614
4 )Tarabichi M.Endoscopic transcanal middle ear surgery.Indian J Otolarngol Head Neck surg 2010;62(01):6-24
5) Patel J et al.Endoscopic Tympanoplasty vs Microscopic Tympanoplasty in tubotympanic csom:a comparative study of 44 cases.International Journal of Research in Medical Sciences.2015August;3(8):1953-1957.
6) El-Guindy A. Endoscopic transcanal myringoplasty. J Laryngol Otol 1992;106(06):493-495
7)Marchioni D,Alicandri-Ciufelli M,Piccinini A,Genovese E,Presutti L.Inferior retrotympanum revisited:an endoscopic anatomic study.Laryngoscope.2010 sep;120(9);1880-6
8) Ayache S,Tramier B,Strunski V.Otoendoscopy in choloesteatoma surgery of the middle ear;what benefits can be expected?Otol Neurotol.2008 Dec;29(8):1085-90
9) Marchioni D,Mattioli F,Alicandri-Ciufelli M,Presutti L.Endoscopic approach to tensor fold in patients with attic cholesteatoma.Acta Otolaryngol.2009 Sep;129(9);946-54.
10 )Dundar R,Kulduk E,Soy FK,Aslan M,Hanci D,Muluk NB,et al. Endoscopic versus microscopic approach to type 1 tympanoplasty in children.Int J Pediatr Otorhinolaryngol.2014 jul;78(7):1084-9
11) Kozin ED,Gulati S,Kaplan AB,Lehmann AE,Remenscheider AK,Landegger LD,et al.Systematic review of outcomes following observational and operative endoscopic middle ear surgery.Laryngoscope.2015 May;125(5):1205-14
12) Preyer S, Endoscopic Ear Surgery- a complement to microscopic ear surgery.HNO 2017.65(Suppl 1):S29-S34DOI 10.1007/s00106-0268-x.
13) Marchioni D,Alicandri-Ciufelli M,Pothier DD,Rubini A, Presutti L 2015 .The round window area and contiguous areas:endoscopic anatomyand surgical implications.Eur ArchOtolaryngol272:1103-1112.
14) Choi N, Noh Y, Park W, er al. Comparison of endoscopic tympano-plasty to microscopic tympanoplasty. Clin Exp Othorhinolaryngol 2017;10(01):44-49.
15 )Kanona H, Virk Js, Owa A. Endoscopic ear surgery: A case series and first United kingdom experience. World J Clin Cases 2015;3(03)310-317.
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