A comparison of endoscopic and microscopic techniques for the repair of tympanic membrane perforations

Abstract

Objective: This study aims to compare endoscopic and microscopic tympanoplasty in terms of graft success rate and hearing gain.

Methods: Medical records of 236 patients (99 females and 137 males) aged 18 to 74 years with chronic otitis media who underwent myringoplasty, between January 2014 and June 2017 were retrospectively compared.   Patients were divided into two groups; microscopic myringoplasty (140 patients), endoscopic myringoplasty (96 patients). Demographic data, pure tone audiometric results preoperatively and 6 months postopera­tively, operation time, hearing gain and graft success rate were evaluated.

Results: The mean operation time was 57.8±9.6 minutes for the endoscopic group and 78.6±17.7 minutes for the microscopic group (p<0.001). The mean preoperative air bone gap (ABG) was 24.1±11.5 dB for the microscopic group and 22.7±9.2 dB for the endoscopic group, whereas the mean postoperative ABG was 11.6±9.9 and 9.8±9.3 dB respectively. Graft success rate was 90.3% (213 patients) for entire group, 89.7% (131 patients) for the microscopic group, and 91.1% (82 patients) for the endoscopic group (p=0.727). The functional success rate (ABG≤10 dB) was 72.5% (171 patients) in the entire group. The mean hearing gain was 12.4±10.8 and 12.8±9 dB in the microscopic and endoscopic groups respectively. 

Conclusion: Endoscopic technique offers similar graft success and hearing outcomes to microscopic technique along with a shorter operation time. 

Keywords

• Conductive,hearing loss,otitis media,tympanic membrane perforation

References

1. 1. Shea JJ Jr. Vein graft closure of eardrum perforations. J Laryngol Otol. 1960 Jun;74:358-62
2. 2. Austın DF,Shea JJ Jr. A new system of tympanoplasty using vein graft. Laryngoscope. 1961 Jun;71:596-611
3. 3. Glasscock ME 3rd, Jackson CG, Nissen AJ, Schwaber MK. Postauricular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope. 1982 Jul;92(7 Pt 1):718-27
4. 4. Sheehy JL, Anderson RG. Myringoplasty. A review of 472 cases. Ann Otol Rhinol Laryngol. 1980 Jul-Aug;89(4 Pt 1):331-4
5. 5. Rizer FM. Overlay versus underlay tympanoplasty. Part II: the study. Laryngoscope. 1997 Dec;107(12 Pt 2):26-36
6. 6. Hardman J, Muzaffar J, Nankivell P, Coulson C. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis. Otol Neurotol. 2015 Jun;36(5):796-804
7. 7. Mer SB, Derbyshire AJ, Brushenko A, Pontarelli DA. Fiberoptic endotoscopes for examining the middle ear. Arch Otolaryngol. 1967 Apr;85(4):387-93 8. Willemot J. Technics of endoscopy and of reproducing the image in otorhinolaryngology. Introduction. Acta Otorhinolaryngol Belg. 1975;29(2):227-33
8. 9. Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999 Jan;108(1):39-46 10. El-Guindy A. Endoscopic transcanal myringoplasty. J Laryngol Otol. 1992 Jun;106(6):493-5 11. Raj A, Meher R. Endoscopic transcanal myringoplasty-A study. Indian J Otolaryngol Head Neck Surg. 2001 Jan;53(1):47-9

9. 12. Marchioni D, Alicandri-Ciufelli M, Molteni G, Genovese E, Presutti L. Endoscopic tympanoplasty in patients with attic retraction pockets. Laryngoscope. 2010 Sep;120(9):1847-55
10. 13. Eren SB, Tugrul S, Ozucer B, Veyseller B, Aksoy F, Ozturan O. Endoscopic Transcanal Inlay Myringoplasty: Alternative Approach for Anterior Perforations. Otolaryngol Head Neck Surg. 2015 Nov;153(5):891-3
11. 14. Celik H, Samim E, Oztuna D. Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations. Clin Exp Otorhinolaryngol. 2015 Sep;8(3):224-9
12. 15. Furukawa T, Watanabe T, Ito T, Kubota T, Kakehata S. Feasibility and advantages of transcanal endoscopic myringoplasty. Otol Neurotol. 2014 Apr;35(4):e140-5
13. 16. Özgür A, Dursun E, Erdivanli ÖÇ, Coşkun ZÖ, Terzi S, Emiroğlu G, Demirci M. Endoscopic cartilage tympanoplasty in chronic otitis media. J Laryngol Otol. 2015 Nov;129(11):1073-7
14. 17. Kakehata S, Futai K, Sasaki A, Shinkawa H. Endoscopic transtympanic tympanoplasty in the treatment of conductive hearing loss: early results. Otol Neurotol. 2006 Jan;27(1):14-9
15. 18. Pothier DD. Introducing endoscopic ear surgery into practice. Otolaryngol Clin North Am. 2013 Apr;46(2):245-55
16. 19. Yong M, Mijovic T, Lea J. Endoscopic ear surgery in Canada: a cross-sectional study. J Otolaryngol Head Neck Surg. 2016 Jan 19;45:4
17. 20. Thomassin JM, Korchia D, Doris JM. Endoscopic-guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope. 1993 Aug;103(8):939-43
18. 21. Aoki K. Advantages of endoscopically assisted surgery for attic cholesteatoma. Diagn Ther Endosc. 2001;7(3-4):99-107
19. 22. Huang TY, Ho KY, Wang LF, Chien CY, Wang HM. A Comparative Study of Endoscopic and Microscopic Approach Type 1 Tympanoplasty for Simple Chronic Otitis Media. J Int Adv Otol. 2016 Apr;12(1):28-31
20. 23. Dündar R, Kulduk E, Soy FK, Aslan M, Hanci D, Muluk NB, Cingi C. Endoscopic versus microscopic approach to type 1 tympanoplasty in children. Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):1084-9
21. 24. Karhuketo TS, Ilomäki JH, Puhakka HJ. Tympanoscope-assisted myringoplasty. ORL J Otorhinolaryngol Relat Spec. 2001 Nov-Dec;63(6):353-7; discussion 358 25. Lade H, Choudhary SR, Vashishth A. Endoscopic vs microscopic myringoplasty: a different perspective. Eur Arch Otorhinolaryngol. 2014 Jul;271(7):1897-902
22. 26. Ayache S. Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol. 2013 Mar;270(3):853-60
23. 27. Harugop AS, Mudhol RS, Godhi RA. A comparative study of endoscope assisted myringoplasty and micrsoscope assisted myringoplasty. Indian J Otolaryngol Head Neck Surg. 2008 Dec;60(4):298-302
24. 28. Kuo CH, Wu HM. Comparison of endoscopic and microscopic tympanoplasty. Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2727-2732
25. 29. Kozin ED, Lehmann A, Carter M, Hight E, Cohen M, Nakajima HH, Lee DJ. Thermal effects of endoscopy in a human temporal bone model: implications for endoscopic ear surgery. Laryngoscope. 2014 Aug;124(8):E332-9
26. 30. Ozturan O, Dogan R, Eren SB, Aksoy F. Intraoperative thermal safety of endoscopic ear surgery utilizing a holder. Am J Otolaryngol. 2018 Sep - Oct;39(5):585-591