Our Results of Endoscopic Cartilage Tympanoplasty in Patients with Tympanic Membrane Anterior Perforation

Yıl 2020, , 442 - 446, 25.12.2020

Secaattin Gülşen , Sercan Çıkrıkcı

https://doi.org/10.35440/hutfd.704151

Öz

Background: Although many grafting techniques and surgical approaches have been described, repair of tympanic membrane anterior quadrant perforations is technically challenging for otorhinolaryngology specialists. In this study, it was aimed to evaluate the surgical and functional results of endoscopic cartilage tympanoplasty in repair of tympanic membrane anterior quadrant perforations.
Materials and Methods: Thirty-four patients who had anterior quadrant tympanic membrane perforation and underwent transcanal endoscopic Type 1 cartilage tympanoplasty between January 1, 2015 and April 30, 2019 were included in the study. The graft success, audiological data and complications of patients were retrospectively analyzed. Patients who had ossicular chain reconstruction, who had cholesteatoma or who did not have regular follow-up and those whose tympanic membrane perforation was not in the anterior quadrant were excluded.
Results: Medical records of 34 patients who underwent endoscopic transcanal cartilage tympanoplasty were examined. There were 15 male (44,1%) and 19 female (55,9%) patients. The average age was 35,44 ± 9,84. Fifteen of the patients underwent surgery on the right ear (44.1%) and 19 on the left ear (55,9%). The mean operation time was 31.56 ± 4.04 minutes. Graft success rates were 94,1% in the 3rd postoperative month and 91,2% in the 6th postoperative month. Postoperative air-bone gap values improved statistically significantly compared to preoperative values according to the pure tone audiometry measurements performed at the sixth month after surgery (p<0,001).
Conclusion: Endoscopic transcanal Type 1 cartilage tympanoplasty is a minimally invasive, effective and reliable surgical treatment option to repair tympanic membrane anterior perforations.

Key words: Tympanic membrane, Perforation, Anterior, Endoscope, Cartilage, Tympanoplasty

Timpanik Membran Anterior Perforasyonu Olan Hastalarda Endoskopik Kıkırdak Timpanoplasti Sonuçlarımız

Öz

Amaç: Birçok greftleme tekniği ve cerrahi yaklaşım tanımlanmasına rağmen timpanik membran anterior kadran perforasyonlarının onarımı teknik olarak kulak burun boğaz uzmanları için zorlayıcıdır. Bu çalışmada, timpanik membran ön kadran perforasyonlarının onarımında endoskopik kıkırdak timpanoplastinin cerrahi ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.
Materyal ve Metod: 1 Ocak 2015- 30 Nisan 2019 tarihleri arasında transkanal endoskopik Tip 1 kıkırdak timpanoplasti yapılan anterior kadran timpanik membran perforasyonu olan hastaların greft başarısı, odyolojik verileri ve komplikasyonlar geriye dönük olarak incelendi. Kemikçik zincir rekonstrüksiyonu yapılan, kolesteatomu olan veya takiplerine düzenli gelmeyen hastalar ve timpanik membran perforasyonu anterior kadranda olmayan hastalar çalışma dışı bırakıldı.
Bulgular: Endoskopik transkanal kıkırdak timpanoplasti yapılan 34 hastanın tıbbi kayıtları incelendi. 15 erkek (%44,1) ve 19 kadın (%55,9) hasta vardı. Ortalama yaş 35,44’dü (17-53 yaş aralığı). Hastaların 15’i sağ kulak (%44,1), 19’u sol kulaktan (%55,9) ameliyat oldu. Ortalama ameliyat süresi 31,56±4,04 dakika (aralık 24-38 dakika) idi. Greft başarı oranları postoperatif 3. Ayda %94,1 ve postoperatif 6. Ayda %91,2 idi. Ameliyat sonrası altıncı ayda yapılan saf ses odyometri ölçümlerine göre postoperatif hava-kemik aralığı değerleri, preoperatif değerlere göre istatistiksel olarak anlamlı derecede düzeldi (p<0,001).
Sonuç: Endoskopik transkanal Tip 1 kıkırdak timpanoplasti karşılaştırılabilir greft başarı oranı ve odyolojik sonuçlarıyla, timpanik membran ön perforasyonlarını onarmak için minimal invaziv, etkili ve güvenilir bir cerrahi tedavi seçeneğidir.

Anahtar Kelimeler

kulak zarı, perforasyon, anterior, endoskop, kıkırdak, timpanoplasti

Kaynakça

• 1. Kakehata S, Futai K, Sasaki A, Shinkawa H. Endoscopic transtympanic tympanoplasty in the treatment of conductive hearing loss: early results. Otol Neurotol 2006; 27:14–19 4
• 2. Yadav SP, Aggarwal N, Julaha M, Goel A. Endoscope-assisted myringoplasty. Singapore Med J 2009; 50:510–12
• 3. Mohindra S, Panda NK. Ear surgery without microscope; is it possible. Indian J Otolaryngol Head Neck Surg 2010; 62:138–41
• 4. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg. 2008;139(3):386-390.
• 5. Tseng C-C, Lai M-T, Wu C-C, et al. Endoscopic transcanal myringoplasty for anterior perforations of the tympanic membrane. JAMA Otolaryngol Neck Surg.2016; 142:1088.
• 6. Celik H, Samim E, Oztuna D. Endoscopic ‘‘push-trough’’: technique cartilage myringoplasty in anterior tympanic membrane perforations. Clin Exp Otorhinolaryngol. 2015; 8:224.
• 7. Visvanathan V , Vallamkondu V , Bhimrao SK . Achieving a Successful Closure of an Anterior Tympanic Membrane Perforation: Evidence-Based Systematic Review. Otolaryngol Head Neck Surg. 2018 Jun;158(6):1011-1015.
• 8. Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108(1):39-46.
• 9. Tarabichi M, Ayache S, Nogueira JF, Al Qahtani M, Pothier DD. Endoscopic management of chronic otitis media and tympanoplasty. Otolaryngol Clin North Am. 2013;46(2):155-163.
• 10. Furukawa T, Watanabe T, Ito T, Kubota T, Kakehata S. Feasibility and advantages of transcanal endoscopic myringoplasty. Otol Neurotol. 2014; 35(4): e140-e145.
• 11. Lade H, Choudhary SR, Vashishth A. Endoscopic vs microscopic myringoplasty: a different perspective. Eur Arch Otorhinolaryngol. 2014; 271(7):1897-1902.
• 12. Harugop AS, Mudhol RS, Godhi RA. A comparative study of endoscope assisted myringoplasty and micrsoscope assisted myringoplasty. Indian J Otolaryngol Head Neck Surg. 2008; 60(4):298-302.
• 13. Ayache S. Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol. 2013; 270(3):853-860.
• 14. Karhuketo TS, Ilomäki JH, Puhakka HJ. Tympanoscope-assisted myringoplasty. ORL J Otorhinolaryngol Relat Spec. 2001; 63(6):353-357.
• 15. S. Ayache M. Beltran, N. Guevara. Endoscopic transcanal myringoplasty for anterior tympanic membrane perforation. European Annals of Otorhinolaryngology, Head and Neck diseases 136 (2019) 413–415.
• 16. Lee HY, Auo HJ, Kang JM. Loop overlay tympanoplasty for anterior or subtotal perforations. Auris Nasus Larynx. 2010; 37 (2): 162-166.
• 17. Schraff S, Dash N, Strasnick B. “Window shade” tympanoplasty for anterior marginal perforations. Laryngoscope. 2005;115(9):1655-1659.
• 18. Peng R, Lalwani AK. Efficacy of “hammock” tympanoplasty in the treatment of anterior perforations. Laryngoscope. 2013;123(5):1236-1240.
• 19. Seidman MD. Anterior transcanal tympanoplasty: a novel technique to repair anterior perforations. Otolaryngol Head Neck Surg. 2008; 138(2):242-245.
• 20. Nardone M, Sommerville R, Bowman J, Danesi G. Myringoplasty in simple chronic otitis media: critical analysis of long-term results in a 1000-adult patient series. Otol Neurotol. 2012; 33(1):48-53.
• 21. Nassif N, Berlucchi M, de Zinis LO. Tympanic membrane perforation in children: endoscopic type I tympanoplasty, a newly technique, is it worthwhile? Int J Pediatr Otorhinolaryngol 2015; 79(11):1860–1864
• 22. Kaya I, Benzer M, Uslu M, Bilgen C, Kirazli T. Butterfly cartilage tympanoplasty long-term results: excellent treatment method in small and medium sized perforations. Clin Exp Otorhinolaryngol 2018; 11(1):23
• 23. El-Hennawi DEM , Ahmed MR , Abou-Halawa AS , El-Hamtary MA . Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations. J Laryngol Otol. 2018 Jun;132(6):509-513.