Total Endoscopic Transcanal Cartilage Myringoplasty: A Prospective Study

Abstract

Introduction Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Objectives The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results. Methods This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months. Results During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% ( n = 123) of the patients 6 months after the intervention. Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively. Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant ( p < 0.001). Conclusion The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

Transcanal Endoscopic Retrograde Mastoidectomy for Cholesteatoma: A Prospective Study

“…The disadvantages of EES include one hand surgery that requires surgical skills. 6,10,11 Bleeding is always the issue, but once the flap is raised, it is not much of the problem even if granulation tissues are present. We had 3 patients who were converted into microscopic ear surgery due to bleeding.…”

“…10 Endoscopic ear surgery (EES) is a recently introduced field in otology, and many otologists are now accepting it. 11 The endoscope was introduced in the world by Harold Hopkins as Hopkins rod endoscope in 1966. 12 However, the first study on transcanal EES (TEES) was only reported in 1992 by El Guindy.…”

Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain

“…Previous studies have shown equivalent or improved results from endoscopic versus microscope-guided tympanic membrane perforation closure and clearance of cholesteatoma in children (8,9). Research suggests that audiometric outcomes are equivalent in experienced hands between TEES and PAM approaches for most common procedures including tympanoplasty, ossiculoplasty, and stapedotomy (3,7,8,(10)(11)(12)(13). Because TEES allows surgeons to complete these procedures with less soft tissue dissection than by a post-auricular approach, examination of secondary patient outcomes related to surgical morbidity may demonstrate a potential benefit of TEES over post-auricular surgery.…”

The Outcome of Endoscopic Assisted Underlay Tragal Cartilage Myringoplasty

“…The endoscope offers a wide and comprehensive transcanal view of all elements of this procedure: the ear canal, tympanic membrane and eardrum, without the need to constantly move the microscope, even with an anterior ridge. (12) Objectives: To clinically assess the postoperative outcomes of endoscopic assisted Trans canal underlay tragal cartilage myringoplasty.…”